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A man with Alzheimer disease (AD) has been taking donepezil (Aricept or a generic), and his dementia is progressing. Do you continue or stop the drug? Do you substitute or add memantine (Namenda)? To answer these questions, U.K. researchers conducted a partially industry-supported, randomized, placebo-controlled trial involving 295 community-dwelling patients with moderate-to-severe AD (mean Mini-Mental State Exam [MMSE] score, 9 out of 30) who had received donepezil for several years. Patients were assigned to continue donepezil alone, stop donepezil and start memantine, take both drugs, or take neither drug.
During 1 year of follow-up, MMSE scores and activities-of-daily-living scores indicated deterioration in all four groups. Patients wh…