Page 178 - The Memory Program How to Prevent Memory Loss and Enhance Memory Power

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Nicotine Is a Cognitive Enhancer

There is another cholinergic system— nicotinic— in the brain that utilizes nicotine as its main
neurotransmitter. Yes, this is the same nicotine that causes addiction to cigarettes! Nicotine
stimulates the release of endorphins, which are the brain's natural morphinelike substances, and
dopamine, which is involved in stimulating the reward-pleasure and arousal systems. The activating
properties of nicotine, which make people more alert and aroused, may partly account for its
addictive potential.

Nicotine receptors are deficient in the brains of patients with Alzheimer's disease. Initial studies
using the nicotine skin patch in Alzheimer's patients were promising, but the latest studies have been
negative. A broader question is whether nicotine can treat mild memory loss or prevent age-related
memory loss. Early population-based studies suggested that smokers were less likely to develop
Alzheimer's disease, but recent work has discounted this theory. Simultaneous administration of
nicotinic and muscarinic compounds has never been attempted in any clinical trial, largely because
of the fear of increased cholinergic toxicity. At this stage, the data on nicotine are insufficient for me
to recommend it as a therapeutic or preventive strategy against memory loss.

Rational Choices

Enhancing cholinergic transmission using cholinergic compounds may be one of the most effective
ways of treating, and possibly preventing, memory loss. Donepezil (Aricept) heads my
recommended list, but high cost and the fact that it is a prescription medication are significant
limitations. Exelon and Remmyl are alternatives to Aricept, but they are also expensive prescription
medications. If you would like to try other options, particularly if you prefer natural substances that
you can obtain in health food stores, you can consider acetyl-l-carnitine or lecithin. But I'd like you
to remember that the data on these other medications are not as convincing as they are for Aricept (or
Exelon or Reminyl). Regardless of which agent you choose, the standard approach is to start at the
lowest dose and increase it gradually until you reach the maximum dose that you can tolerate without
side effects. Do not take more than one of these medications simultaneously, because the risk of
toxicity increases.