It was a bit shocking. The wife remarked on the comments of her husband’s neurologist. He was rumored to malign memory enhancing drugs used in the treatment of Alzheimer’s Disease. He was of the opinion that this class of drugs benefited the drug companies more than the victims of a senile dementia. The wife was understandably confused by the disparity between the opinion of the neurologist and the claims of the drug companies. The shock was the public admission of what many physicians voice in private.
Over the last ten years, most patients I’ve evaluated with a change in mental status, due to any cause, have already been prescribed memory enhancing medications. The drug companies caution that these drugs should be limited to the victims of a senile dementia of the Alzheimer’s type. It is very common to observe these drugs used in the treatment of stroke and head injuries. Is this a good thing?
Unfortunately, this clinician has never witnessed a significant increase of verbal memory performance as a consequence of these medications. This experience applies both to the preferred use of these drugs in the treatment of Alzheimer’s, as well as off-label use of memory enhancing medications. It is not intended as a blanket condemnation, rather it reflects the lack of statistically significant benefit displayed on well-normed tests of verbal memory. There may be many people who have a significant increase of verbal memory with the use of these drugs, but none of these responders have been evaluated by this clinician. Memory enhancing drugs that boost the neurotransmitter acetylcholine may display increased agitation, weight loss, and even chronic nausea with vomiting. These reactions are fortunately not universal. This clinician has witnessed the resolution of these symptoms many times after a reduction or discontinuation of the medication. Personal experience of medication that affects glutamate levels in the brain is that they are neither very harmful or helpful in the treatment of moderate to severe Alzheimer’s Disease.
Given the modest benefits advanced by the drug companies, and the lack of personal observation as to their effectiveness, it may not come as a shock that I rarely recommend memory enhancers. Family members are often convinced of their benefit based upon commercial advertising. I have never witnessed a family member request memory enhancers based upon their personal experience, or the experience of a close friend. This is not to say that memory enhancers never have beneficial effects, just not in this clinician’s limited experience. Much of the public and even some physicians are highly influenced by these drug advertisements.
The latter stages of Alzheimer’s Disease are often fraught with weight loss and agitation. Victims of a senile dementia become too inattentive to sit through a whole meal, requiring frequent prompts and even hand feeding to keep up their body weight. By the middle stages of Alzheimer’s, the loss of other cognitive functions largely negates a mild increase in verbal memory. These mid-stage patients would still have trouble with planning, praxis, attention, judgment, flexibility, etceteras. Even a significant increase in verbal memory would not return these victims to an independent lifestyle. Memory enhancing drugs that commonly produce symptoms of weight loss and agitation should be used with obvious caution.
This clinician’s advice is to proceed with, you guessed it, caution. Consider having a neuropsychologist perform pre and post testing to measure any significant increase in verbal memory as a consequence of these medications. If there is not a significant increase in verbal memory after a six week trial, consider requesting the attending physician to reduce and eventually discontinue the medication. If an acetylcholine boosting medication is utilized, and the patient develops weight loss and agitation, work with the physician to determine if the symptoms are secondary to the memory medication. Senile dementia of the Alzheimer’s type is a horrid disease that can cripple an entire family. Pills without a clear benefit should be considered as a risk to the patient over time; possibly creating undesired symptoms and interacting with other medications in an unpredictable fashion. I strongly suggest to formulate conclusions based upon observation-not advertising.