Why Other Medications Did Not Make the Cut
The cholinergic compounds lecithin and Alcar just missed the cut because the data are much weaker than for Aricept (or Exelon or Reminyl). DHEA (discussed in the next chapter) is not on my list, not only because its efficacy against memory loss has not been established, but also because it is more toxic than the medications that are on the list. The data on hydergine and the nootropics do not suggest sufficient action against memory loss. The COX-II inhibitors did not make it to the list either, mainly because they have just been released and we have no information on their use against memory loss. Ongoing and future clinical studies may demonstrate significant antimemory-loss properties for the COX-II inhibitors, in which case Celebrex or Vioxx might well vault to the top of the list.
The FDA Has Yet to Approve Any Medication for Mild-Memory Loss
Note that none of the prescription medications are approved by the FDA for age-related or mild memory loss, so not all physicians will be willing to prescribe them. However, many neurologists and psychiatrists are prescribing one or more of these medications (off-label) for these purposes.
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 continuously for several years to decades. Ginkgo biloba also appears to be quite safe during long-term use. Phosphatidylserine has not been studied in long-term trials, but its lack of side effects during several months of daily administration indirectly suggests that it is likely to be safe even when taken for several years at a stretch.
Which Medications Should You Take?
If you wish to take a memory enhancer, what medication should you choose from this list? Obviously, you cannot take the whole lot for several reasons: the high cost and large number of capsules required, the increased risk of toxicity, and the lack of solid evidence that combinations are better than single agents. Adding selegiline to vitamin E, for example, does not improve matters for patients with Alzheimer’s disease, even though individually each agent has a small effect. Critically, combining too many medications can be dangerous because the risk of toxic interactions will skyrocket. The solution is to follow the medication guidelines in the following tables, based on whether you have a normal memory or have mild memory loss.
I will now review the possible combinations of medications, and the Memory Program more broadly, according to categories divided on the basis of age, gender, and preventing future memory loss versus treatment for mild memory loss. I will not repeat the doses and side effects of each medication; this information can be obtained from these tables and the preceding text in this chapter (and earlier chapters).
Taken From: The Memory Program How to Prevent Memory Loss
and Enhance Memory Power
