Case of Mayonnaise

When I joined Columbia University in 1985, I worked with a nurse who was, to put it mildly, overweight. One afternoon, I stopped by her desk to ask her a question and found her preparing for a well-deserved lunch. First, she brought out an enormous bowl of salad, full of greens, a few carrots thrown in for color. The gargantuan portion didn't faze me, because I had already been in the United States for five years and had become quite familiar with American eating habits. Actually, I was...

Action Steps to Reduce Stress

Focus on reducing not only the big but also the small sources of stress. Try to mentally compartmentalize the stimuli that engulf you focus on the immediate task at hand, one at a time. Constantly prune extraneous information to keep your life from being overloaded. Avoid conflict over trivial matters let them drop. Be aware of the impact of high levels of anxiety, and emotional states more generally, in distorting the memory of specific events. This knowledge can help you deal with faulty...

Foods Rich in Antioxidants

Broccoli Blueberries, strawberries Corn Citrus fruits (oranges, grapefruit) Vitamin A is an antioxidant that neutralizes bad oxygen and shields the membranes of brain cells from injury. Research suggests that it may diminish the risk of heart attack and stroke (not yet fully proven) and thereby decrease the likelihood of memory loss. The nutritional supplement dose of vitamin A is 10,000 to 50,000 units daily, or 10,000 to 25,000 units daily when taken together with 15 mg of beta-carotene....

Medications

Vitamin E 400 to 1,200 IUs daily (400 if you bleed easily, otherwise 800 to 1,200 avoid if taking anticoagulants for medical reasons do not exceed 400 IUs if you also take aspirin or ginkgo). 2. Consider adding vitamins A and C (see table on page 202) to your diet, which should already be rich in these vitamins. 3. If you are worried about future memory loss and want to be very active in preventing it, consider taking phosphatidylserine. 4. By this age you should have consulted your doctor...

Go Slow Dont Try to Remember Everything All at Once

This dictum may seem self-evident, but many people do not recognize that the speed at which you can process information, more than the actual volume of data that can be handled by the brain, slows down considerably with age. An older person can learn the same amount as a younger person it just takes longer, and this slowing down begins in middle age. This is because neuronal network data transfer has slowed down due to gradual decay of brain cells. So if you set unrealistic timetables for...

How Depression Causes Memory Loss

Joan complained about memory loss even though her symptoms were caused by depression. In other words, memory loss masked her clinical depression, for which treatment was successful. Therefore, if you have begun to experience memory loss and you also feel down or blue (or lack all feelings) most of the time, depression may be the source of your memory problems. Depression itself may be related to stresses and traumatic events in your life, but sometimes depressive illness can strike for no...

Mnemonics

The word mnemonic comes from the Greek goddess Mnemosyne, who knew everything past, present, and future. Therefore, loosely translated, mnemonics can be used to remember almost anything. The memory questionnaire in the first chapter had a section on how frequently you use mnemonics. In the loci technique, you create an imaginary house and place items you need to remember in specific rooms, using visual imagery. The peg technique involves the mental use of pegs or anchors for each event, and is...

Large Strokes

A large stroke is caused by blockage of a major blood vessel, most commonly the middle cerebral artery that supplies the regions of the brain controlling the motor and sensory systems, with loss of speech in the case of left-sided stroke. The middle cerebral artery supplies mainly the frontal and parietal lobes, and an area of the temporal lobe that does not include the hippocampus. Hence a large stroke causes only partial deficits in memory, primarily due to frontal lobe damage. These memory...

Pluripotent Nerve Cells A Neuroscience Controversy

A healthy diet, regular exercise, and intellectual and social stimulation are clearly beneficial to brain function. There is a molecular basis to the effects of these types of environmental stimulation in the brain. Although most nerve cells in an older person's brain have indeed lost the ability to reproduce, there are a few primitive cells, called pluripotent cells, that retain the capacity to differentiate or evolve into several types of nerve cells at any time during the life span,...

Promemory Diet Action Steps

Decrease intake of saturated fats such as red meat, pizza, desserts. Maintain your water and fluid (nonalcohol) intake. Eat fruits and vegetables, which are vital sources of antioxidants. Supplement with vitamin E and consider vitamins A and C as well. Keep Exercising Even very old people can benefit from a rigorous exercise program. Maria Fiatarone, a geriatrician at Tufts University, published a study in the New England Journal of Medicine in which a hundred frail, elderly nursing home...

Stimulating Nerve Cell Growth

In infant mice, an enriched environment of toys, high-quality food, games, and other stimuli increases nerve cell growth and branching in the brain. Compared to normally caged mice living a spartan existence, mice exposed to barely two months of this enriched environment show a 15 percent increase in the number of brain nerve cells. You know that in children, intensive education accompanied by strong nurturing and healthy social stimulation often leads to outstanding academic and subsequent...

St Johns Wort and SAME

What about hypericum, otherwise known as St. John's wort Many patients are already taking this agent when they first come to our depression clinic (I codirect both the Memory Disorders Center and the Late Life Depression Clinic at our hospital). Some people report minimal to mild improvement on St. John's wort, and others report no change whatsoever in their depression. The National Institute of Mental Health is now supporting a large-scale clinical trial to find out if St. John's wort really...

Psychotherapy

Psychotherapy can be useful in the treatment of milder forms of depression. Cognitive-behavioral and interpersonal psychotherapy, which require the therapist to be very active compared to traditional psychoanalysis, have been shown to be effective in the treatment of mild to moderate depressive illness. Highly motivated patients show the greatest benefit from these forms of therapy for example, cognitive therapy requires patients to do homework exercises to help correct their negative,...

