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).

  • Statins

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)
There is some evidence that vitamin D may be beneficial in some patients with Alzheimer’s (Am J Alzheimers Dis Other Demen. 2011 Nov;26(7):511-20. Epub 2011 Dec 27.The beneficial role of vitamin D in Alzheimer’s disease.Lu’o’ng KVNguyên LT.). Although there is evidence that vitamin D supplementation in the elderly is not entirely benign, in those with established Alzheimer’s the possible benefits may outweigh the risks.

Investigational Agents

  • Bexarotene (Tagretin®)
Tagretin is a medication approved for the treatment of certain skin cancers. It was shown to rapidly clear the evidence of Alzheimer’s in the brains of mice. As the researchers noted, many times in the past they have been able to do this with mice, but whether it works in humans is still unknown.
  • Intranasal Insulin
There is some evidence to suggest that intranasal insulin may have a modest effect on cognition in some patients with dementia. (J Clin Endocrinol Metab. 2012 Feb;97(2):366-76. Epub 2011 Dec 7.Effect of intranasal insulin on cognitive function: a systematic review.Shemesh ERudich AHarman-Boehm ICukierman-Yaffe T.)