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Memory White Paper - 2011

by Peter V. Rabins, M.D., M.P.H.

About the Author | Letter from the Author | Table of Contents | ExcerptMemory White Paper

To order this White Paper. Excerpt below


Peter V. Rabins, M.D., M.P.H., received his medical degree from Tulane University School of Medicine and his degree in public health (M.P.H.) from the Tulane University School of Public Health. He completed his residency in psychiatry at the University of Oregon. Currently, he is codirector of the Division of Geriatric Psychiatry and Neuropsychiatry at the Johns Hopkins University School of Medicine, as well as a professor of psychiatry with a joint appointment in the Department of Internal Medicine and the Bloomberg School of Public Health. Dr. Rabins is serving as the principal investigator on a National Institute of Mental Health study of Alzheimer’s disease in the community and a National Institute of Neurological Disorders and Stroke study of late-stage care for Alzheimer’s disease patients.

Dr. Rabins has spent his career studying psychiatric disorders in the elderly. His current research includes the development of scales to measure impairment in people with severe dementia and the study of visual hallucinations in a variety of psychiatric and neurological conditions. He has published extensively in such journals as the American Journal of Psychiatry, the Journal of the American Geriatrics Society, and the Journal of Mental Health.


Dear Reader:

Welcome to the 2011 Memory White Paper—your personal guide to the prevention, diagnosis, and management of memory problems, ranging from age-associated memory issues to mild cognitive impairment and Alzheimer’s disease. You will also find helpful advice on caring for someone with memory problems.

This year’s highlights include:

  • What weight gain can do to your brain.
  • Nutritional supplements to prevent dementia: Are any worth a try?
  • Why having a spouse with dementia may put you at risk too.
  • Not-so-trivial pursuits to keep cognitive decline at bay.
  • The dangers of antipsychotic medications for people with dementia.
  • Intriguing and unexpected findings about beta-amyloid.
  • The latest developments in genetics and Alzheimer’s.
  • Advance directives and other legal documents to fill out now.
  • New Alzheimer’s therapies on the horizon.
  • How to care from afar for your loved one with dementia.

If you have any memory or Alzheimer’s-related queries you would like answered in the White Papers or comments about the White Papers in general, please send an e-mail to the editors at

Wishing you the best of health in 2011,

Peter V. Rabins, M.D., M.P.H.


The Biology of Memory 
Age-Associated Memory Impairment 
Preventing Dementia
Mild Cognitive Impairment
Reversible Memory Loss
Irreversible Dementias
Alzheimer’s Disease
Coping With Caregiving

Chart: Medications for Treating Alzheimer’s Disease 2011

Abbreviations and Acronyms
Health Information Organizations and Support Groups
Leading Hospitals for Neurology and Neurosurgery

Excerpt from pages12 - 13

Can Supplement Prevent Dementia?

A possibility remains for some, but, for the most part, no

Americans spend over $25 billion each year on dietary supplements that promise everything from slender waistlines to better sex lives. A large and growing portion of this market is devoted to products that claim to improve memory or prevent the onset of dementia and Alzheimer’s disease.

But as researchers investigate these substances to see if there is merit to the claims, they are, by and large, coming up empty-handed. Ginkgo biloba, perhaps the most well known of the “memory enhancers,” has been declared ineffective by medical experts based on recent, high-profile studies. And the most encouraging news on other supplements is that more research is needed before they can be recommended and deemed beneficial.

That means there isn’t enough reason to try any of these products at this point to ward off cognitive decline. Following are the most current findings on the spectrum of purported memory supplements.


This supplement is derived from the Curcuma longa plant, a member of the ginger family. Turmeric, the primary spice in curry, is made from the root of this plant.

Laboratory research shows that curcumin has antioxidant and anti-inflammatory properties; antioxidants protect against the damaging effects of free radicals, which are associated with age-related disorders like heart disease and dementia. Curcumin also might help to reduce the accumulation in the brain of beta-amyloid, the distinguishing plaques of Alzheimer’s.

Several ongoing studies in humans are currently examining the effects of curcumin on Alzheimer’s disease, dementia, and other conditions, but no data are yet available.