Signs of a Transient Ischemic Attack TIA and What to Do When It Occurs

Sudden changes in sensation (to touch, pain, or heat), speech, or vision. Acute confusion or memory lapses that last for a few minutes to hours. Any or all of these symptoms may resolve spontaneously, but this is no reason to rejoice. Go to your doctor or emergency room immediately, preferably accompanied by someone close to you. Like Joe Smith, many people tend to wait because they usually recover without a hitch from the initial TIA, and when the full-blown stroke strikes it is often too late...

Trace Elements To Take or Not To Take Them

Except for iron, all the heavy metals described in this section come under the category of trace elements because they are needed in microscopic quantities for normal bodily function. These metals can become toxic if taken in high doses. You may recall my earlier story about how my father's Parkinson's disease was going to be treated with an Ayurvedic heavy metal concoction, and I put a stop to it because of the potential for toxicity. Traces of lead, mercury, or arsenic, which are...

Your Comprehensive Memory Program

One must have a good memory to be able to keep the promises one makes. Become familiar with all aspects of the Memory Program before you decide which of these components you wish to employ in your own life. If you have reached this far in the book, you know that the Memory Program must be tailored to the individual. Much of the material in this chapter follows directly from what I covered in earlier chapters. To reiterate, there is no magic memory pill, no silver bullet. To help preserve and...

Embolism

I already described the mechanism behind clot or thrombus formation and the risk of hemorrhage (bleeding) from an aneurysm. An embolus is a thrombus that initially forms in the heart, often around a diseased heart valve. The thrombus is then mechanically dislodged and propelled by the heart's pumping action into the big carotid arteries going in a straight line to the head. The embolus flies through the wide carotids but then gets stuck in a slimmer branching artery inside the brain. The...

How Aging Affects Your Memory

If a young or middle-aged man, when leaving company, does not recollect where he laid his hat, it is nothing but if the same inattention is discovered in an old man, people will shrug up their shoulders and say, His memory is going. Age-related memory loss occurs in all mammals, from mice to humans. Research has narrowed down the myriad biological theories of aging into a few that are backed by scientific evidence genetically programmed cell death, disruption of biological clocks, and free...

Small Strokes Big Strokes

Blockage of the arteries supplying the heart is the most notorious action of fatty plaques, but these cholesterol-filled growths occur just as often in the brain. There are many narrow, crooked, tortuous blood vessels in the brain, and these curves and kinks become the danger points fatty, cholesterol-filled plaques stick to the inside walls and grow in size until they slow down blood flow, then a blood clot gradually forms and eventually causes complete blockage. When their blood supply is cut...

Bright Future Awaits

The graveyard of memory research has turned into a fertile field budding with roses of all shapes and colors. The rose isn't a bad analogy while the final product will be extremely beautiful, you are likely to meet a few thorns along the way. In this book, I have reviewed our current knowledge base and laid out a comprehensive program to help you prevent memory loss due to the aging process, or to identify and treat mild memory loss if it has already set in. But all this is based on current...

Associations or Links

When you experience a new event, the hippocampus starts communicating with the parahippocampus, which is a big part of the neighboring association cortex in the brain, to see if the new event can be associated or linked with an older memory in storage. If it can be linked, the event is easier to remember and a new memory link is formed in the hippocampus and parahippocampus, which may in turn link up to even older memories stored in other parts of the temporal lobe or the frontal lobe. We all...

Memory Healthy Diet

Contrast these drastic tactics to the methods used by David Finestone, the forty-nine-year-old corporate executive that I described in the introduction. He came to see me with the symptom of forgetting names and appeared to have suffered from a very small stroke. Based on my advice, he lost weight by cutting back on his intake of saturated fats, primarily red meat and pizza. His program also included eating more fresh fruit and green vegetables, in addition to beginning regular physical...

Blocking Formation of Toxic Compounds

Most of the existing therapies, and those in research development, focus on stimulating natural promemory factors the good guys in the brain, or by blocking destruction of the good guys (e.g., cholinesterase inhibitors). But what about the opposite strategy blocking the bad guys the toxic enzymes, the destructive genes and neurotransmitters that trigger and mediate cell death Antioxidants represent one such approach. But in recent years, the focus has shifted to more sophisticated techniques...

If Youre Older Take a Daily Multivitamin Tablet

These vitamin deficiencies are rare but are becoming more widespread among the elderly who live alone or are disabled. They may not keep track of what they need to eat, or when they should eat. Problems with dentures also worsen nutritional deficiencies. Maintaining proper hydration and nutrition is essential. Family members who take interest, federally funded programs like Meals on Wheels, and the simple act of adding a multivitamin tablet to the daily diet are all useful and effective...

Never Stop Learning

In the mid-1990s, a professor at one of my alma maters, the National Institute of Mental Health and Neurosciences in Bangalore, India, planted himself at my doorstep in New York. He was on a trip to Rio de Janeiro for an international conference and had arranged an essential, educational detour in North America before proceeding south. During his stay with me, he observed various facets of our department at Columbia University in action. Before he left for Rio, he summarized his New York...

Techniques to Improve Your Memory

There are many books devoted to memory improvement by using a variety of tricks and techniques. I will not discuss techniques used by high school and college students to cram for exams, and instead will focus only on those methods that can help prevent age-related memory loss in people above the age of forty. 1. Pay attention. Pay attention to what needs to be learned or remembered. This seems obvious, but it's easy to lose track and forget things when you are pulled in many directions by...

