ravastigmine vs donepezil

mathreader

My DH's neurologist seems very knowledgable and nice but sometimes things confuse me. My DH was taking donepezil, but the neurologist switched him to revastigmine because he takes escitolopram for depression and apparently there is a risk from taking donepezil with escitalopram. From what I have seen it looks like a minimal risk but we went along with it. In the meantime, because his MRI and PET scan didn't show anything definitive, the neurologist wants him to retake his extensive neuropsychological testing (after a year). I feel so bad for my DH who found that testing exhausting and really doesn't want to do it again. I'm confused. Do MRI's and PET scans always show dementia or Alzheimers? Do neurologists ever really decide it's one of the two or do they keep testing? DH has agreed to go again, although he, and I, know it will show he has declined over the past year. I'm beginning to feel really bad that I took him to a neurologist but I'm wondering if memantine would help.

Daughter of a Marine

Mathreader, my DH was prescribed Galantamine (Razadyne) and Memantine (Namenda) about 12 yrs ago when first diagnosed with dementia. These meds delayed progression of the disease but we have now run out of time. He is now stage 6 and recently placed in memory care (most painful decision of my life). I spoke with a gerontologist who specializes in dementia and she advised to keep him on Memantine for life - said it would not stop disease progression but that we would not want him to experience the impact of stopping the memantine (Galantamine has been discontinued since it's intended for earlier stages). He is physically strong but his brain is being ravaged - lives in his own altered reality, talking as if he's still at work, asking me if I called the person he sees on tv, etc. He was just placed about 10 days ago and I'm trying to adjust to life in our home without him. Not sure I ever will.

Crkddy

Mathreader, take this with a grain of salt since I'm no doctor. Based upon the experience of my DW, her EO Alzheimer's diagnosis was based upon analysis of her spinal fluid called an ADmark Phospho-Tau / Total Tau test by Athena Diagnostics. This, along with her initial neuropsychological exam. Her MRI showed mild atrophy but was not definitive for Alzheimer's, and she did not receive a PET scan. Her neurologist started her on Donepezil immediately but did not seem to have an effect. He then added memantine and I could tell an improvement in symptoms. She is still on Donepezil and memantine 6 1/2 years later.

Pat6177

math reader, I can’t address your first question - my DH continues on both Donepezil and memantine. He’s in late stage 5.
as for your second question, it seems like everyone’s PWD ended up with a diagnosis differently. My DH was diagnosed based on history, CAT scan and neuropsych testing. Diagnosed with mixed dementia - Alzheimer’s and vascular. Approx. 1 1/2 yrs after the first round of neuropsych testing, the doc wanted it repeated. I got the impression that the repeat testing is common and the progression seen in the repeat testing confirmed the diagnosis. When the neuropsychologist gave us the results of the second round of tests, she said there would not be any need to repeat the testing in the future.

Iris L.

The brief MMSE done in office can be used to assess progression. Once the dementia diagnosis has been made, what is the point of a comprehensive neurocognitive exam? Think about if the results would change any of the current treatment plan. Neurocognitive testing is expensive and lengthy.

For me, I underwent another extensive neurocognitive testing about two years after my diagnosis of cognitive impairment nos. The results showed no significant change. My neurologist has offered computer based Neurocognitive testing, lasting about 45 minutes, in the office. My Amyvid PET scan showed no amyloid plaques, so no Alzheimer's Disease. I don't mind the computer testing because I want to see how my cognition is fairing. But I'm not interested in further imaging studies. I continue on Exelon patch and memantine.

Iris

Stan2

I am not sure any diagnosis in the case of dementia is definitive. In our case my, after the physical testing and neuropsych evaluation DW was diagnosed with "major cognitive disorder consistent with Alzheimers". After another round of neuropsych testing a year later we were told there was no need for further testing as it would only be an additional stressor. She was prescribed donepezil and a year later memantine but she can't tolerate either in the mornings so she is actually at 1/2 dosage of both in the evening only. I never did see a positive effect from donepezil but I believe I do from the memantine.