Medications to Enhance Memory

Are you wondering if medications might be useful if you or a loved one are experiencing memory loss, mild cognitive impairment, or dementia? Below are some that might help. In this three-part series, we will begin with medications for memory. Speak to your doctor for more information.

Remove or minimize any medications that could be causing cognitive impairment

Before adding any medications, we always first work to remove or minimize any medications that could cause cognitive impairment. These include many medications in the following classes:

• Anticholinergic medications (many prescription medications are anticholinergic—ask your doctor about yours)
• Antihistamines, including over-the-counter antihistamines such as diphenhydramine (Benadryl)
• Narcotic pain medications, like morphine and oxycodone (Percocet)
• Muscle relaxants like cyclobenzaprine (Flexeril)
• Benzodiazepines, such as diazepam (Valium) and lorazepam (Ativan)
• Sedatives/sleeping aids, like zolpidem (Ambien), mirtazapine (Trazodone), and quetiapine (Seroquel)—except melatonin, which is fine
• Anticonvulsants, like gabapentin (Neurontin) and valproic acid (Depakote)
• Neuroleptics, like haloperidol (Haldol) and risperidone (Risperdal)
• Many incontinence medications, like oxybutynin (Ditropan) and tolterodine (Detrol)

Medication therapy for memory impairment

For those with memory impairment due to a disease, we recommend the use of the cholinesterase inhibitors. These medications stop the breakdown of acetylcholine at the synapse between two neurons, leading to an increase of this neurotransmitter in the brain. This class of medications was developed for individuals with Alzheimer’s disease dementia, but also works for mild cognitive impairment, vascular dementia, and dementia with Lewy bodies. These medications include donepezil (Aricept), rivastigmine (Exelon), and galantamine. The expected benefits include a small but noticeable improvement in memory that will be persistent even as the individual declines. In other words, cholinesterase inhibitors are symptomatic memory boosters, producing slightly better memory at any given level of function. Thus, if an individual shows initial benefit with this class of medication, we generally recommend they stay on it for the remainder of their lives. The major side effects are directly related to their pro-cholinergic action and include loss of appetite, nausea, frequent bowel movements, vivid dreams, increase in saliva, runny nose, muscle cramps, and rarely a slowing of the heart. We recommend an electrocardiogram (ECG) be obtained after the individual is at their target dose to detect any slowing of the heart. Note that taking the medication in the morning can sometimes eliminate vivid dreams. Over-the-counter magnesium oxide can often improve muscle cramps. (See Budson & Solomon, 2016, for additional details.)

Strategies and memory aids to improve memory function

We also recommend the following memory strategies and aids (see Budson & O’Connor, 2017, for details):

Memory Strategies

• Practice active attention
• Minimize distractions in the environment
• Take breaks
• Repeat information spaced out over time
• Make connections
• Create visual images
• Put it in a location
• Use the first letter
• Use chunking
• Cluster information by topic
• Invent rhymes
• Get emotional
• Test yourself
• Write it down
• Learn the name well
• On the tip of your tongue? Relax
• Don’t block the name
• Review names prior to a social event

Memory Aids

• Golden rules for memory aids: don’t delay, keep it simple, make it routine
• Get organized
• Designate a memory table
• Use a pillbox
• Rely on calendars or daily planners
• Take advantage of technology
• Keep a notebook
• Make lists
• Use reminder notes
• Develop routines

Exercise, exercise, exercise

Lastly, the evidence is so strong that aerobic exercise can improve memory that no discussion of memory enhancement therapies would be complete without strongly stating that we recommend aerobic exercise at least 30 minutes daily, five days each week for those with memory loss due to normal aging or mild cognitive impairment (see Budson & O’Connor, 2017, for details). Unfortunately, the data does not suggest cognitive benefit with exercise for those with dementia.

Things that don’t work

What about Prevagen or Gingko Biloba? Unfortunately, there’s no convincing evidence that these over the counter medications are beneficial for either healthy individuals or those with memory disorders.

© Andrew E. Budson, M.D., 2019. All rights reserved.