Medications -The Memory Guru of India

That May Lead to Memory Impairment



There are medications on the market to treat specific medical conditions that have a detrimental effect on your memory. If you  believe  a  medication  that  has  been  prescribed  to  you  is impairing your memory, discuss this medication with your doctor. It is possible that the medication or dosage can be altered.

Below is a sample of medications that may be negatively impact-

ing  your  memory.

    The  Truth  about  Herbs, Supplements,  and Alternative  Treatments 


            one  of  the  biggest  misconceptions  regarding  the  use 

           of herbal products and supplements is that they are much

            safer than medications prescribed by a doctor. This wide-


spread belief about the safety of these products is based on the fact

that many people choose to take advice from their friends rather

than make an appointment with a qualified doctor.

       How many times have you found yourself at the supermar-

ket, your kid’s baseball game, or even at a family gathering trying

   You must be careful about where you  receive your information. 


to deal with your Cousin Joe’s advice on the herbal product he

thinks is best for your painful ingrown toenail? Of course, this is

an exaggeration; however, we would bet that you can recall at

least   one   instance    in   which    you    sought    advice    from    an

ill-equipped    individual     about   an   aspect    of  your   health    or

well-being. This is not to say that there are no safe and effective

herbal medications on the market for your health concerns. It is

to say that you must be careful about where you receive your


       In this chapter, you will learn about some of the herbal, sup-

plemental,  and  alternative  treatments  that  supposedly  help  to

improve memory. You will also learn about some herbs you should

avoid  rather  than  incorporating  them  into  your  “memory  regi-

men.” However, before discussing any herbs or supplements, there

are some things you should understand to get the full benefit of this

chapter, and the following one on prescribed medications.

       First, the material in both chapters 6 and 7 is based on clini-

cal studies that were all conducted in the past few decades. Since

all of the information we have regarding the efficacy and safety of

herbal treatments and supplements is derived from clinical trials,

let’s  be  sure  you  understand  exactly  what  clinical  trials  are.

       Merriam-Webster’s       Collegiate    Dictionary    (11th    edition)

defines a clinical trial as “a scientifically controlled study of the

safety and effectiveness of a therapeutic agent (as a drug or vac-

cine) using consenting human subjects.” Clinical trials are the

gold    standard      on    which     health     professionals     rely   for  

evidence-based  practices  regarding  the  safety  and  efficacy  of

medications  or  products.  However,  because  these  studies  are

conducted in controlled settings, the “real-world” use of these

products may vary between individual patients. That’s why it is

essential that you follow the instructions of your doctor, pharma-

cist,  or  the  package  label  when  taking  such  products.

       Another concern you should have when considering using

herbal and nutritional supplements is that they are poorly moni-

tored when compared to the meticulous regulatory process that

prescribed medications must undergo. Although it is likely that

stricter regulations on nonprescription products eventually will

be put in place, you must understand that there is currently a vast

difference between herbal and prescribed medications when it

comes  to  the  laws  of  our  federal  government.

       Therefore, we are presented with a number of distinct prob-

lems when considering the quality of nonprescription products.

First of all, the packaging on these products doesn’t always reflect

the entire set of ingredients that have been compounded in the

product.    Also,   the  manufacturers      of  these   products    are   not

required to provide evidence regarding the safety or efficacy of

the product. For that reason, common drug interactions and side

effects are seldom known, which can lead to a number of poten-

tial  cascading  events  that  might  affect  other  aspects  of  your

health. Furthermore, the manufacturing centers of these prod-

ucts are neither inspected nor monitored by the Food and Drug

Administration  (FDA).

       Having said all that, we also want to say that there are many

herbal products and supplements that have been independently

studied and found to be efficacious for treating many types of con-

ditions. Many vitamins, hormones, herbs, nutritional supplements,

and alternative medications claim to improve your memory. We

will  now    take  an   in-depth    look   at  some    of  these   products.                                                               


Hopefully, you will gain some clarity as to which products to con-

sider as possible additions to your “memory regimen” and which

products to consider as part of your “ancient memory.” 




Ginkgo biloba, one of a class of nutritional supplements referred

to as phytomedicinal  (meaning medicines derived from plants), is

one of the most widely sought supplements on the market today.

The leaves and seeds of this tree provide the extract Egb, which

has been shown to provide benefit to vital organs such as your

heart, lungs, and brain. The concentration of this compound is at

its highest in autumn when the ginkgo’s leaves begin to change

color. Note that formulations of ginkgo biloba contain only about

2 percent of the Egb extract in the final product.

