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explaining off-label prescribing in court. In reality, many physicians, particularly psychiatrists and
neurologists, prescribe medications off-label. This is because there is a wide gap between patients'
needs and what the FDA has been willing to approve for a variety of brain disorders.

Donepezil (Aricept) for Mild Memory Loss

There are more and more people like Diane Pozniak who are taking donepezil (Aricept) for memory
loss. Some, like Diane, have very mild symptoms that fall beneath most clinicians' scanning radar,
while others have more clear-cut symptoms that can be called mild to moderate memory loss without
dementia. After all, if donepezil is successful in improving memory in a condition like Alzheimer's
that is horrendously difficult to treat, why shouldn't it work as well, or even better, for milder forms
of memory loss? As Diane's story demonstrates, there is a place for donepezil in such a situation. In
fact, recent studies suggest that it has a broad array of actions in improving memory: patients with
multiple sclerosis show improved memory on donepezil compared to placebo, and patients taking
antidepressants and similar medications (some with known anticholinergic effects) report a
subjective improvement in memory on donepezil. (There was no objective memory testing or
placebo control in that study, so view the results with caution.)

Before you run off to get a prescription of donepezil (Aricept) from your doctor, it is important for
you to understand exactly how cholinergic medications work; this will give you a sound basis on
which to make your decision to take or not to take Aricept.

Science in Evolution: The Cholinergic Story

In 1976, Peter Davies, who was examining autopsied brains of patients with Alzheimer's disease,
reported the death of nerve cells that normally produced the neurotransmitter acetylcholine. Around
the same time, David Drachman showed that administering scopolamine, which is an antagonist of
acetylcholine, to normal people could produce memory impairment and other cognitive deficits that
mimicked Alzheimer's disease. These discoveries began the race to develop an effective medication
that could reverse the acetylcholine deficit seen in patients with Alzheimer's disease.