Lecithin is an essential ingredient of living cells.

It prevents cholesterol accumulation in arteries, and helps prevent liver degeneration.

Phosphatidylcholine is the active element in lecithin that works against memory loss.

Phosphatidylcholine is broken down to choline, which the body then uses to synthesize acetylcholine.

Lecithin has a prolonged duration of action and needs to be taken only once or twice a day.

Like choline, in more than a dozen controlled studies of Alzheimer's patients, lecithin's effects have been very small and quite inconsistent. Similar results have emerged from the few placebo-controlled studies of lecithin to treat mild to moderate memory loss; there have been no studies to prevent age-related memory loss.

Your average daily diet contains approximately I gram of lecithin, but this is too little to have any promemory effects. You need to take a large amount—2 to 10 grams a day—to produce a very small, and debatable, improvement in memory. Lecithin can be purchased in health food stores. The amount of the vital component, phosphatidylcholine, varies from 25 to 55 percent in content in these products. The higher the proportion of phosphatidylcholine, the more likely lecithin may have a mild cognitive-enhancing effect.

The relative failure of choline and lecithin, medications that directly enhance cholinergic function, brings us back to the indirect strategy that led to the development and success of donepezil (Aricept): inhibition of the enzyme acetylcholinesterase. No one really understands exactly why, but this indirect route works much better than the direct approach. Among the cholinesterase inhibitors, physostigmine, acetyl-l-carnitine, tacrine, and donepezil are the most prominent.

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