This Time the Doctor Was Right Joes Story

My most dramatic patient with cerebrovascular disease had a TIA, not a stroke. In 1981, I was on night call as the emergency room physician when a man walked in with his wife. Joe Smith, a tall, massive construction worker in his late forties, said he had only a minor problem that needed to be checked out and didn't really feel the need to be in the emergency room. His wife, however, was very concerned and had dragged him to our ER under protest. The story that emerged started to ring alarm...

Types and Dosage of Estrogen

There are different types of estrogen in the blood and in the brain estriol and estradiol, for example but they are all fairly similar in their actions. For postmenopausal women, estrogen ranks high on my list of medications to prevent age-related memory loss, and as a potential treatment for mild memory loss. If you have had a hysterectomy, the simplest therapeutic approach is to take conjugated estrogen, which is marketed as Premarin. The standard Premarin dose is a single tablet of 0.625 mg...

The Essential Promemory Diet

Decrease intake of saturated fats such as red meat, pizza, desserts. Cook with canola, sunflower, corn, or olive oil, which are all high in good unsaturated fats. Fish has high protein and unsaturated fat content, which lowers the risk of heart attacks and strokes. At least two daily helpings each of fruits and vegetables citrus fruits (oranges, grapefruits drinking juice instead of eating the actual fruit is okay) and berries are important sources of antioxidants, and green leafy vegetables...

Caffeine

Caffeine dilates the blood vessels and increases blood flow in the brain, which may explain why it seems to improve cognitive performance, at least in low doses. Caffeine also increases arousal and speeds up communication among nerve cells in the brain. This increase in alertness, a sense of being sharper, is what leads to better performance on cognitive tests, including tests of memory. But high doses can lead to adverse effects, including tolerance and even withdrawal, as any heavy user can...

Exercise Is Important for Your Memory

Perform moderate, regular exercise three to six times per week. Regulate aerobic and anaerobic exercises to your age, health, and tolerance level. Aerobic brisk walking thirty minutes, jogging twenty-five minutes, swimming twenty minutes, formal exercise programs in aerobics classes. Mixed aerobic and anaerobic running, tennis, cycling, exercise equipment (stationary cycle, StairMaster, treadmill, NordicTrack, newer, low-impact workout machines). Before you liftweights, start with at least...

Other Novel Strategies

AMPA receptors are present throughout the brain, and are involved in synaptic connections between brain cells. These AMPA receptors play a role in boosting both learning and memory, and ampakines are substances that amplify or enhance these signals. Some investigators are trying to develop drugs that can amplify the AMPA signal, while others believe that this is a waste of time because ampakines share many similarities to caffeine, which improves attention and mental arousal with no direct...

Ive Always Had a Few Drinks at Night Marys Story

Mary O'Brien, a sturdy, jovial, sixty-four-year-old woman, complained of a gradually worsening memory over a three-year period. She lived with her husband and was close to her four grown children and nine grandchildren. I completed an extensive neurological, psychiatric, and neuropsychological evaluation that showed moderately severe deficits in recent memory associated with generalized brain atrophy on MRI scan. These results strongly suggested Alzheimer's disease. But as I usually do before I...

How Stress Affects Memory in the Brain

There are three biological theories of how stress leads to poor memory 1. Corticosteroids cause damage to the hippocampus. 2. Chronic stress increases toxic free radical formation. 3. Stress stimulates the sympathetic nerves, which in turn leads to high blood pressure and heart disease, thereby increasing the risk of strokes in the brain. The scientist Robert Sapolsky developed the first theory excessive stress leads to increased production of corticosteroids, which inhibit the utilization of...

Planning Pen and Paper Are Better Than Your Head

Planning is an integral part of getting organized. Spend the extra time you need to prepare for what you need to do before rushing headlong into it. Reducing your stress level will help you avoid making mistakes due to hasty action, be it at work, at home, or in the stock market. Don't feel shy about using pen and paper Notebooks (paper pen or computerized) and lists are excellent memory aids. And if you suffer from moderate memory loss, you need to take this a step further keep detailed lists...

Risk Factors for Stroke

Your preventive strategy should focus on reducing risk factors for stroke reduce stress go for annual medical checkups if you have a strong family history of stroke reduce your weight and the intake of saturated fats in your diet maintain regular exercise habits take cholesterol-lowering medicines if proper diet and exercise together are not enough to keep your levels low stop smoking keep your blood pressure under control with a low-fat diet, low-salt intake, and if necessary, antihypertensive...

Trace Metals in Your Diet

Selenium is a trace element that has antioxidant properties and is claimed to be an antimemory-loss agent, but it has not been tested rigorously in people who have memory loss. There are other elements magnesium and zinc in particular that are necessary for normal brain function in small quantities, or traces. Until more solid evidence is forthcoming, and given the potential toxicity of these metallic elements and compounds, I don't recommend taking supplements of any trace metals. The amounts...

Cocaine and Amphetamines

Cocaine ('crack in its concentrated form) and amphetamines ('speed Ecstasy) increase the release of catecholamines, a broad group of chemical neurotransmitters in the brain. Dopamine is a catecholamine that gives rise to the subjective sensation of pleasure and promotes adventuresome, novelty-seeking behavior. Not surprisingly, cocaine and amphetamines produce euphoria, a sense of being on top of the world, plus high levels of energy. I once took a single dose of amphetamine as a normal subject...

