Memory Medications

The search for medications that can renew a fading memory or enhance a normal one has been gathering momentum at a geometric pace for more than a decade, ever since the FDA approved tacrine (Cognex), the first drug for the treatment of Alzheimer's disease. There is not yet a pill proven to conquer age-related memory loss, although there is certainly no shortage of herbal preparations that make this claim. There are a growing number of FDA-approved medications for the symptomatic treatment of memory disorders. An even larger number of candidates are in the drug-development pipeline.

Currently available drugs can slightly improve symptoms and temporarily slow the progress of dementia; these drugs are being prescribed more and more frequently for mild cognitive impairment. Importantly, supplements of vitamin E are also helpful— about as effective for Alzheimer's disease as the prescription drugs. However, as of now, we don't have a medication that can cure any of these memory disorders or reverse the course of the neuronal damage that they cause.

Many pharmaceutical companies are making use of the wealth of new findings on the biology of Alzheimer's disease to develop medications that, ideally, will halt this memory disorder by tar- ,133

The drugs now used to treat dementia and mild cognitive impairment work by altering the activity and availability of neurotransmitters in the brain that play a key role in memory. Most currently approved drugs increase the availability of acetylcholine, a key neurotransmitter involved in memory function. These drugs, called cholinesterase inhibitors, include donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon), and tacrine (Cognex).

While they are generally equally effective, the cholinesterase inhibitors differ in their convenience of use and their side effects. Donepezil is the most convenient of the drugs because it's taken just once a day, whereas the others have to be taken twice a day. The most common side effects of cholinesterase inhibitors are gastrointestinal symptoms, including nausea and diarrhea, with decreased appetite and weight loss. Despite the fact that all of these medications are of the same class, some people occasionally develop side effects to one but not to another. Tacrine, the oldest of the drugs, is rarely prescribed anymore because it has the most severe side effects—it can cause liver damage.

A newer drug, called memantine (Namenda), relies on a different mode of action. Memantine is an NMDA (N-methyl-D-aspartate) receptor antagonist, which blocks glutamate, another neurotransmitter, from latching onto NMDA receptors. Receptors are sites on neurons that receive specific neurotransmitters. Although the precise mechanism of memantine's beneficial effect is unclear, it may be that blocking NMDA receptors prevents overstimulation by excessive levels of glutamate that can be toxic to neurons and synapses, leading to memory loss and problems with other brain functions. The most common side effects reported with memantine include dizziness, confusion, headache, and constipation.

geting the underlying pathology. I feel optimistic that disease-modifying therapy is on the horizon.

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