Page 90 - The Memory Program How to Prevent Memory Loss and Enhance Memory Power

Page 79

When in doubt, I usually do a few things. First, I talk to my neurologist and psychiatrist colleagues
to see if they can give me some interesting leads, come up with a new idea, maybe dig up the files of
another patient who presented similar symptoms. This approach didn't help me very much in Jack
Kaufman's case. Second, I read the latest books and medical literature to see if they might shed light
on the matter. This strategy didn't help me very much either. So I was beginning to consider my
fallback position: recognize that I don't have the answer, discuss the situation with the patient, and
explain that longer term follow-up with a trial-and-error treatment approach might be necessary.

But my curious diagnostic mind wasn't yet ready to accept defeat. Earlier, Jack had downplayed
the impact of migraine headaches that occurred at a frequency of once or twice a month. On further
investigation, he divulged the truth. Although the migraine attacks were not frequent, he often took
painkillers as soon as he felt that an attack might be coming on. These included not only
acetaminophen (regular Tylenol), but also Tylenol 3, which contains a small dose of codeine in
addition to acetaminophen. Codeine is a narcotic that belongs to the same chemical class of
substances as morphine and heroin, though it is much weaker in its effects. For most people, the
codeine dose in Tylenol 3 is too small to have any impact on memory, but Jack sometimes took up to
four tablets in a single day when he sensed the “aura” of an impending migraine attack. On days
when the attacks did occur, he sometimes exceeded this dose.

Jack was unable to identify a clear time relationship between taking Tylenol 3 and his loss of
memory, because his medication intake was erratic and unpredictable, which is why he hadn't
reported it to me during the initial evaluation. I explained to him that there was a distinct possibility
that the codeine in Tylenol 3 was having a subtle impact on his memory. Jack had obtained the
prescription with multiple refills from an internist whom he saw barely once a year. Jack agreed with
my recommendation to get an opinion from a headache specialist. The headache specialist stopped
Tylenol 3 and switched him to sumatriptan (Imitrex), a powerful antimigraine medication that should
be taken only just before or during a migraine attack, because frequent use is potentially risky. Jack
had to adjust his approach to this new reality, but the great advantage was that when he took
sumatriptan at the start of an attack, the migraine literally disappeared. Over the next few months, his
cognitive abilities steadily improved, and he had no further incidents or episodes of memory failure.
On repeat neuropsychological testing conducted a year later,