Treatment of Memory Problems
The same strategies listed under prevention should be the foundation of any treatment approach. In addition, certain medications and supplements play a role in the treatment of memory and cognitive problems.
- Cholinesterase Inhibitors
All of these agents seem to result in statistically significant (but small) improvements in memory in patients with dementia, and some studies suggest that they may have similar effects in people with other types of milder memory problems. Four cholinesterase inhibitors, tacrine, donepezil, rivastigmine, and galantamine are currently approved for use in Alzheimer’s Disease by the United States Food and Drug Administration (FDA). Tacrine was the first agent approved for use in AD, but it can cause hepatotoxicity and is rarely used. The choice between the other three agents is largely based upon cost, individual patient tolerability, and physician experience, as efficacy appears to be similar.
- Memantine (Namenda®)
Memantine reduces the decline in function in Alzheimer’s disease by binding to N-methyl-D-aspartate (NMDA) receptors and blocking the actions of glutamate. Unlike the cholinesterase inhibitors, there is less information suggesting that this medication helps in other forms of memory difficulty. In Alzheimer’s Disease, the combination of memantine and a cholinesterase inhibitor seems to be the most effective intervention and is commonly used.
This is a recent review of these medications – (Can J Psychiatry. 2011 Oct;56(10):579-88. Pharmacological treatment of Alzheimer disease. Massoud F, Léger GC).
Currently available statins in the United States include lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, and rosuvastatin. These agents are competitive inhibitors of HMG CoA reductase, the rate-limiting step in cholesterol synthesis. Unlike the cholinesterase inhibitors there are significant differences among these agents. They all seem to reduce the risk of dementia in people with elevated cholesterol. Unfortunately, in some people their immediate (as opposed to long term) effects can be to worsen mood and/or memory.
- Modafanil (Provigil®)
Provigil is not a memory enhancement drug per se. It can, however, help certain kinds of cognitive problems. It is an alertness enhancer that helps people who have trouble focusing on a question or problem.
- Calcitriol (Vitamin D)
- Bexarotene (Tagretin®)
- Intranasal Insulin