       In the last decade or so, there have been a number of studies

about ginkgo’s role in improving health. One research study con-

ducted by the Bronfman Science Center in Massachusetts and

published in the New England Journal of Medicine studied 98

men  and  132  women,  splitting  them  into  two  groups  of  115

(Solomon  et  al.  2002).  One  group  received  40  milligrams  of

ginkgo biloba three times a day for six weeks, while the other

group received a placebo for the same time period. Two hundred

and three of these subjects completed the six-week regimen. The

results of the study indicated that ginkgo biloba did not enhance

the “cognitive function of learning, memory, attention, and con-

centration or naming and verbal fluency in elderly adults without

cognitive  impairment”  (Solomon  et  al.  2002,  835).

       Another  study,  conducted  by  the  New  York  University

Medical Center and the Memory Centers of America, concluded 

that  patients  with  very  mild  to  moderate  forms  of  dementia

showed     improvement       with   ginkgo,   while   severely    demented

patients demonstrated only a slowing down in the progression of

their  disease  (Le  Bars  et  al.  2002).

       There  have  not  been  a  clinically  significant  number  of

reported  drug  interactions  for  those  using  ginkgo;  however,  it

should  be  used  with  caution  due  to  its  antiplatelet  effects  in

patients who are taking anticoagulation medications. Although

there are no requirements to report side effects for herbal medi-

cations,   there   have    been   some    commonly       reported    adverse

effects, including mild gastrointestinal upset, gas, nausea/vomit-

ing,  headaches,  and  diarrhea. 

Bottom line: Ginkgo may slow down brain damage from progres-

sive dementias. Research also shows that it may provide some

mild improvements in cognitive functioning for those suffering

from Alzheimer’s disease and other progressive dementias. It may

also help correct some lapses and changes in cognition caused by

normal aging. Ginkgo will not boost memory or enhance cogni-

tive functioning and it is certainly not a miracle IQ enhancer. It is

a proven antioxidant that will help to prevent rather than cure

memory impairment.






As if enduring monthly menstruation, pregnancy, childbirth, risk

of breast cancer, and menopause wasn’t enough, some research

indicates  that  postmenopausal  women  have  a  greater  risk  of

developing  Alzheimer’s  disease  than  elderly  men  do.  This  has






created an increasing controversy as to whether women are at a

greater risk of developing dementia.

       Doctor  Gayatri  Devi,  from  the  New  York  Memory  and

Healthy Aging Services, has created a Web site on women and

Alzheimer’s disease. She finds that among estrogen’s effects on

women’s mood, attention, and language skills are also effects on

postmenopausal patients’ memories. She says there are estrogen

“docking sites” present throughout the brain and that when they

are activated, they stimulate memory. Moreover, she says that

estrogen increases the presence of some neurotransmitters in the

brain,  such  as  acetylcholine,  which  has  been  associated  with

stimulating  memory  and  muscle  functioning.  Because  of  the

decline  in  estrogen  after  women  go  through  menopause,  their

chances  of  developing  Alzheimer’s  disease  do  indeed  increase

(Devi  2004).

       This leads us into the increasingly complex area of replac-

ing the estrogen that is lost. You might think it would be a simple

fix just to give estrogen tablets to postmenopausal women and

thus prevent memory loss; however, it’s not that easy. Several

clinical   trials  conducted      in  recent    years   indicate    estrogen

replacement in postmenopausal patients is actually contraindi-

cated. The Women’s Health Initiative Memory Study (Espeland

et  al.  2004)  found  that  women  receiving  conjugated  equine

estrogen demonstrated an increased risk for dementia. The study

also  showed  that  hormone  replacement  therapy  was  not  only

ineffective for dementia but that it actually caused detrimental

effects  to  patients’  health.

       On the other hand, a study conducted at the University of

Southern  California  (Brinton  2004)  concluded  that  estrogen

therapy enhances “neurological health” and prevents or allevi-

ates Alzheimer’s disease. So how are we supposed to know which

study is accurate? Well, that’s the same question the researchers



 at the University of Southern California asked themselves after

seeing the results from the Women’s Health Initiative Memory

Study. They performed a follow-up study, which indicated that

both of the studies were accurate. This time, the researchers at

the   University    of  Southern     California    said   that  if  estrogen

replacement      therapy     were    begun     in   the   early   stages    of

postmenopause when the neurons are still healthy, it did indeed

decrease  the  risk  for  developing  Alzheimer’s  disease.  Also,  its

efficacy depends on the type of progestin in the hormone replace-

ment  combination. 


Bottom line: Estrogen is one of the most intensely studied hor-

mones  affecting  memory  impairment.  Well-controlled  studies

have demonstrated mixed results. There seems to be some agree-

ment that the earlier it is used the better. It has been shown to

delay the onset of Alzheimer’s disease, but not to improve mem-

ory. When combined with progesterone, side effects can be seri-

ous,  including  an  increased risk for breast  cancer. 




