Galantamine May Help Block the Road to Alzheimer's

Remember, Galantamine Is Your Memory’s Friend

Galantamine May Help
Block the Road to Alzheimer's

Against a stealthy and treacherous foe, early nutritional intervention is wise
By Will Block

It’s a poor sort of memory that only works backwards.
— Lewis Carroll

eave it to Lewis Carroll (who was a logician, by the way) to put such an amusing twist on the subject of memory. Granted, “remembering” the future is a tricky business (even in the Terminator movies), but we want our backwards memory, at least, to work well and reliably, no matter how old we become. Whether it’s for the business of remembering when the next insurance premium is due or the pleasure of recalling all the good times with our loved ones, forgetting is not an acceptable option.

Regardless of the extent of our native gifts in the memory department, all of us want to stay sharp for as long as we live. As much as we may try to hang on to our mental edge, however, some slippage does seem to be an inevitable part of growing older, and we learn to accept it as nature’s way. “Normal aging,” we call it—a catchall term that encompasses any health-related problem we think we can’t do anything about as time marches on.

Normal aging is an insidious concept, though, because it leads to acceptance of things that we may not have to accept—at least not to the degree that is “normal.” There is scientific evidence to support the idea that staying mentally active through daily reading, playing games, solving puzzles, etc. (but not watching TV—sorry!) helps keep the ol’ brain in good shape. Our gray matter is better able to remember the past, cope with the present, and minimize its chances of fading from gray to black in the future. “Use it or lose it” applies to our brains as well as our muscles.

Galantamine Protects Against Alzheimer’s Disease

The basic prescription for good health, including such vital aspects of good mental health as memory and other cognitive functions, is: (1) regular physical exercise (which profits the brain by promoting good circulation and a host of favorable biochemical effects), and (2) good nutrition, including supplements that can provide special benefits that may be lacking in even a healthy diet. One such supplement, a chemical compound extracted from certain flowers, is galantamine, which has a unique, dual mode of action in protecting and preserving cognitive functions in patients with mild to moderate Alzheimer’s disease. Galantamine also, most likely, has these effects in people who may be on the road to Alzheimer’s. The name of that road is mild cognitive impairment.

Memories Good and Great

It’s probably no coincidence that great accomplishment in some human enterprise often goes hand-in-hand with a great memory. The more you know—and can easily recall—the better able you are to do great things. That some people are blessed with better memories than others is obvious, and in a lucky few, their ability is extreme. We envy those who effortlessly remember, e.g., a lengthy poem they memorized in their youth and may not have thought of for many years, or who can recall the name and face of everyone they ever met.

Such people are rare, of course, and exceedingly rare are those with a “photographic” memory. After just one reading of something—almost anything—that they wish to remember well, they know it thoroughly (often verbatim) and permanently. Sometimes this ability is accompanied by great musical talent or ambidexterity. A combined case of these gifts was a Jesuit priest, Russell Woollen, who was an outstanding pianist. He could easily sight-read the most complex score and know it note-for-note thereafter, with no need ever to see it again. He could also write with either hand, forward or backward, right side up or upside down—all with equal facility.

No one understands how such amazing feats are accomplished, but the fact that the human brain has evolved in such a way as to allow them to occur in some individuals is wondrous and inspiring to the rest of us.

**WARNING** MCI!

Mild cognitive impairment (MCI) can be defined as the clinical state of individuals who are significantly memory-impaired but are otherwise functioning well and do not meet the clinical criteria for dementia. It does not mean the relatively inconsequential memory impairment of normal aging, but rather a substantial degree of impairment that goes beyond that—without, however, qualifying as outright dementia, such as Alzheimer’s disease or vascular dementia. In that sense, MCI can be regarded as a transitional phase between good health and the early, or mild, stage of dementia. In MCI, it’s typically your short-term memory that is affected, making it difficult, e.g., to recall what happened yesterday even if you well remember events of long ago, and even if your thinking and reasoning skills are intact.


Galantamine can sometimes
bring about modest improvements
in the patients’ condition.


