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Drugs within the class known as N-methyl-D-aspartate (NMDA) blockers include memantine (Namenda), which has been approved by the FDA for the treatment of moderate-to-severe Alzheimer disease. After NMDA blockers are started, a notable improvement in basic activities of daily living (for example, eating, grooming, dressing) is noted. This drug can be used in combination with existing AChE inhibitors. Although observed effects will be modest, these improvements significantly aid caregivers, such as nursing home personnel or family members, in their interactions with these patients.

• How NMDA blockers work: NMDA blockers guard against overexcitement of NMDA receptors by the brain chemical glutamate. Overexcitement of NMDA receptors by abnormally high brain levels of glutamate is thought to be responsible for decreased nerve cell function and, eventually, nerve cell death. NMDA blockers may also be helpful in other neurodegenerative conditions, such as Huntington disease, AIDS-related dementia, and vascular dementia.
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• Who should not use these medications: People with allergy to NMDA blockers should not take them.
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• Use: Tablets may be swallowed with or without food.
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• Drug or food interactions: Drugs that alter urine acidity, like sodium bicarbonate or acetazolamide (Diamox), may cause memantine to accumulate in the body.
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• Side effects: Common adverse effects include dizziness (7%), headache (6%), and constipation (5%).

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