Vitamin E is one of the fat-soluble vitamins essential for life. It

can be found in some types of vegetables and in grains, fruits,

meats, eggs, fish, and oils. This indispensable vitamin has demon-

strated clinically significant antioxidant properties. Antioxidants

have the ability to destroy neurotoxic free radicals created during

normal metabolic processes. Free radicals are atoms or groups of

atoms with an odd (unpaired) number of electrons and can be

formed  when  oxygen  interacts  with  certain  molecules.  Once

formed these highly reactive radicals can start a chain reaction,                                                                      


like dominoes. The chief danger comes from the damage they can

do when they react with important cellular components such as

DNA, or the cell membrane. Cells may function poorly or die if

this occurs. These free radicals have been widely studied in recent

years and have been found to be an important cause of cognitive

degeneration  in  Alzheimer’s  disease  and  even  mild  cognitive

impairment (Clinical Pharmacology 2004).

       This link between vitamin E and Alzheimer’s disease has

sparked numerous clinical trials to challenge this remarkable dis-

covery. Unfortunately, most of the studies found that taking a

vitamin  E  supplement  may  be  beneficial  only  if  consumption

begins  at  the  very  early  stages  of  dementia.

       For example, in 2004, the School of Medicine at the Uni-

versity of Pennsylvania published the results of a double-blind

study that supported their hypothesis that antioxidant therapy,

given to older mice, did not show a clinically significant differ-

ence when compared to the placebo given (Sung et al. 2004).

Also, the School of Medicine at Duke University has published

an article stating there is no evidence that vitamin E can serve as

preventative therapy in patients who are not yet experiencing

Alzheimer’s  disease  (Burke  and  Morgenlander  1999).

       Before these studies, it was thought that a maximum dose of

2000 IU (international units) taken throughout the day would

provide beneficial effects to memory. However, this high a dose

could create a bleeding problem in patients who suffer from a

vitamin K deficiency. Also, it could have negative effects on the

thyroid, adrenal hormones, immune responses, and sexual per-

formance. Note that there have been similar findings with vita-

mins  C  and  B  as  well.



Bottom line: Vitamin E has been shown to be one of the most

effective and efficient antioxidants on the market. It has been




shown to act against toxic byproducts (free radicals) deposited in

the brain. Vitamin E assists with the destruction of neurotoxic

free radicals created by oxidative metabolism. Originally, the rec-

ommended dose to address memory problems was as high as 2000

IU. It is now thought that much lower doses will have the same

effect with significantly decreased side effects. Although many

well-controlled studies have reported conflicting results, vitamin

E  is  still  one  of  the  best  choices  of  natural  supplements  for

addressing good  memory maintenance.






Vitamins B      (thiamine), B     (pyridoxine), B     (folic acid), and B

              1                 6                   9                       12



(cyanocobalamin)        have    all  been   suggested,    in   one   way   or

another, to play a role in memory function. B1 is a water-soluble

vitamin found in yeast, cereal grains, legumes, peas, pork, and

beef. It has been studied in children by Columbia University in

New  York  and  found  to  increase  reaction  time  and  stimulate

memory. There is no credible evidence yet to suggest that adults

should use thiamine for the improvement of memory or to pre-

vent  memory  loss.  B6     is  also  a  water-soluble  vitamin  found  in

cereal grains, legumes, liver, meat, eggs, and vegetables. It mainly

is associated with mood control. There have been some anecdotal

accounts as to its effect on memory, but only subjective correla-

tions between the two. B6        is found in yeast, liver, kidneys, and

green leafy vegetables. B12  is found in meat and certain types of

fish.  When  a  declining  memory  is  present,  the  possibility  of

decreased B6     and B12  levels is among the first clinical consider-

ations. This is the groundwork for many ongoing studies.






Bottom  line:  The  B  vitamins  can  prove  dangerous  if  levels

become too high. Consult your physician or pharmacist before

beginning to take these as supplements to your normal nutrition.






Garlic is among the most studied herbal supplements available on

the  market  today.  Its  medically  active  constituent,  allicin,  is

derived  from  the  bulb  of Allium  sativum,  which  has  been  used

since  the  early  Egyptian  and  Chinese  dynasties.  More  than  a

thousand articles written over the past twenty years have been

published about its potential effectiveness against infections, high

blood glucose and cholesterol, neurotoxic free radicals, and clot

formation. However, throughout many years of study, a strong

correlation  between  the  consumption  of  garlic  and  improved

memory performance has not been established.



Bottom line:  Garlic  does  contain  some  components  that  may

assist memory functioning. Although there has not been a proven

direct correlation between garlic and memory enhancement, it is

worth  trying. It  may  help  and it will do no harm.