Fish Oil

Fish oil contains omega-3 fatty acids like docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are also found in fatty fish like sardines, lake trout, albacore tuna, flounder, and salmon.

Observational studies suggest a link between diets high in omega-3 fatty acids and a reduced risk of cognitive decline and Alzheimer’s disease, possibly owing to the anti-inflammatory and antiamyloid effects of fish oil. However, a 2008 randomized, controlled trial found that after 26 weeks of  supplementation, regular use of DHA and EPA had no effect on cognitive skills compared with a placebo. Additional long-term, well-designed studies are still needed, since the existing studies don’t help assess prevention.

Ginkgo Biloba

This herbal supplement, extracted from the dried leaves of the ginkgo tree, has antioxidant and antiamyloid properties. It has been used around the world for centuries to treat a number of conditions.

A 1997 study found improved cognitive functioning in people with Alzheimer’s who took ginkgo, but the effect was modest (people who took ginkgo could answer one more question correctly than those who hadn’t) and more recent evidence does not back up that early finding. In 2008, a large randomized, controlled trial found that ginkgo had no preventive effect against dementia or Alzheimer’s in more than 3,000 people over age 75 with no memory loss or with mild cognitive impairment; a 2009 follow-up study confirmed those results.

Huperzine A

Derived from the plant known as Chinese club moss, Huperzine A (or Hup A) is theorized to be a natural cholinesterase inhibitor, the most effective main class of drug used to treat Alzheimer’s by slowing the breakdown of the chemicalacetylcholine, which helps form new memories. Hup A may also have antioxidant properties.

The few clinical trials of Hup A as a treatment for dementia have been small studies conducted in China. These results show some promise, and larger studies of Hup A have started in the United States. The results have not yet been published.

Resveratrol and Grape Seed Extract

Resveratrol is a type of polyphenol, a plant-based compound with antioxidant properties.Found in grape seeds, grape skins, red grape juice, and red wine, it’s being researched because many studies suggest that moderate intake of red wine has a possible role in longevity, heart disease, and cancer prevention and treatment.

Some evidence suggests that resveratrol might decrease levels of beta-amyloid in cells, but this is based mostly on preliminary studies in animals. Clinical trials in humans have yet to be conducted. Vitamin B6, Vitamin B12, and Folic Acid These three B vitamins play an important role in lowering blood levels of the amino acid homocysteine. Elevated levels of homocysteine are associated with several disorders  including strokes, heart attacks, cognitive decline, and Alzheimer’s disease.

A 2007 study found that total folic acid intake from supplements and diet—but not from vitamin B6 or B12—might reduce the risk of developing Alzheimer’s. More recent studies found that supplements containing these nutrients had no effect on cognitive functioning, dementia, or Alzheimer’s, though long-term use of folic acid supplements might help the cognitive functioning of older people with high levels of homocysteine.

Vitamins C and E

Vitamins C and E are antioxidants, and a handful of earlier, observational studies found that these vitamins might protect against cognitive decline, vascular dementia, and Alzheimer’s  disease.

However, the results of several later investigations have been less promising. One study found that vitamin E supplements showed no benefit to patients with mild cognitive impairment, and another determined that vitamins C and E did not reduce the risk of dementia among men taking the supplements for short or long periods of time.

The Bottom Line

Besides the supplements listed above, many more are marketed for their alleged ability to boost memory or cognitive functioning, including phosphatidylserine (PS), choline, bacopa, vinpocetine, piracetam, lemon balm, and coenzyme Q10 (CoQ10).

However, the reality is that these supplements have not been studied extensively, or they have shown little potential. Part of the problem is that the U.S. Food and Drug Administration (FDA) doesn’t require supplements to be tested to the same degree as prescription drugs.

Remember that there is no “silver bullet” that will undo bad habits, so continue to follow the fundamentals of good health: Exercise, do not smoke, and eat a well-balanced, nutritious diet. If you have high blood pressure, elevated cholesterol levels, or diabetes, make sure you get them adequately treated.

And if you do decide to take any kind of supplement, always remember to use caution and inform your doctor. Supplements can worsen certain health problems and interact with prescription and over-the-counter drugs to cause severe side effects or render your medication less effective.

The Memory and Alzheimer's Treatment Center at Johns Hopkins


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