Page 169 - The Memory Program How to Prevent Memory Loss and Enhance Memory Power

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exercise. She also listened to my advice about stress-reduction and relaxation techniques, but I had
the distinct impression that she would not follow through with any action. She pointed out that she
was so busy with a full-time job plus extensive schoolwork that she could not spare any time to go
regularly to the gym, take walks, or start a stress-reduction program. She wanted a pill to help her
memory, and after some thought, I advised her to start taking vitamin E 800 IUs daily.

She returned a month later in the same state, saying that she needed something stronger to help her
because her performance in class had not changed despite her best efforts. She was convinced that
this was solely because of her poor memory, and her earlier neuropsychological testing had
suggested that this indeed might be the case. She was burning the midnight oil on a daily basis, so I
knew her cognitive problems were not due to lack of effort. I decided to prescribe donepezil
(Aricept) 5 mg daily.

A month later, she was grinning from ear to ear. She had just received a B in a class where just a
few weeks earlier, she had fully expected to get a D or even an F. She felt more alert, and reported a
distinct boost in her memory function. Out of curiosity, I repeated a few key elements from the
neuropsychological test battery. There was some improvement in her performance on the Selective
Reminding Test, but I could not entirely rule out a practice effect because she had done a similar test
three months earlier. During the next year, she continued to maintain her improvement, and she
successfully finished her business degree with above average grades. At no time was there a dramatic
change in her cognitive test performance, indicating that the effect of Aricept was mild to moderate
at best. But from Diane's perspective, it certainly did the trick.

Prescribing Off-Label Is Common

Donepezil (Aricept) is approved by the FDA for Alzheimer's disease, and not for the treatment of
mild memory loss. So what on earth was I doing prescribing this medication to Diane Pozniak, who
had very mild memory loss by any definition, someone who clearly did not have any signs of
dementia or Alzheimer's disease? The answer to this seemingly loaded question is quite
straightforward. Although the FDA “labels” the use of a medication only for a specific disease or
diseases, all licensed physicians are free to prescribe approved medications for other conditions if
they wish to do so. Obviously, if something goes wrong and a lawsuit ensues, the physician will have
a tough time