CREB and Knockout Mice

A memory trace is solidified if there is a small gap in time between the pieces of information that need to be remembered. Using this technique, which is called spaced training, scientists engineered a fruit fly to have a photographic memory. In the same fruit fly species, they triggered a master gene called CREB, which has the ability to goad a number of other genes into action. In this manner, the fruit fly with a fabulous memory was born. Ideally, if we could stimulate CREB in the same way...

Alcohol Induced Brain Damage A Clinical Chameleon

Mary O'Brien illustrates that steady, moderate- to high-volume alcohol consumption can affect your memory. But why some people are more vulnerable than others remains a bit of a mystery. Genetic factors can play an important role people from a few Native American tribes are so genetically sensitive to alcohol that they can lose control and become violent after only one or two drinks. Clearly, psychological and social influences are also important. More puzzling is alcohol's range of effects...

Social Isolation Leads to Stress and Memory Loss

Loss of loved ones, loneliness, lack of things to do after retirement, and health problems can be major sources of stress, particularly in older people, who may lose hope. As we all know, severe depression is common following the profound trauma of bereavement. What is less well known is that memory loss occurs during the grieving process. In my own experience, I had poor concentration with memory lapses for several weeks after my father's death. I lost track of what people told me at work and...

Long Term Efficacy Data Are Lacking But Safety Data Do Exist

Although I have emphasized that we do not have data about any medications on long-term prevention of memory loss, we do have safety data on long-term use for many of these medications. The vitamins can be taken on a daily basis for years, and so can estrogen in women, provided there is gynecological monitoring. Aricept has been prescribed for several years of continuous usage without major adverse events in Alzheimer's patients, and selegiline has been taken by many Parkinson's patients...

Estrogen in Long Term Prevention of Memory Loss

Clinical anecdotes and observations about the power of estrogen have been supported by the results from systematic studies, especially of elderly women living at home. In a report from the Baltimore Longitudinal Study on Normal Aging, 472 menopausal and postmenopausal women were followed for sixteen years. Women on estrogen-replacement therapy were 50 percent less likely to develop dementia. Other studies of women living in the community have also shown that estrogen provides a protective...

Actions of Piracetam and Related Nootropics

In animal studies, they increase glucose metabolism in nerve cells. In other animal studies, piracetam increased the number of acetylcholine receptors and the amount of acetylcholine released into synapses. In the laboratory, nootropics can boost memory in animals and reverse memory loss induced by toxic drugs. Piracetam may improve communication between the right and left halves of the brain. Since this informational transfer and integration may be linked to creativity, many artists and...

Nootropics Drugs Meant to Make You Smarter

Nootropics, called ''smart drugs by some aficionados, refer to a wide range of potential memory-enhancing medications. over time, the term has become restricted to describe a relatively narrow class of medications. Nootropics were developed with the idea that they would work not only for people with memory disorders but would also improve cognitive performance in normal individuals. The hope was that somehow these medications would help nerve cells sprout and form connections with other nerve...

Properties of Hydergine

Increases blood flow and glucose utilization in the brain. 2. Indirectly helps decrease free-radical formation. 3. Stimulates the production of the neurotransmitters norepinephrine and dopamine, which help to maintain attention and alertness (mental arousal, vigilance). These actions may account for hydergine's activating and mild mood-elevating effects, which occur in some people. As you may have gathered, I am not a great fan of hydergine, and neither are most physicians these days. I think...

Hydergine The First FDAApproved Antidementia Medication

Hydergine is derived from ergot alkaloids (present in rye fungus) that are also used in antimigraine medications. The drug company Sandoz (now part of Novartis) began to study hydergine after it learned that ergot alkaloids were used by nontraditional practitioners to lower a pregnant mother's blood pressure during childbirth. Sandoz's goal was to use hydergine to lower blood pressure and the risk of stroke this didn't pan out, but they did manage to get it approved as a treatment for dementia....

Physiologic Actions of Phosphatidylserine

Phosphatidylserine is present in the membrane that surrounds each cell, and it can alter the fluidity and functional state of these cell membranes. Stabilizing cell membranes may shield the nerve cell from injury and death. Phosphatidylserine indirectly increases the production and release of several neurotransmitters, including epinephrine, norepinephrine, serotonin, and dopamine. These neurotransmitters, especially norepinephrine and dopamine, are known to improve attention, concentration,...

Rational Choices

Enhancing cholinergic transmission using cholinergic compounds may be one of the most effective ways of treating, and possibly preventing, memory loss. Donepezil (Aricept) heads my recommended list, but high cost and the fact that it is a prescription medication are significant limitations. Exelon and Remmyl are alternatives to Aricept, but they are also expensive prescription medications. If you would like to try other options, particularly if you prefer natural substances that you can obtain...

Nicotine Is a Cognitive Enhancer

There is another cholinergic system nicotinic in the brain that utilizes nicotine as its main neurotransmitter. Yes, this is the same nicotine that causes addiction to cigarettes Nicotine stimulates the release of endorphins, which are the brain's natural morphinelike substances, and dopamine, which is involved in stimulating the reward-pleasure and arousal systems. The activating properties of nicotine, which make people more alert and aroused, may partly account for its addictive potential....