There  has  been  some  speculation  that  patients  suffering  from

dementia      do   not   have    the   ability  to   convert    choline    to



 acetylcholine in the brain. As mentioned earlier, in the section

dealing with estrogen, acetylcholine is an important neurotrans-

mitter in muscle and memory functioning. Choline is just one

component of a substance known as lecithin. As with the other

products  discussed  in  this  chapter,  there  have  been  numerous

clinical trials to determine if lecithin or choline would retard the

progression of the different stages of dementia.

       One  study  conducted  by  researchers  at  Duke  University

Medical Center found that using a high dose (20–35 grams per

day) of lecithin did not slow the early onset of Alzheimer’s disease

(Heyman et al. 1987). The study had a total of thirty-seven quali-

fied subjects. Lecithin was administered to sixteen of the subjects

and  a  placebo  was  given  to  the  remaining  twenty-one  people.

The study’s findings suggest that no differences were observed

between the patients receiving lecithin and those given the pla-

cebo. In addition, the high doses that some believed might have

improved or alleviated dementia could have caused side effects

such as anorexia, excessive sweating and salivation, and gastroin-

testinal  distress.



Bottom line: Acetylcholine has been identified as one of the pri-

mary neurotransmitters involved in cognitive functioning. Much of

our current approach to treating memory impairment is to increase

the level of acetylcholine available in the brain. Choline is one of the

primary    building   blocks   of  acetylcholine    and   should   therefore

enhance the production of acetylcholine in the brain. This is the pri-

mary mechanism of action in most of the memory medications on

the market that fall into the category of cholinesterase inhibitors

(see chapter 7 for more details). The major problem with taking raw

choline is that it has considerable difficulty crossing the blood-brain

barrier and making its way into the brain.









Curcumin is an Indian spice found in the tropical plant turmeric.

This spice gives American-style mustard and Indian curry their

yellow color. Turmeric is thought to have significant effects as an

anti-inflammatory, cancer-prevention agent, and memory stimu-

lant. In 2001, the University of California at Los Angeles Depart-

ment of Medicine and Neurology studied the effects of this spice

(Frautschy et al. 2001). The study concluded that curcumin did

suppress  oxidative  damage  in  rats.  Studies  are  currently  being

conducted to determine how effective this spice is for humans.



Bottom line: Studies of this spice have revealed properties that

seem to prevent structural correlations related to memory loss.

The use of curcumin is primarily supported by the study done at

the University of California at Los Angeles. The study suggested

that curcumin reduces brain changes related to memory loss. The

results also suggest that curcumin assists in removing amyloid  (a

starchlike protein complex associated with a variety of chronic

diseases) from the brain. Curcumin has limited side effects, so its

combined antioxidant and anti-inflammatory properties should

prove  helpful.






Coenzyme Q10, discovered in 1957 at the University of Wiscon-

sin,  comes  from  beef  heart  and  seafood.  It  is  thought  to  be

involved in supplying the neurons in the body with energy. It has

been suggested that this fat-soluble antioxidant may protect the






brain from the natural aging processes. However, its main claim

to fame is its beneficial effects on      the heart.



Bottom line: Coenzyme Q10 is an essential part of our diet that is

now used medicinally to treat a long list of conditions where lack

of  energy  and  poor  nutrition  are  implicated.  Its  mechanism  of

action strongly suggests that, potentially, it could play an impor-

tant  role  in  preventing  neurological  decline;  however,  further

studies are  needed to prove  or disprove this  speculation.







There  are  other  herbal  and  nutritional  supplements  worthy  of

note. Huperzine, an extract from Chinese club moss, has been

shown to provide benefits to patients with a progressed stage of

memory loss. It provides little to no benefit to patients with mild-

to-moderate cases of memory loss. Selenium is a trace element

that has been shown to have beneficial effects on brain function.

It is found in garlic and is credited for garlic’s effects on memory.

(See the section on garlic above for more information.)






In addition to the herbal and nutritional supplements that we

have covered thus far, there are other treatments available that

may help to improve your memory. These range from high blood






pressure and cholesterol medications to vaccines and antibiotics.

For the remainder of this chapter you will learn why, and why not,

vaccines and antibiotics may potentially protect your memory. In

chapter  7,  which  discusses  prescription  medications,  you  will

learn more about the high blood pressure and cholesterol medica-

tions that may have beneficial effects on memory.






       Certain types of memory disorders are associated with the

progressive accumulation of proteins (A beta) in the brain that

can lead to immune responses, which trigger a cascade of harmful

events. These are the grounds for investigating the use of vac-

cines    to    prevent     memory       deterioration.     According       to

Merriam-Webster’s Collegiate Dictionary  (11th edition), vaccines

are  “a  preparation  of  killed  microorganisms,  living  attenuated

organisms, or fully virulent organisms that is administered to pro-

duce  or  artificially  increase  immunity  to  a  particular  disease.”

