Unfortunately, not all doctors are aware of the major improvement we can experience when namenda (memantine) is started early, along with the aricept.  I've copied two references below that you can print out to show to your doctor.  I feel so very badly when I hear of people who are not given the chance of benefitting from their use. 

Ebixa^® * (Namenda in the States)

What is Ebixa^® (memantine hydrochloride) and what is its promise?

This story has to start by talking about another neurotransmitter called "glutamate," quite different from acetylcholine in that it's not destroyed by an enzyme after doing its job of conveying the message across the junctions between nerve cells.

Instead it's taken back up into the nerve endings from which it was released (recycled). This uptake requires that the glutamate combines first with special receiving molecules on the nerve endings called glutamate receptors (also known as "NMDA receptors").

However, there's a twist to the story here. All the cells of the body contain a lot of glutamate because it has important metabolic roles aside from being a neurotransmitter. When cells get sick (any cells) this glutamate leaks out, and in the nervous system the levels that glutamate can reach outside sick nerve cells can be so high as to be toxic, indeed quite deadly. This is one of the reasons nerve cells die in Alzheimer's disease -- their sickness could be mild, but the glutamate leakage multiplies the threat.

Memantine acts by blocking the glutamate receptors and preventing the re-uptake of the glutamate into the nerve endings. Since the glutamate threat develops somewhat late in Alzheimer's disease, memantine stands as one treatment that can be effective at moderate to advanced stages of the disease. The beauty of this approach is that the drug allows enough glutamate to get back for the sick nerve endings to use it as a transmitter, but prevents the massive uptake that would be toxic to the endings.

And there is better news: ongoing research is finding that combining cholinesterase inhibitors together with memantine seems to greatly improve the outcome, more than predicted from the sum of the effects of either drug alone. So combination therapy seems likely to become an exciting therapeutic approach in the future.

[The contents of this page are provided for information purposes only and do not represent advice, an endorsement or a recommendation, with respect to any product, service or enterprise, and/or the claims and properties thereof, by the Alzheimer Society of Canada. The information contained in this report was current at the time of printing, October 2005.]

Combination Therapy with Namenda
May Help Improve Quality of Life

With Alzheimer's disease, each patient is unique – and the treatment needs of each person with the disease will change over time. Although the person you are caring for is already on treatment, you may be wondering if more can be done to treat his or her symptoms. In some cases, combination therapy with Namenda^® (memantine HCl)  may offer additional benefits and may be an appropriate option.

Namenda + Aricept

The results of a clinical trial published in the Journal of the American Medical Association showed Alzheimer's patients taking Namenda in combination with Aricept^® (donepezil) experienced a slower rate of decline in thinking, function and behavior compared to those taking Aricept alone. 

The study found that combination therapy with Namenda+Aricept may:

• Improve and maintain thinking
• Help maintain the ability to perform activities of daily living such as grooming, finding belongings and conversing
• Significantly improve behavior
• Delay the onset of negative behavioral symptoms such as agitation, aggression and irritability in asymptomatic people

By treating the symptoms of Alzheimer's disease, Namenda, in combination with Aricept, may do more to treat the symptoms of the disease and allow people with Alzheimer's to recognize and interact with family and friends longer and may help make life more manageable for everyone involved.