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Do Therapies for Memory Work?

Updated: Mar 4, 2020

You may have heard that current therapies for memory or memory loss "don't work." I would like to hear your comments about this in the posts below, but in my experience, this is not true.

Therapies for memory do work. The drugs currently approved for Alzheimer's Disease help memory, cognition, and overall functioning in life. Donepezil (brand name Aricept) pills and rivastigmine (brand name Excelon) patch do improve memory, cognition, function in people with Alzheimer's Disease, and even hallucinations in people with Lewy Body disease. They improve ability to do daily activities. In my clinical experience, I have also seen them improve attention and focusing, as well as balance, and prevent falls. Memantine (brand name Namenda) may also slow memory and cognitive decline, even in severe Alzheimer's patients. Discontinuation of these medicines may be associated with higher risk of placement in nursing homes. Ergoloid (brand name Hydergine) helps memory in people with Vascular Cognitive impairment. Rivastigmine (brand name Excelon) patch helps memory in people with Parkinson's and Lewy body dementia. Other medications that help stimulate the brain, such as citalopram (brand name Celexa), bupropion (brand name Wellbutrin), or dextroamphetamine-amphetamine (brand name Adderall) may help concentration, learning, mood, social behavior, and overall quality of life.

Even better than medications are the day-to-day activities that can be done with people with memory loss. Cognitive stimulation benefits people with memory loss over and above the effects of medications. Aerobic exercise actually grows the memory areas of the brain on MRI in people between the age of 55 and 80. Therefore, if medication, cognitive stimulation, social activity, and aerobic exercise are combined, memory loss could be slowed down significantly.

However, these therapies are often started too late, in the moderate or severe stage of memory loss, when they may have less effects. I believe that when started in the mild stage, they help the person more, because they have more years of preserved memory and function than if they were started in the moderate or severe stage. You may have heard from various sources that there is currently no therapy to "slow Alzheimer's down," but this is not true. See these research articles (1, 2, 3, 4).

The reason is that memory loss often goes unnoticed or misdiagnosed by general medicine practitioners or family medicine doctors in 39 to 91% of patients (see link and link). This may be because they do not have sufficient time to conduct memory testing or speak to family individually. I have also seen general physicians let family members "speak for" the patient, while the patient remains silent at a general checkup, so any inattention, repeating themselves, or language disturbances are not noticed. The other reason is that many people with memory loss are not aware of their symptoms due to their brain shrinking in the self-awareness areas (a condition called anosagnosia). So, often people themselves do not complain of memory loss, but the family or friends notice changes. Often, family or friends are hesitant about mentioning this to the doctor in front of their loved one with memory loss.

These therapies are also started too late because general physicians often do not have the tools to test for mild stage memory loss. The MiniMentalStatus (or MMSE) exam is not sufficient. The Montreal Cognitive Assessment (MOCA) may be more effective, but takes too long in most general practice visits. The MiniCog is another test that is a required component of the Annual Wellness Visit for Medicare patients, but may miss 25% of cognitively impaired patients. The main learning point I received from my fellowship in Cognitive Neurology is that the details of symptoms shared by close friends or family alone, without the patient in the room, is the most sensitive way to detect cognitive impairment. However, this takes time, as the family or friend may need to be spoken to in a separate room as the patient, and then a cognitive test can be done with the patient. Current insurance reimbursement often does not allow for this time in most medical practices.

The other reason that most trials show a "modest" benefit for people with memory loss or Alzheimer's, is that we are often not sure if the patients actually have Alzheimer's. It was not until the 2010's that amyloid PET scans were routinely used in clinical trials to confirm a diagnosis of Alzheimer's Disease. So, much of the research on donepezil, rivastigmine, memantine, exercise, cognitive, and social activity were likely on a mix of people with Alzheimer's and/or Vascular Cognitive Impairment, the two most common types of dementia. Amyloid PET scans are now available almost everywhere, but not approved by insurance yet, and often cost $2000-3000 out of pocket.

So, current therapies for memory loss do help, and it depends on which type of memory loss a person has. There are completely reversible forms of memory loss. There are improvable forms of memory loss. And there are progressive forms of memory loss than can be slowed down.

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