Some  researchers  believe  that  if  it  was  possible  to  induce  the

immune reaction caused by the accumulation of proteins in the

brain, that would be a very important step in the direction of pre-

venting  memory  impairment.

       Vaccines are used to create the undesired immune response

before  it  occurs  naturally  in  order  to  prevent  future  memory

impairments. This is like being injected with the flu vaccine to

prevent you from catching the flu. This is a relatively new con-

cept; numerous studies are in the works but are still to come.

There  was  one  clinical  study  in  which  patients  received  the

Abeta vaccination; however, some patients suffered from severe

inflammation  of  the  brain,  causing  the  suspension  of  the  trial

(Broytman and Malter 2004). The study was by no means a waste






of time, but merely the spirited beginning for future studies and

formulations  on  the  Abeta  vaccination.



Bottom line: Vaccines are an exciting and very promising devel-

opment that, in the future, potentially may be the key that opens

the  lock  for memory loss.








It’s important for you to weigh the benefits versus the risks when

considering  the  use  of  herbal  products  and  supplements.  The

claim that because they can be purchased without a doctor’s pre-

scription  means  they  are  safe  enough  to  use  unsupervised  has

plagued many professional health-care providers for decades. The

truth of the matter is that these products are not regulated by the

FDA and potentially could be harmful to your health if taken


       There are many herbal products, supplements, and alterna-

tive treatments available to you for the treatment and prevention

of  memory     loss,  including    ginkgo    biloba,  estrogen,    vitamins,



     Weigh the benefits versus the risks

     when considering the use of herbal

              products and supplements.






garlic, lecithin, curcumin, and perhaps the use of vaccines. As

you’ve read, many clinical studies have been conducted to deter-

mine the effectiveness of these products for improving memory.

On the whole, most of the available studies do not support using

herbal  products  and  supplements  as  a  reliable  means  to  bring

about a “miracle memory.” However, if taken appropriately, sev-

eral  of  these  products  can  provide  beneficial  effects  for  other

aspects  of  your  health.



     Prescription  Medications

 That  Affect  Your  Memory



             ow, let’s imagine a perfect world for a moment. Suppose

            you’ve started to notice that your memory is not as keen

             as it used to be and you visit your doctor for a consulta-


tion about it. Instead of the usual time-consuming neurological

tests and the painful needle pricks to determine the precise treat-

ment or exercises for your condition, the doctor prescribes a new

state-of-the-art medication for you. For our purposes, let’s call this

medication “Instamem.” The doctor tells you, “Just take one tablet

of Instamem every morning before breakfast, and you should soon

start seeing improvements in your memory.”


        Let’s suppose that you’ve followed your doctor’s instructions

and a week later you start remembering things you haven’t remem-

bered for decades. At your follow-up appointment, you tell your

doctor that you can now remember the name of your first girlfriend

or boyfriend, your home phone number as a child, or even your

third-grade teacher’s name, the one who always scolded you for

not sitting still in your seat during the math lesson.

       Okay, let’s return to reality now. The development of a med-

ication that would stimulate childhood memories, like Instamem,

is a big stretch. It’s still beyond all our technological skills, at least

for now. There are, however, new medications becoming available

that have halted or slowed the progression of memory loss.

       The purpose of this chapter is to give you a basic under-

standing of the medications currently available to you that can

have either positive or negative effects on your memory. In this

chapter, we will also take a look at some medications, such as

cholesterol and blood pressure medications, that have been spec-

ulated about as having the ability to improve memory. Although

most of the research on these medications is performed with the

more severe and chronic forms of memory impairment (e.g., Alz-

heimer’s disease), many parallels in how the mechanism of action

might improve less severe memory challenges can still be drawn.

The treatment of memory loss, no matter how mild it is, offers an

exciting  prospect  for  the  future.



           New medications are becoming

             available that have halted

              or slowed the progression

                        of memory loss.



           Prescription Medications That Affect Your Memory



       Before we go any further into this chapter, there are a few

things that must be addressed for you to benefit from the infor-

mation presented here. As with chapter 6 on herbal and nutri-

tional  supplements,  this  chapter  is  based  primarily  on  many

clinical  trials  that  were  conducted  in  recent  years.

       Medication management is a principal component of your

medical care. It is vitally important to select one physician as your

primary care doctor who will coordinate your care and under-

stand all aspects of your health condition. Also, don’t be afraid to

visit your local drugstore pharmacist with any concerns you may

have regarding the use of your medications. Whomever you rely

on to help you with managing your medication, that person must

be aware of the names and dosages of all the medications and

supplements  you  are  currently  taking.

       Also, it might be helpful to prepare in advance a list of your

medications and any questions you might have for your doctor

before your next scheduled visit. Many of us suffer from what can

be called the “white coat syndrome.” In this syndrome, people

frequently become very anxious and nervous when interviewed

by a doctor wearing a white lab coat. Such nervousness some-

times  causes  us  to  forget  to  ask  important  questions  that  we

would  have  otherwise  asked.