Rivastigmine Exelon

Rivastigmine (Exelon) received FDA approval to treat Alzheimer's disease in May 2000, and it is a cholinesterase inhibitor that is very similar to donepezil (Aricept) in its clinical effects. Rivastigmine is given in doses of 3 to 12 mg daily but has to be taken twice (morning and evening), unlike the once-a-day dose for donepezil. Rivastigmine's common side effects include stomach upset, headache, and fatigue. More research is needed to find out if Exelon possesses any significant advantages...

Donepezil Aricept to Treat Alzheimers Disease

In the double-blind study that provided the basis for obtaining FDA approval, outpatients with mild to moderate Alzheimer's disease were randomized to receive 10 mg donepezil daily (157 patients), 5 mg donepezil daily (154 patients), and placebo (162 patients). Both the 5 mg and 10 mg donepezil groups showed an average 3 to 8 percent advantage over placebo on cognitive performance and global clinical improvement. The peak effect occurred after six weeks on medication, and by six months the...

The Rise and Fall of Tacrine Cognex

As the largely negative clinical trials with choline, lecithin, and acetyl-l-carnitine demonstrate, promemory effects in rats or mice are not easy to replicate in people. Improving cognition in the primitive rodent brain is a lot simpler than boosting it in the ultracomplex human brain. As a matter of fact, by the mid 1980s, research with a variety of cholinergic compounds lecithin, choline, phosphatidylcholine, acetyl-l-carnitine, and physostigmine had run into a dead end, despite the...

Properties of Acetyllcarnitine Alcar

Is found in muscle and helps get energy out of fat. Can repair damage in lymphocytes, a type of white blood cell that is essential for normal immune function. Boosts metabolism within nerve cells, and slows the loss of nerve growth factor that helps maintain the functioning of nerve cells in the hippocampus and frontal cortex. In fact, acetyl-l-carnitine raises the levels of nerve growth factor by 30 to 40 percent in the brains of rats. Prevents the loss of acetylcholinesterase, thereby...

Choline

Choline is directly converted into acetylcholine by combining with acetic acid, and you might think that choline should work quite well as a memory enhancer. Unfortunately, although animal studies show that choline heightens attention and helps to transfer information from short to long-term memory, the clinical data are inconsistent and unimpressive. Several placebo-controlled trials to treat Alzheimer's disease have met with failure. Similar efforts with choline have not worked in people with...

Different Ways to Boost Acetylcholine

Cholinesterase inhibitors are compounds that inhibit the action of this enzyme, acetylcholinesterase. Treatment with cholinesterase inhibitors indirectly raises the level of acetylcholine by preventing its breakdown, thereby leading to improved attention, mental arousal, learning, and memory. In fact, cholinesterase inhibitors have now reached the forefront of treatment in Alzheimer's disease, and memory loss more broadly. If you step back for a moment and think about the issue, this indirect...

Role of Acetylcholine in Cognition

Increase in acetylcholine leads to improved attention, mental arousal, and memory. From age forty to ninety, the nucleus basalis of Meynert gradually and progressively loses up to half its cholinergic nerve cells. This loss of cholinergic nerve cells causes a delay in the brain's ability to process information quickly and accurately, which is why aging leads to slower reactions as well as to mild memory loss. In Alzheimer's disease, the nucleus basalis is nearly wiped out within a few years...

Science in Evolution The Cholinergic Story

Brain Templaate

In 1976, Peter Davies, who was examining autopsied brains of patients with Alzheimer's disease, reported the death of nerve cells that normally produced the neurotransmitter acetylcholine. Around the same time, David Drachman showed that administering scopolamine, which is an antagonist of acetylcholine, to normal people could produce memory impairment and other cognitive deficits that mimicked Alzheimer's disease. These discoveries began the race to develop an effective medication that could...

Donepezil Aricept for Mild Memory Loss

There are more and more people like Diane Pozniak who are taking donepezil (Aricept) for memory loss. Some, like Diane, have very mild symptoms that fall beneath most clinicians' scanning radar, while others have more clear-cut symptoms that can be called mild to moderate memory loss without dementia. After all, if donepezil is successful in improving memory in a condition like Alzheimer's that is horrendously difficult to treat, why shouldn't it work as well, or even better, for milder forms...

Prescribing Off Label Is Common

Donepezil (Aricept) is approved by the FDA for Alzheimer's disease, and not for the treatment of mild memory loss. So what on earth was I doing prescribing this medication to Diane Pozniak, who had very mild memory loss by any definition, someone who clearly did not have any signs of dementia or Alzheimer's disease The answer to this seemingly loaded question is quite straightforward. Although the FDA labels the use of a medication only for a specific disease or diseases, all licensed...

Dianes Story

Diane Pozniak, a fifty-four-year-old divorced woman, worked during the day and took classes at night with the goal of obtaining a business degree and advancing her career and financial situation. She was not doing well in her classes and felt that it was because her memory was not good. She feared that these memory lapses would make it impossible for her to pass the required courses to complete her degree. On the other hand, she had no problems functioning at her day job as an administrative...

Choosing Antioxidants to Prevent Memory Loss

The brain needs the same nutrients and vitamins as the rest of the body it just needs a lot more of them. There is evidence supporting the use of antioxidants like vitamin E, and to a lesser extent vitamins A and C. One or more of these essential vitamins is a must in any program to prevent memory loss. One note of caution these antioxidants are true long-term prevention agents and not quick-fix therapies. You will not see any immediate effects on your memory, and may not observe any change for...

