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 assistant. Her concern about memory loss arose from the fact that her mother had died of dementia in a nursing home, and Diane was worried that she had begun to get a similar illness.

On neuropsychological testing, she performed within the expected range for her age on most tests, except that her delayed recall score on the Selective Reminding Test, which evaluates the ability to learn lists of words and keep them in memory (a test described in chapter 1), was slightly below par. Her blood tests showed no metabolic, thyroid, or nutritional deficiencies, and her MRI scan was normal. Physically, she was in good health with nothing abnormal on her medical or neurologic examination. She seemed somewhat anxious and was clearly under stress, but I did not think she had an anxiety disorder or depressive illness.

I talked to her about her health habits, particularly the importance of reducing saturated fat in her diet and the need for regular exercise. She also listened to my advice about stress-reduction and relaxation techniques, but I had the distinct impression that she would not follow through with any action. She pointed out that she was so busy with a full-time job plus extensive schoolwork that she could not spare any time to go regularly to the gym, take walks, or start a stress-reduction program. She wanted a pill to help her memory, and after some thought, I advised her to start taking vitamin E 800 IUs daily.

She returned a month later in the same state, saying that she needed something stronger to help her because her performance in class had not changed despite her best efforts. She was convinced that this was solely because of her poor memory, and her earlier neuropsychological testing had suggested that this indeed might be the case. She was burning the midnight oil on a daily basis, so I knew her cognitive problems were not due to lack of effort. I decided to prescribe donepezil (Aricept) 5 mg daily.

A month later, she was grinning from ear to ear. She had just received a B in a class where just a few weeks earlier, she had fully expected to get a D or even an F. She felt more alert, and reported a distinct boost in her memory function. Out of curiosity, I repeated a few key elements from the neuropsychological test battery. There was some improvement in her performance on the Selective Reminding Test, but I could not entirely rule out a practice effect because she had done a similar test three months earlier. During the next year, she continued to maintain her improvement, and she successfully finished her business degree with above average grades. At no time was there a dramatic change in her cognitive test performance, indicating that the effect of Aricept was mild to moderate at best. But from Diane's perspective, it certainly did the trick.

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