Every drug on the market carries the potential for causing side

effects  as  well  as  whatever  benefit  it  confers.  For  this  reason,

when a doctor must select a patient-specific medication for any






memory condition, potential side effects must also be considered.

If the risks of developing serious side effects, or adverse reactions,

from the medication outweigh the benefits, then it is unlikely that

medication is the best choice for that patient.

       Possible  side  effects  of  each  medication  covered  in  this

chapter are listed. However, it is important to understand that

not all side effects are listed here and even if a side effect is men-

tioned here, that doesn’t mean you will develop it. In contrast to

the herbal and nutritional products discussed in chapter 6, pre-

scription medications are both regulated and regularly monitored

by  the  FDA.  Therefore,  drug  interactions  and  side  effects  are

required  by  law  to  be  reported  to  the  FDA.







Research is continuing on medications to improve memory and

cognitive functioning. Overall, the reality today is that although

the available medications may help to improve memory or to slow

the   progress   of  cognitive    decline,   these   medications     cannot

reverse existing deficits. Generally, when we think of memory-

enhancing     medications,     our   thoughts    go   to  the  medications

developed for Alzheimer’s disease. Although most of the studies

on memory have been conducted on people with diseases such as

Alzheimer’s, some of these medications are often prescribed for

other forms of mild cognitive impairment.

       Memory-enhancing medications fall into several classes of

drugs.   These    are   cholinesterase    inhibitors,    NMDA       receptor

antagonists, and ergot alkaloids, to mention but three. First we




will discuss the class of cholinesterase inhibitors, which were the

pioneers  of  these  memory  medications.



       Cholinesterase Inhibitors



       Most  of  the  memory  medications  currently  accepted  by

medical practitioners are cholinesterase inhibitors. These have

been shown to slow down the progression of memory deteriora-

tion and to restore the ability to handle the cognitive aspects of

daily  activities.

       As stated above, these medications will not stop or cure

progressive memory problems, but they have demonstrated the

ability to alleviate some problems with memory. Cholinesterase

inhibitors act by increasing the amount of acetylcholine in the

brain. Acetylcholine is believed to be important for memory and

learning capabilities. Now we will take an in-depth look at some

of  the  medications  that  belong  to  this  class  of  drugs.






       In 1993, tacrine, also known as Cognex, was the first drug

approved for the treatment of symptoms associated with demen-

tia, including impaired abilities in language use, reasoning, mem-

ory, and focused attention. Tacrine inhibits acetylcholinesterase,

the enzyme that breaks down acetylcholine, and, as stated above,

acetylcholine is believed to be essential for cognitive functions.

Unfortunately,  tacrine  therapy  has  also  been  associated  with

liver dysfunction. Furthermore, the medication must be taken

four times a day, which is another reason that patients have diffi-

culty  staying  with  a  tacrine  regimen.




       Also,   according     to   Maltby    and    colleagues    (1994),     a

double-blind clinical trial in which tacrine was given to patients

with mild-to-moderate symptoms of Alzheimer’s disease found

that tacrine provided no benefit to these patients. However, five

years after that study, Mayeux and Sano (1999) found an average

of 4.5 percent improvement in cognitive functioning following

treatment  with  tacrine.



Side effects: The most commonly reported side effects include

liver dysfunction, nausea/vomiting, diarrhea, myalgia, and ataxia.

Less common side effects include anorexia, constipation, gas, dry

mouth, indigestion, anxiety, hallucinations, and agitation. Car-

diovascular side effects are  uncommon.



Bottom line: Tacrine is ineffective for curing or stopping the pro-

gression of memory loss. However, it has been proven to slow

down the progression of memory loss. At present, this is not a bad

option,  considering  that  it  does  provide  some  limited  clinical







       Donepezil,     also   known      as  Aricept,     was   the    second

cholinesterase inhibitor approved by the FDA for the treatment

of dementia. It has been used for patients with mild-to-moderate

dementia     conditions     to   decrease    the   associated    symptoms.

Donepezil is the most widely prescribed medication of its kind

because it has not been associated with liver dysfunction and has

to  be  administered  only  once  a  day.

       The    Medical     Center     at  Duke     University     has   made

donepezil the focal point for one of its many studies (Krishnan et

al. 2003). This double-blind study  administered either donepezil






or a placebo for twenty-four weeks to sixty-seven patients with

mild-to-moderate Alzheimer’s disease. For the first twenty-eight

days, 5 milligrams of donepezil was administered daily, then 10

milligrams a day after that. The results clearly showed that the

patients who received donepezil drug therapy had clinically sig-

nificant improvement in their cognitive scores when compared

to  the  patients  who  received  the  placebo.