Other Antioxidants

Flavonoids, which are components of ginkgo biloba, are strong antioxidants. A subtype of flavonoids called proanthocynadin is found in grape seeds and pine bark. Grape seed extract and pine bark extract are marketed as antiaging products, but these substances have not been systematically studied. Green tea contains polyphenols that have antioxidant properties, and milk thistle extract contains the antioxidant silymarin. Barley and wheat juice contain large amounts of the enzyme superoxide...

Vitamin C The Essential Acid

Vitamin C (ascorbic acid) is essential for the nervous system, and is concentrated a hundred times more in the cerebrospinal fluid compared to other body fluids. Vitamin C is a strong antioxidant. In earlier times, sailors on long voyages deprived of citrus fruits (vitamin C) developed scurvy, a condition causing decay of skin and teeth. Older people who stop eating vitamin C-rich citrus fruits and vegetables may develop memory loss and mild confusion. At the opposite end of the age spectrum,...

Vitamin A

Vitamin A is essential for normal functioning of the retina, and its deficiency causes night blindness, which used to be fairly common until the latter half of the twentieth century. Beta-carotene is converted by the body's natural enzymes into vitamin A, and eating beta-carotene-rich foods like carrots prevents vitamin A deficiency. Both beta-carotene and vitamin A are antioxidants and free-radical scavengers, and many people take them regularly as antiaging medications. However, unlike...

Selegilines Promemory Actions

Inhibition of the enzyme monoamine oxidase-B, which in turn leads to a reduction in the formation of toxic free radicals. Stimulation of superoxide dismutase, a powerful naturally occurring enzyme in the body that also destroys free radicals. This dual antioxidant action likely underlies selegiline's action in delaying functional decline in Alzheimer's disease. Giving selegiline to mice leads to a higher density of nerve fibers in the frontal cortex and hippocampus. Mice given selegiline at...

The Antioxidant Selegiline or Deprenyl

Jozsef Knoll, a Hungarian university professor, developed selegiline as an antidepressant medication in the 1950s. Its antidepressant action is related to its ability to inhibit the enzyme monoamine oxidase-B (MAO-B), thereby raising the brain level of monoamines, which function as neurotransmitters. These monoamines include dopamine, which is needed for normal muscle control, sex drive, cognition, and novelty seeking or adventurous behavior. Based on its actions on the brain's dopamine system,...

Take Vitamin E to Prevent Memory Loss

Vitamin E is present in high-fat (but luckily, low-saturated fat) foods like vegetable oils, germs, nuts, and seeds. It is impossible for you to get more than 200 IUs daily through diet alone. Since vitamin E-rich foods can only go so far, you should take 400 to 800 IUs of vitamin E daily as a promemory (and antiaging, more broadly) dose, with 1,200 units for those among you who are more adventurous. Higher doses of vitamin E can cause headache, raise blood pressure, and increase the risk of...

Vitamin E for Memory Loss

In the Introduction, I described the story of David Finestone, a forty-nine-year-old man whose memory loss for names was probably caused by a small stroke. His treatment regimen consisted of cutting down on saturated fats, eating more fresh fruits and vegetables, taking an aspirin a day for its anticoagulant effects to prevent further strokes, and ingesting a capsule of 800 IUs of vitamin E daily. At that time, the antioxidant and antiaging properties of vitamin E were well known, but there...

How Vitamin E Works

Vitamin E is a free-radical scavenger that destroys toxic free radicals like bad oxygen and hydrogen peroxide these antioxidant properties may benefit patients with Alzheimer's disease and protect against memory loss due to the aging process. The anticoagulant properties of vitamin E, which distinguish it from the other antioxidant vitamins A and C, may help protect against stroke. In laboratory experiments, exposing brain cells to vitamin E limits the number of cells damaged by glutamate, a...

Vitamin E

A few years ago, a visiting speaker at our weekly departmental presentation praised the virtues of vitamin E as a potential treatment for several neurologic and psychiatric disorders, and as a general antiaging therapy. At the end of his talk, Dr. Jack Gorman, one of my colleagues who likes to occupy the front row, rose to his full height of six feet three inches and asked the speaker how much vitamin E he took daily. The speaker turned the question around and asked Jack how much he took daily....

Alternative Medications Facts

Among the current alternative medications, only ginkgo biloba has established cognitive-enhancing properties, though its effect is small in magnitude. You should consider taking 120 mg daily of EGb 761 (ginkgo biloba) as one of the medications in your memory program. More solid clinical evidence about the promemory properties of ginseng, melatonin, and other alternative agents is needed before they can be recommended for regular use. Phosphatidylserine (PS) is sold in health food stores. Some...

Melatonin

Melatonin is a naturally occurring hormone that is formed mainly in the pineal gland. The pineal gland is the size of a small capsule and sits in the lower middle part of the brain. Descartes called the pineal gland the seat of the soul, but we now think of it merely as the source of melatonin, which regulates sleep and is involved in immune processes. Melatonin release from the pineal gland has a predictable twenty-four-hour cycle an increase in the evening is associated with drowsiness and...

Ginsengs Actions in the Brain

Ginseng seems to increase mental alertness and then maintain it in a relatively steady state, thereby smoothing out the ups and downs of the stress response. Pharmacologically, ginseng may stimulate the production of epinephrine, which helps to indirectly suppress stress-induced release of cortisol and related steroids that may damage hippocampal nerve cells. Ginseng seems to boost cholinergic neurotransmission in the brain. Given the link between loss of cholinergic nerve cells and memory...