MCI does not necessarily lead to dementia, but it usually does, so it would be foolish for anyone with MCI to count on good luck in the hope of avoiding that terrible, tragic condition.* It is fortunate, in a sense, that nature has provided MCI as an early warning system for dementia, but the trick lies in actually detecting the warning, which is often so subtle that it goes unnoticed until it’s too late. At least 4 million Americans already have Alzheimer’s, and experts estimate that another 8 million have MCI, mostly undiagnosed. With the aging of the population, those numbers are expected to increase dramatically in the coming years unless effective interventions can be found.


*For more details on the risk, see “Galantamine May Help with Mild Cognitive Impairment” (sidebar entitled “Does MCI Beget Dementia?”) in the February 2003 issue of Life Enhancement.


Diagnosing MCI Is Tricky

Not surprisingly, it is difficult, and somewhat arbitrary in any case, to differentiate between normal aging and MCI, or between MCI and mild dementia. The transition is gradual, and so subtle that the patient may be the last to know. It’s more likely that a family member or close friend will notice the changes taking place, and it’s for that reason that doctors tend to rely on these individuals’ more objective testimony of the patient’s condition in making a diagnosis. The diagnosis will depend not only on such personal insights, of course, but also on a variety of objective tests designed to assess different aspects of cognitive function, such as memory, attention, learning, language, reasoning ability, and the ability to visualize spatial relationships.


Computer-graphic image of the human brain, in which the hippocampus is highlighted in pink and aqua (representing two anatomically distinct regions of this vital structure).
A neurologist might also want to use brain-imaging techniques—computed tomography (CT) or magnetic resonance imaging (MRI)—to detect any abnormalities in the brain that could account for the cognitive impairment. The most characteristic such abnormality that is often detectable, even before clinical dementia has set in, is a shrinkage of the hippocampus, a region of the brain (actually, there are two such regions, one in each hemisphere) that is intimately involved in the processing, storing, and recall of newly acquired information, and with linking new memories to older ones. A certain amount of hippocampal shrinkage, and thus memory impairment, is characteristic of aging (there’s that “normal aging” again), but in patients with MCI, the rate of shrinkage is significantly greater, and in those with Alzheimer’s disease, it’s greater still.

Good Nutrition Includes Supplements

From a diagnostic point of view, the bad news is that the definition of MCI is still a work in progress, complicated by the fact that there are other, similar conditions that differ subtly but significantly from “true” MCI.1 The good news is that progress is being made in refining universally acceptable standards by which to assess and diagnose the patient’s condition more or less objectively. Inevitably, though, there is still a good deal of subjective judgment involved. The more experienced the doctor is, of course, the better his or her judgment is likely to be. In any case, the crucial question is: What should be done about the patient’s condition once the doctor has decided what that condition is?

Assuming that the condition is not serious enough to warrant drug intervention, we are back to those twin pillars of good health (and of preventing impaired health from getting worse): exercise and nutrition. It’s encouraging to note that more and more doctors are coming around to the realization that “nutrition” does not mean food alone, but also supplements (which aren’t called nutritional supplements for nothing). And when it comes to Alzheimer’s disease, one such supplement towers above the rest: galantamine.*


*Galantamine actually became an FDA-approved “drug” (called Reminyl®) for Alzheimer’s disease in 2001, although the agency’s action in that regard was unjustified: galantamine was grandfathered under the Dietary Supplement Health and Education Act of 1994, having been sold as a nutritional supplement before October 15, 1994. Fortunately for the public, it is still legally sold as such.


Galantamine Works in Two Ways

Abundant scientific research has shown that, in patients with mild to moderate (and even “advanced moderate”) Alzheimer’s disease, galantamine provides noticeable improvements not just in memory function but also in global ratings of overall function, as well as in cognitive tests, assessments of the activities of daily living, and behavior.2,3† These benefits accrue not just to the patients, but also, indirectly, to their caregivers, whose great burden is thus often made lighter—a real blessing.


†See “Galantamine Works Even Better than Was Thought” in Life Enhancement, April 2003.


The therapeutic benefits of galantamine are attributed to its unusual dual mode of action:

  1. It is an efficient acetylcholinesterase inhibitor, which boosts the brain’s levels of the vital neurotransmitter acetylcholine.
  2. It is an efficient modulator of nicotinic receptors in the brain, which helps to protect them from degradation and loss and to make them more receptive to acetylcholine molecules, thus facilitating neurotransmission.

