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Aricept has been shown to improve cognition in patients with multiple sclerosis, and is now being
tested in people with mild to moderate memory loss. The other newer cholinergic agents may have
similar properties. The underlying rationale is that cholinergic nerve cells decay in all of us during
the aging process, and cholinesterase inhibitors can reverse this deficit and thereby improve
cognitive performance.

Combination Therapies Need to Be Tested

From a theoretical perspective, tackling different pathways that lead to memory loss may be more
beneficial than dealing with only one pathway, but a few studies that attempted combination
therapies met with poor results. The Alzheimer's study using vitamin E plus selegiline showed no
advantage for the combination over either medication taken alone. Earlier, Ken Davis's group at
Mount Sinai Medical Center in New York tried a medication cocktail to simultaneously correct the
cholinergic and adrenergic (norepinephrine) deficits in Alzheimer's disease, but the combination did
not work well in a clinical trial.

But another incidental finding suggests that the search for an optimal combination therapy should
not be abandoned. In the tacrine study of patients with Alzheimer's disease, the medication's effect
was strongest in women taking estrogen, indicating that the combination was better than tacrine
alone. In an entirely different field, AIDS treatment underwent a revolution after combinations of
protease inhibitors were shown to be much more effective than single medication regimens. In the
future, I expect that a number of combinations will be studied from the potpourri of therapies for
memory loss: ginkgo biloba, donepezil, vitamin E, estrogen, and COX-II inhibitors, to name a few.
At this stage, it is impossible to predict which combination of two or three or four medications will
prove superior to treatment with individual medications.

Note that the Memory Program relies on a multilayered strategy that includes the judicious use of
carefully selected combinations of medications.

Stimulating Nerve Cell Growth

In infant mice, an enriched environment of toys, high-quality food, games, and other stimuli
increases nerve cell growth and branching in the brain. Compared to normally caged mice living a
spartan existence, mice exposed to barely two months of this enriched environment show