Ginseng

Ginseng root preparations, used extensively in Chinese medicine for centuries, are now popular across Asia, Europe, and the United States. In the seventeenth and eighteenth centuries, its medicinal properties achieved such fame that fortunes were paid for prize roots, as if they were rare diamonds. The reasoning behind ginseng's use is that it repairs yang energy. It is believed to have broad antiaging effects and is often given to treat fatigue and impotence. Male rats fed on ginseng initiate...

Promemory Actions of Ginkgo

Leaf extracts improve the ability of mice to remember newly learned behavior. In animal studies, enhances recovery from injury to the frontal lobes. In animal studies, acts against the memory deficits associated with aging. In a few clinical studies, slows memory decline in dementia. In healthy young adults, speeds up reaction time in stimulus-response tests, improving alertness. Anticoagulant properties may protect against stroke (and hence indirectly against memory loss). Antioxidant effects...

Ginkgo Biloba

Ginkgo biloba is taken by millions of people. As with many other organic plant extracts, anecdotal health claims abound for ginkgo. Many people think of it as a general tonic and consider memory enhancement as a sidelight. Others call it a fad that they wouldn't touch with a pole of any size. But what are the facts What do we really know about ginkgo biloba Ginkgo contains many organic substances, which include flavonoids, terpenoids such as ginkgolides and bilobalide, and several acids. These...

The Major Alternative Systems of Medicine

Ayurveda is a complex system described in ancient Hindu religious and medical texts, detailing the use of literally hundreds of natural substances as medicines. Unani is a system of medicine developed centuries ago in Arabia and Persia, which later mingled with local influences in the Indian subcontinent. Its popularity has dwindled over time. Chinese medicines include a variety of plants and their extracts to treat both symptoms and diseases. Many of them are meant to promote health and block...

The Roots of Ayurveda

During my medical school years, I read some of the Ayurvedic texts, translated from Sanskrit into English, that described a wide range of therapies herbs and plant extracts, metals, and bloodletting for various maladies. The vedas, among which Ayurveda is only a small component, were both the Encyclopaedia Britannica and the Bible of ancient Indian civilization. They were rooted in religion but con tained a great deal of practical information and advice for everyday living. A number of...

Global Trade Practices

Many developing countries like India and china refuse to grant meaningful patent protection to drug companies because it is likely to raise the cost of prescription medications to levels far above the average person's ability to pay for them. Currently, the pharmaceutical industry in these and most developing countries consists mainly of chemical companies that copy and manufacture new medications developed by large multinational drug companies in the United States, Europe, and Japan. Only when...

BR16A Travails of a Promemory Ayurvedic Preparation

Chittaranjan Andrade, has studied an Ayurvedic preparation that now goes by its modern name, BR-16A. In controlled animal experiments, he showed that BR-16A improved learning and reversed short-term memory deficits in mice. But when he approached the four manufacturers of BR-16A in India, none of them were willing to fund further basic research to find out which of the twenty or more ingredients in the substance was responsible for improving memory. They also...

Alternative Remedies

For twenty-three years, my father suffered from Parkinson's disease, a chronic, disabling brain disorder to which he eventually succumbed. Muhammad Ali, Janet Reno, and Michael J. Fox are among the prominent people who suffer from this illness. Parkinson's disease is caused by a deficiency of the neurotransmitter dopamine. The most widely used western or allopathic treatment, Sinemet, is a combination of levodopa and carbidopa that works by increasing dopamine levels within the brain. This is...

Taking Medications to Improve Memory What to Ask Your Doctor

Why am I taking this particular medication How does this medication work on my memory How much improvement can I reasonably expect Does it interfere with any other medicines I am taking Is the medicine addictive in any way Can I drink alcohol while taking it Is there any risk in stopping it for a few days at a time Most studies of treatments for mild memory loss have evaluated people over a few months or at most a year or two. If there is a slight improvement in memory functioning, will this...

Why Alternative Medications Vary in Quality and Content

The FDA requires pharmaceuticals, both prescription and over-the-counter, to be tested periodically to prove that their actual content lies within a 10 percent range of what is listed on the label a 300 mg tablet must contain between 270 mg and 330 mg in serially tested batches, otherwise the manufacturer is forced to stop producing the medication. Such testing is not required for unregulated herbal, plant, or other alternative products sold in health food stores or similar outlets, which is...

FDA Does Not Approve Medications to Prevent Age Related Memory Loss

The FDA does not recognize age-related memory loss to be an illness and is hence unwilling to approve any medication to prevent or treat this condition. This attitude has worked against research development efforts for both pharmaceutical agents and alternative remedies, because no company will invest tens of millions of dollars in clinical research on a compound or natural substance if at the end of this effort there is no hope of regulatory approval. This situation has led to most studies of...

Worldwide Regulation of Medications

Prescription medications are regulated strictly by the FDA in the United States, and over-the-counter medications are regulated to a lesser extent. Regulation of prescription medications is more lax in nearly all other countries compared to the United States. If a medication does not have major side effects, most European regulatory bodies will approve it as a prescription medication even if it hasn't been firmly proven to work in treating the illness. Alternative medications are not regulated...

Regulating Alternative Medications

Alternative remedies, which are unregulated by any federal agency, have increased in popularity mainly based on anecdotal reports and beliefs assume a therapy works unless someone can prove that it does not work (innocent until proven guilty). This approach is diametrically opposed to the scientific method underlying pharmaceutical testing and approval (guilty until proven innocent), and has created a bridge that has proven difficult to cross. Fortunately, the NIH has begun to fund randomized,...

