Galantamine’s Usefulness May Begin Early

ild is nice, usually. Mild weather, a mild-mannered person, a mild mustard—all nice. Even our ailments aren’t so bad when they can be described as mild: a mild cold, e.g., or a mild case of the blues. With time and a little TLC, they usually go away, and we’re as good as new. We don’t worry about things that are mild. There are so many severe things to worry about, like terrorists and termites and taxes and . . . uh . . . there was one more thing I wanted to add here, but I can’t remember what it was. I must be having a mild memory lapse.

Uh-oh. What if . . . nah, I’m too young for that kind of thing. Couldn’t happen to me. Besides, even if it were happening, I’d surely know about it early on, isn’t it?

Um, sorry, those words didn’t come out quite right. But with time and a little TLC, they usually go away, and . . . oh, wait, I said that already—about something else, I think.

Enough already! It’s not as though I’m cognitively impaired or anything, I’m just having a mild episode of . . . something.

MCI Is a Major Risk Factor for Dementia

OK, that was silly and a bit exaggerated, but here’s the point: mild cognitive impairment (MCI) is something that can sneak up on anyone, even middle-aged people who are seemingly in good health. (See the sidebar, “What Is MCI, Exactly?”) Worse yet, it can slip quietly into your brain and take up residence without your even knowing it. And it usually doesn’t go away—it just goes from mild to worse, if you don’t fight back. In the worst-case scenario, it can eventually lead to dementia—most likely Alzheimer’s disease or vascular dementia—and that’s no laughing matter.

That MCI is a major risk factor for both Alzheimer’s disease and vascular dementia is beyond question, but it is not clear whether it will inevitably lead to either of these diseases. (See the sidebar, “Does MCI Beget Dementia?”) In any case, mild cognitive impairment can be thought of as a transitional phase between normal aging and early (mild) dementia.* Whereas normal aging takes the mental clarity of youth and merely fogs it up somewhat, MCI will probably, eventually, drag it down into the black hole of dementia. Researchers believe that if MCI could be nipped in the bud, millions of people might be spared the irreversible loss of memory and other cognitive functions that come with Alzheimer’s disease and vascular dementia.

*Scientists who are concerned with the cognitive decline associated with normal aging lament the fact that they can’t define the parameters clearly. They continue, however, to refine their methods of qualitative and quantitative analysis of this amorphous condition. Meanwhile, as with many other phenomena that do not lend themselves readily to clear definition, clinical experience has taught the experts to “know it when they see it.”

MCI Can Steal Your Mental Faculties

Nipping MCI in the bud implies, for starters, that you know, or at least suspect, that it’s there—and therein lies a major problem. The word insidious may have been invented to describe MCI, a thief so subtle and sly that it often steals away the very faculties that would enable you to recognize it in the first place.

Not that you—all of us—don’t become aware from time to time, as we grow older, of a certain tendency to forgetfulness and perhaps a little dulling of the gleaming razor that once shaved the fuzz off our thoughts. That’s normal, and nothing to worry about—as long as our thoughts don’t become so fuzzy that they start resembling those of Winnie-the-Pooh, whose brain, as we know, was made of fluff. As endearing as Pooh was, he was, well, not the brightest creature in the Hundred Acre Wood.

But how do you know if you’re getting sort of fuzzy in the brain? How do you know if those episodes of forgetfulness are not a benign accompaniment to growing older, but rather symptoms of something more sinister? How do you know, in short, if you’re becoming the victim of mild cognitive impairment?

Early Detection of MCI Is Invaluable

The answer is, you may not know, unless it becomes so obvious that someone near and dear to you screws up the courage to tell you (in which case you may not believe it anyway) or you get yourself tested by experts in this field. As with most disorders, early detection is invaluable. Using certain tests—primarily involving measures of short-term recall (a weakness in which is the leading indicator of MCI)—they can tell the difference, more or less, between MCI and the normal effects of getting older. It’s “more or less” because this is far from an exact science, and the criteria for deciding among alternative diagnoses are themselves rather fuzzy.¹

The experts do the best they can, however. Their goal is threefold: (1) finding ways of diagnosing MCI more accurately; (2) finding ways of slowing or halting its progress; and (3) most importantly, figuring out how to prevent it to begin with. In our rapidly aging society, the problem of MCI and dementia is so great that combating them has become a major public health issue and a high priority for scientists at universities, drug companies, and government research laboratories. At least 4 million Americans already have Alzheimer’s, and experts estimate that another 8 million have MCI, mostly undiagnosed. Those numbers are expected to increase dramatically in the coming years unless we can find effective interventions.