Side effects: At 5 milligrams per day, donepezil is relatively well

tolerated. The majority of side effects are seen at the initiation of

drug therapy and at higher doses. The most commonly seen side

effects include fatigue, nausea/vomiting, diarrhea, anorexia, and

muscle cramping. Nausea/vomiting and diarrhea are frequently

reported when patients stop taking the medication. Less common

side effects include a decline in understanding language, bloating,

chest  pain,  aggression, dizziness, and urinary  incontinence.



Bottom line: Donepezil definitely provides beneficial effects for

decreasing the symptoms associated with mild-to-moderate con-

ditions of dementia. It is considered superior to tacrine because it

has fewer side effects and more convenient dosing intervals. It is

being  used  to  treat milder  forms of memory loss.






       Rivastigmine, also known as Exelon, is one of the newest

cholinesterase inhibitors. It was introduced in 2000. To receive

therapeutic benefit, a twice-daily dose is required. It has been

administered to and studied in more five thousand patients from

many  different  countries.  The  School  of  Medicine  at  Indiana

University conducted a study to determine whether the response

to rivastigmine is related to the severity of cognitive impairment






(Farlow et al. 2001). This was a nationwide study that concluded

there is indeed a correlation between the two. Patients suffering

from a more rapidly progressing disease state responded better to

treatment with rivastigmine than did patients who were experi-

encing  a  slower  progression  of  cognitive  impairment.



Side effects: Unfortunately, the dose at which clinical benefit is

seen (greater than or equal to 6 milligrams per day) is also the dos-

age at which side effects begin to appear. The more commonly

seen  side  effects  include  nausea/vomiting,  anorexia,  diarrhea,

abdominal pain, constipation, dyspepsia, gas, and belching. Some

of these side effects can be decreased if rivastigmine is taken with

food.  To  date,  no  liver  dysfunction has been  reported.



Bottom line: Rivastigmine has been proven to provide clinical

benefit for up to two years in patients who suffer from a more rap-

idly progressing form of dementia. Unfortunately, this drug is an

unlikely option for treating  milder forms of forgetfulness.






       Galantamine, also known as Reminyl, is derived from the

plant Galanthus nivalis. A six-month study at the University of

Washington  concluded  that  galantamine  at  24  milligrams  per

day significantly improved overall brain functioning and cogni-

tion  among  Alzheimer’s  patients  (Raskind  et  al.  2000).



Side effects: Galantamine should be administered with plenty of

water and food to decrease side effects. The most common side

effects include nausea/vomiting, diarrhea, abdominal pain, dys-

pepsia, dizziness, headache, decreased heart rate, and tremors.



 Bottom line: Galantamine is similar to rivastigmine in that it acts

as a cholinesterase inhibitor. It also requires a twice-daily admin-

istration and shows no harmful effects on the liver if taken at

appropriate dosages.



       NMDA Receptor Antagonists



       The brain’s N-methyl-D-aspartate (NMDA) receptors are

important for memory and learning abilities. Overstimulation of

NMDA receptors is thought to be one of the causes of Alzhei-

mer’s disease. When NMDA receptors are overstimulated by glu-

tamate,  the  most  profound  excitatory  neurotransmitter  in  the

brain, it leads to neurological damage due to increased calcium

concentrations in the brain’s neurons. NMDA receptor antago-

nists are among the newer classes of medications to treat memory







       Memantine, also known as Namenda, is the first drug of its

kind approved for the treatment of moderate-to-severe Alzhei-

mer’s disease. It is believed that memantine blocks the stimulat-

ing   effects  of  glutamate.     Like   the  cholinesterase     inhibitors,

memantine is not a cure for memory impairment or progressive

dementias, but it can slow the progression of symptoms and help

to improve memory functioning. The usual dosage is 10 milli-

grams twice daily. The School of Medicine at New York Univer-

sity conducted a twenty-eight-week study on memantine for the

treatment of mild-to-severe forms of dementia (Reisberg et al.

2003).    The    study   concluded      that  memantine       exhibits   few






adverse  effects  and  actually  reduces  clinical  deterioration  in




Side effects: As the study indicated, memantine appears to be

relatively well tolerated. The most common side effects include

insomnia, agitation, headache, fatigue, pain, confusion, drowsi-

ness,  and  hallucinations.  Minimal  cardiovascular  events  have

been  reported with the use of memantine.



Bottom line: NMDA receptor antagonists are new and promis-

ing agents in the treatment of memory disorders. Today, mem-

antine is the only NMDA receptor antagonist approved by the

FDA for use with Alzheimer’s disease patients. It has relatively

few side effects and is an exciting new development for this class

of medications. It also has relatively few drug interactions and can

be combined with cholinesterase inhibitors for synergistic effects.