Many Natural or Alternative Remedies Are Also Medicines

Robert's most striking feature was that he did not consider ginkgo, ginseng, saw palmetto, or melatonin to be medicines. And because these were natural substances that he obtained in a health food store, he was willing to spend a fair amount of money on them despite his financial difficulties. Many people do not count alternative remedies, or substances that occur naturally and are marketed for their health effects, as medicines. The reality is that many of these products do contain active...

Dont Take Any Medications Roberts Story

Robert Molson, a fifty-six-year-old man living in Greenwich Village, came to see me, stating that his memory had begun to decline, he was forgetting names more easily, and he was misplacing things more often. He was afraid he was getting Alzheimer's disease. He worked as a paralegal and hadn't yet run into problems at work, but he did point out that nothing short of a disastrous performance on his part would even be noticed in the New York City court system. He also had financial problems that...

Small Catch The Practice Effect

As discussed in the Preface, in evaluating treatments for memory loss, a unique factor absolutely mandates a placebo-controlled trial. This is called the practice effect. When you first try to complete neuropsychological tests, which include the tests of memory described in chapter 1, some parts seem difficult. The next time you do the same tests, you are likely to perform better, even on those tests that seemed hard to do the first time. This is the practice effect, which means that repeated...

Guilty until Proven Innocent

In a court of law, you are innocent until proven guilty. In science, you are guilty until proven innocent. The FDA assumes that medications don't work (guilty) and that it's up to the pharmaceutical company, or whoever else is bringing the claim, to prove that the medication is more effective than placebo in a minimum of two separate double-blind (neither the patient nor doctor knows if active medication or placebo is given) clinical studies involving hundreds to even thousands of patients.

Current Research Priorities

Making an early diagnosis and finding a treatment with robust effects are among the current research priorities in this field. If you already suffer from mild memory loss that continues to worsen even after you adopt the memory-enhancing strategies described in this book, I recommend physician consultation to make sure that you are not suffering from early dementia, whether it be Alzheimer's or a less common type. Medications That Prevent and Treat Memory

Frontotemporal Dementia

Frontal or frontotemporal dementia is a less common subtype. Earlier, all such cases were thought to have Pick's bodies, a specific type of microscopic abnormality, but many cases of frontotemporal dementia do not show this lesion. The clinical features overlap with those of Alzheimer's disease, but ''frontal lobe disinhibition signs are more prominent overeating, sleeping excessively, hypersexuality, motor agitation, and impulsive and unpredictable behavior. Following damage to the temporal...

Other Dementias

After Alzheimer's disease, the second most common form of dementia is vascular dementia, which is a direct result of multiple strokes destroying large portions of brain tissue (discussed in chapter 12). Diffuse Lewy body disease is a diagnosis that has gained in popularity in the 1990s. Lewy bodies are microscopic structures present in the brains of patients with Parkinson's disease. At least one-third of Alzheimer's patients also have clinical features of Parkinson's disease tremor, slow...

Potential Therapies

Caring for and treating patients with Alzheimer's disease costs over 100 billion annually in the United States alone. The introduction of FDA-approved cholinesterase inhibitors for treatment, and their potential utility in treating memory loss due to the aging process, has given rise to new hope that we are on the way to meaningful therapies for this terrible illness. There are suggestions that vitamin E, ginkgo biloba, estrogens, and anti-inflammatory agents may slow the progression of...

What If Memory Loss Persists after Depression Improves

In some people with both depression and memory loss, the memory deficit may not improve even after the depression is successfully treated. In such a situation, the memory loss that accompanies depression may be the first sign of Alzheimer's disease. We showed this in a community study of elderly subjects, where the presence of depression conferred a threefold increased risk of developing Alzheimer's disease during a follow-up period of up to five years. George Alexopoulos's research group at...

When Did Ronald Reagans Alzheimers Begin

During a deposition in 1990, President Ronald Reagan could not recall the name of the chairman of the Joint Chiefs of Staff. We now know that he went on to develop Alzheimer's disease. Did he already have the disease at that time, or perhaps even earlier While we will never know the answer definitively, his experience illustrates how Alzheimer's disease often starts. In Reagan's case it began with forgetting names, a common symptom of age-related memory loss. This is classic for Alzheimer's...

Evaluate Your Memory

A good storyteller is a person who has a good memory, and hopes other people haven't. Woody Allen once said that the brain was his second favorite organ. While the brain may indeed be the number two choice for many of us, it is by far our most important organ, and memory is one of its most critical functions. In this part of the book, you will learn how to assess your memory and determine whether it is normal or abnormal. You will also learn about the basic processes underlying memory formation...

The Memory Program

This comprehensive Memory Program has three major steps, each involving several components Step 1. Identifying and treating specific, reversible causes of memory loss Step 2. General measures to protect against memory loss that include a healthy diet, physical exercise, and memory training Step 3. Medication strategies to maintain and improve your memory. I will first describe the Memory Program in its entirety, and then individualize the program by focusing on subcategories of people, based on...

Your Future Memory Program

The long-standing defeatism about preventing and treating memory loss has now given way to a feeling of growing excitement that we will soon have the keys to the memory kingdom. But we have just scratched the surface, and new knowledge will eventually render obsolete our current repertoire of preventive and treatment strategies, including some of the components in the Memory Program. Several potential therapies for age-related memory loss are still in the development stage. These include a new...