Scientists believe that the second of these functions (which is not shared by either of the most widely prescribed anti-Alzheimer’s drugs, donepezil and rivastigmine) is largely responsible for galantamine’s exceptional effectiveness against Alzheimer’s.4 It has been found that galantamine, usually at dosages of 24 or 32 mg/day, provides substantially longer-term benefits than donepezil or rivastigmine. Furthermore, although galantamine is not a cure for Alzheimer’s (there is no cure), it can not only slow the progression of the disease but halt it altogether (not always, but sometimes), and it can sometimes even bring about modest improvements in the patients’ condition.5,6

Galantamine Combats the Thieves of Memory

Whether or not galantamine is as effective against MCI as it is against Alzheimer’s disease is not yet known, but it seems likely that this will prove to be the case, based on what is already known about the brains of MCI patients. Some neuropathological features of Alzheimer’s disease—notably hippocampal shrinkage and the presence of brain abnormalities called plaques and tangles—have been observed in MCI patients, and it has been postulated that such features may even occur in people in whom no symptoms of cognitive impairment have yet appeared.7

To think that a health problem as serious as Alzheimer’s disease could be brewing within us without giving any outward signs is unsettling, to say the least. In this regard, it is much like hypertension—except that hypertension is easy to detect with a simple blood pressure measurement.

Since Alzheimer’s and its precursor, mild cognitive impairment, can be so stealthy and treacherous, it behooves us to use any reasonable means to prevent them from stealing into our minds and stealing away our memories. It could be that galantamine is one of the best ways to do that, allowing us to retain our treasured “poor sort of memory that only works backwards.”

Score One Each for Art and Technology

"If music be the food of love, play on," said Shakespeare, in one of his loveliest thoughts. Somewhat less poetically, psychologists in modern England have recently said that if the arts be a means of communication for patients impaired by dementia, they should pursue them. In studies with patients who had difficulty in communicating through speech, the researchers found “an amazing ability to express themselves through photography, collage, and sculpture.”1

Although the patients’ cognitive abilities were not improved by these pursuits, they were able to convey what they were feeling in ways they had never done before. The same statement could be made about anyone taking up a new artistic pursuit, of course, but the point here is that healthy people have many ways of expressing themselves, whereas those with dementia do not. Thus, encouraging them to follow their muse, so to speak, could be a boon both for them and for their caregivers.

On the other side of the coin, researchers in England and Scotland have turned to technology and developed a personal digital assistant (PDA), which is a small, handheld computer, for patients with significant memory impairment.1 The device is designed to help them remember dates, appointments, medication schedules, etc., and it is said to be easy to program for such purposes. It could even serve as a daily reminder to do something artistic.

  1. Reaney P. Arts, technology may help dementia patients. Reuters Health Report, June 24, 2003.

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. Blesa R, Davidson M, Kurz A, Reichman W, van Baelen B, Schwalen S. Galantamine provides sustained benefits in patients with “advanced moderate” Alzheimer’s disease for at least 12 months. Dement Geriatr Cogn Disord 2003;15:79-87.
  4. Samochocki M, Höffle A, Fehrenbacher A, et al. Galantamine is an allosterically potentiating ligand of neuronal nicotinic but not of muscarinic acetylcholine receptors. J Pharmacol Exp Ther 2003;305: 1024-36.
  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.
  7. Burns A, Zaudig M. Mild cognitive impairment in older people. Lancet 2002 Dec 14;360:1963-5.

Dual-Action Galantamine

Galantamine provides a heralded dual-mode action for boosting cholinergic function: it inhibits the enzyme acetylcholinesterase, thereby boosting brain levels of acetylcholine, and it modulates the brain's nicotinic receptors so as to maintain their function. The recommended daily serving ranges from a low of 4 to 8 mg of galantamine to begin with to a maximum of 24 mg, depending on the individual's response.

For an added measure of benefit, it is a good idea to take choline, the precursor molecule to acetylcholine, as well as pantothenic acid (vitamin B5), an important cofactor for choline. Thus it is possible to cover all bases in providing the means to enhance the levels and effectiveness of your acetylcholine.


Will Block is the publisher and editorial director of Life Enhancement magazine.

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