From the Guidelines
Namenda (memantine) is not specifically approved or recommended for treating mood changes in dementia, and its primary use is for cognitive symptoms in moderate to severe Alzheimer's disease. The evidence from high-quality studies, such as those included in the 2008 guideline from the American College of Physicians and the American Academy of Family Physicians 1, suggests that memantine may have some benefits in terms of cognitive function and quality of life, but its effects on mood changes are not well-established. While some patients may experience indirect improvements in mood as their cognitive function stabilizes, memantine is not considered a first-line treatment for managing agitation, depression, anxiety, or other mood disturbances in dementia.
Some key points to consider when evaluating the use of memantine for mood changes in dementia include:
- The primary indication for memantine is moderate to severe Alzheimer's disease, and its effects on mood changes are not well-established 1.
- Non-drug interventions, such as establishing routines, modifying the environment, or providing meaningful activities, may be effective in managing mood and behavioral symptoms in dementia 1.
- Medications specifically targeting mood symptoms, such as selective serotonin reuptake inhibitors (SSRIs) for depression or low-dose antipsychotics for severe agitation, may be considered if necessary, but they carry significant risks 1.
- The choice of pharmacologic agents should be based on tolerability, adverse effect profile, ease of use, and cost of medication, as the evidence is insufficient to compare the effectiveness of different agents for the treatment of dementia 1.
In terms of specific recommendations, healthcare providers should discuss mood changes specifically with their patients and consider other approaches first, rather than expecting memantine alone to address these symptoms. Further research is needed to evaluate the effectiveness of pharmacologic therapy for dementia and to assess whether treatment affects outcomes, such as institutionalization 1.
From the Research
Memantine and Mood Changes in Dementia
- Memantine has been shown to have a positive effect on mood in patients with moderate to severe Alzheimer's disease 2, 3.
- Studies have demonstrated that memantine can improve mood, behavior, and cognitive function in patients with Alzheimer's disease 2, 3.
- In patients with mild to moderate vascular dementia, memantine has been shown to improve cognitive function, but the effect on mood is less clear 2, 3.
- Memantine has also been found to reduce agitation in patients with moderate to severe dementia 3.
- The exact mechanism by which memantine improves mood in dementia patients is not fully understood, but it is thought to be related to its ability to block excessive glutamate release and prevent excitatory neurotoxicity 4, 2.
Efficacy of Memantine in Different Dementia Subtypes
- Memantine has been shown to be effective in managing Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, Parkinson's disease dementia, and vascular dementia 5.
- The use of memantine in different dementia subtypes is supported by its ability to improve cognitive function, behavior, and global status 2, 3, 5.
- Memantine may be a simple and safe therapeutic option when the diagnosis of the dementia subtype is unclear or when there is no clear therapeutic option 5.
Safety and Tolerability of Memantine
- Memantine is generally well-tolerated, with a low incidence of adverse effects 4, 2, 6.
- The most common adverse events associated with memantine include headache, diarrhea, and dizziness 6.
- Memantine has been shown to be safe and effective in patients with moderate to severe Alzheimer's disease, either alone or in combination with cholinesterase inhibitors 4, 6.