Galantamine for Dementia: Proven Long-Term Benefits

An intervention that appears particularly promising is galantamine, a compound extracted from various flowers, such as the snowdrop, daffodil, and spider lily. Galantamine has a long history of use in Europe as a natural herbal remedy for a variety of ailments. During the past decade, modern science has discovered overwhelming evidence of its efficacy and safety in the treatment of mild to moderate cases of Alzheimer’s disease, and it is also effective against the other major form of dementia, vascular dementia.^2,3,4*

*Life Enhancement has published 17 prior articles on galantamine, starting in October 2000. Comprehensive reviews of the results described in the first 15 of them can be found in the last two: Remember Galantamine? (How Could You Forget?) and Galantamine Combats Alzheimer’s and Vascular Dementia, which can be found in the September 2002 and November 2002 issues, respectively.

Because of its unique dual mode of action, galantamine appears to be superior to the most widely prescribed anti-Alzheimer’s drugs, donepezil and rivastigmine.* It has been found that galantamine (usually at dosages of 24 or 32 mg/day) provides substantially longer-term benefits than donepezil and rivastigmine and that, unlike those drugs, it can not only slow the progression of Alzheimer’s but halt it altogether (not always, but sometimes), and it can sometimes even bring about modest improvements in the patients’ condition.^5,6 It is not, however, a cure for Alzheimer’s—there is no cure.

*Galantamine itself became an FDA-approved “drug” in 2001, although the agency did not have the right to take that action: galantamine was grandfathered under the Dietary Supplement Health and Education Act of 1994, having been sold as a dietary supplement before October 15, 1994. It is still legally sold as such.

Research Is Underway on Galantamine for MCI

It’s tempting to think that an agent that can alleviate the symptoms of dementia could do just as well, if not better, against the less severe symptoms associated with mild cognitive impairment, thus perhaps halting or reversing that condition and preventing it from progressing to the stage of full-blown dementia. Indeed, it seems highly likely that galantamine could do that, because it is, beyond any doubt, effective in combating mild to moderate cases of Alzheimer’s disease and vascular dementia. There is no substitute for actual clinical evidence, however, and a major international study to investigate the MCI question is currently underway. The results will be reported in this magazine as soon as they are published.

Galantamine Could Be the Best Thing Yet

It’s still not clear whether MCI is really just early-stage dementia or a distinct disorder that often develops into dementia for whatever reason. From a scientific point of view, it’s important to find out, but from a practical point of view, does it matter? Not any more than understanding gravitational theory matters if you want to avoid falling off a cliff. All that matters is doing whatever you can to prevent MCI, or combat it if you already have it. The earlier it’s detected, the better your chances of dealing with it effectively.

Will leading an exemplary life—good diet, plenty of exercise, no smoking, etc.—guarantee immunity from MCI? Sadly no, although it will almost certainly improve the odds. So lead an exemplary life! (Giving advice is so easy—I should do it more often.) Happily, a further improvement of the odds may be achievable with nature’s own galantamine, which could turn out to be the best weapon in the fight against mild cognitive impairment.

References

1. Ritchie K, Touchon J. Mild cognitive impairment: conceptual basis and current nosological status. Lancet 2000;355:225-8.
2. Olin J, Schneider L. Galantamine for Alzheimer’s disease (Cochrane review). In The Cochrane Library, Issue 2, 2001. Oxford: Update Software.
3. Lilienfeld S, Kurz A. Broad therapeutic benefits in patients with probable vascular dementia or Alzheimer’s disease with cerebrovascular disease treated with galantamine. Ann NY Acad Sci 2002;977:487-92.
4. Meyer JS, Xu G, Thornby J, Chowdhury MH, Quach M. Is mild cognitive impairment prodromal for vascular dementia like Alzheimer’s disease? Stroke 2002;33:1981-5.
5. Tariot PN. Maintaining cognitive function in Alzheimer disease: how effective are current treatments? Alzheimer Dis Assoc Disord 2001;15 Suppl 1:S26-33.
6. Erkinjuntti T, Kurz A, Gauthier S, Bullock R, Lilienfeld S, Damaraju CV. Efficacy of galantamine in probable vascular dementia and Alzheimer’s disease combined with cerebrovascular disease: a randomised trial. Lancet 2002 Apr 13;359:1283-90.