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inhibitors that has been approved by the FDA to treat arthritis, has started a large-scale placebo-
controlled clinical trial to evaluate the new medication's effects in treating people with mild cognitive
impairment. Similarly, Searle, which makes another COX-II inhibitor called celecoxib (Celebrex), is
completing a similar trial in people with mild cognitive impairment.

These COX-II inhibitors hold some promise as promemory agents. Other drug companies are
likely to develop similar compounds. These new medications are as powerful as older NSAIDs, and
because they preferentially enter the brain more than the rest of the body, they seem to be less likely
to cause the side effects of stomach irritation, ulcers, and bleeding.

Therapeutic Guidelines for Anti-inflammatory Medications

For anti-inflammatory agents, a few broad guidelines are in order. Although steroids like prednisone
have the strongest anti-inflammatory properties, these are fairly toxic compounds that are quite tricky
to use. In addition, the negative results in the recent Alzheimer's study have convinced me to exclude
steroids from the Memory Program.

Among the NSAIDs, the antioxidant and anticoagulant properties of aspirin give it a slight edge
over the other available compounds. If you have risk factors for stroke or heart attack— for example,
a strong family history or a high cholesterol blood level— an aspirin a day is a good idea. It may also
protect against memory loss, given its antistroke and anti-inflammatory properties. Other NSAIDs
like ibuprofen (Motrin) or indomethacin (Indocin) also irritate the stomach lining, though to a lesser
extent than aspirin (enteric-coated or buffered aspirin helps but does not always solve the problem).
The other NSAIDs do not share aspirin's anticoagulant properties that help reduce the risk of stroke
and heart attacks.

Our best hope for the use of anti-inflammatory agents to prevent memory loss lies with the new
COX-II inhibitors. We should know about the results of the Merck and Searle trials to treat mild to
moderate memory loss within the next couple of years, and if they are positive, these medications
could become the linchpin of a therapeutic strategy against memory loss due to the aging process.
The relative lack of side effects will allow most people to take these medications without difficulty.
Stay tuned for the results of the COX-II inhibitor trials in people with mild to moderate memory loss.