       Ergot Alkaloids



       Ergot alkaloids have an entirely different type of mecha-

nism than cholinesterase inhibitors and NMDA receptor antago-

nists.  For  this  class  of  drugs,  the  information  about  how  they

work is largely based on animal studies. It is thought that ergot

alkaloids work by means of increasing the uptake of oxygen and

improving neuronal cell metabolism while correcting low levels

of specific neurotransmitters in the brain. Future directions for

this class of medications indicate promising results for the treat-

ment  of  memory  loss.




       Ergoloid  Mesylates



       Ergoloid mesylates, also known as Hydergine, are used in

combination with other medications for the treatment of cogni-

tive  impairment  in  older  individuals.  They  have  been  around

since   the   early   1950s.   The    studies   conducted      on   ergoloid

mesylates    have    had   conflicting    results.  Thompson       and   col-

leagues,  in  an  article  published  in  the New  England  Journal  of

Medicine  (1990), demonstrated that no differences were seen in

patients taking ergoloid mesylates compared to patients taking a

placebo. On the other hand, a study in 1994 by Schneider and

Olin found some improvements in the associated symptoms of




Side effects: Ergoloid mesylates have been associated with car-

diovascular  effects,  including  decreased  heart  rate  and  blood

pressure.  Other  commonly  reported  side  effects  are  headache,

dizziness, fainting, and gastrointestinal symptoms (nausea/vomit-

ing, anorexia,  dyspepsia, and stomach cramping).



Bottom line: Ergot alkaloids warrant further investigative trials

to determine their effectiveness for treating memory loss. Because

of their large number of side effects and their lack of efficacy,

ergoloid  mesylates  are  not  considered  first-line  agents  for  the

enhancement or  improvement of  memory functioning.



       Off-Label Medications



       Off-label medications  are medications prescribed by physi-

cians  to  treat  disease  states  other  than  those  for  which  the






medication received FDA approval. Several classes of medica-

tions have been suggested for off-label use because of their bene-

ficial effects on cognitive impairment. We will take a brief look at

statins, calcium channel blockers, NSAIDs (nonsteroidal anti-

inflammatory  agents),  and  antibiotics  in  the  next  section.






       Statins  are  medications  used  to  lower  cholesterol.  Some

examples      of   medications       in   this   class    include    Lipitor

(atorvastatin),  Zocor  (simvastatin),  and  Mevacor  (lovastatin).

High cholesterol has been found to have a significant correlation

with  the  many  causes  of  progressive  dementia.  The  School  of

Medicine  at  Brown  University  (Scott  and  Laake  2001)  con-

ducted a study on statins to determine whether they reduce the

risk  of  developing  neuronal  plaques  (this  “hardening”  of  the

brain’s  neurons  is  one  of  the  factors  thought  to  contribute  to

memory loss as we age, and to more severe forms of memory loss,

such  as  Alzheimer’s  disease,  as  well).

       The researchers concluded that there is not enough evi-

dence to recommend using statins to reduce the risk of Alzhei-

mer’s disease, but that there is evidence that statins do play a role

in slowing the progression of the disease (Scott and Laake 2001).

Further research is needed on the use of statins for this condition.



       Calcium  Channel  Blockers



       Calcium channel blockers (CCBs), for example, verapamil,

are used for a variety of cardiovascular conditions, including high

blood pressure and chest pain. As mentioned earlier in this chap-

ter  in  regard   to  the   NMDA       receptor   antagonists,    increased


calcium levels in the brain coincide with cognitive decline. One

would think that if the inward flow of calcium was blocked, that

there would be a beneficial effect on neurological decline; how-

ever,  many  studies  have  found  the  opposite  effect  to  occur.

       A  study  performed  at  the  University  of  Calgary  suggests

that people taking long-term doses of calcium channel blockers

are at much greater risk for experiencing cognitive decline than

those using other agents       for cardiovascular health (Maxwell et

al.  1999).



       NSAIDs  (Nonsteroidal

       Anti-Inflammatory  Drugs)



       Inflammation within the brain has also been implicated as

one of the causes of memory loss and even of Alzheimer’s disease.

Certain neurons that process acetylcholine are particularly vul-

nerable to inflammation. Thus, nonsteroidal anti-inflammatory

drugs, such as indomethacin and ibuprofen, have been used to

treat  such    conditions.    It is also   believed   that   patients   with

chronic conditions due to inflammation, such as arthritis, have a

lower risk of developing long-term memory impairment because

of their long-term use of NSAIDs. As with other medications dis-

cussed in this chapter, we now turn to clinical trials to determine

the reality about the results of using NSAIDs to cope with mem-

ory  loss.

       Researchers at the School of Medicine at the University of

Brighton conducted a study of ibuprofen on this matter and con-

cluded  there  is  not  enough  evidence  to  recommend  the  use

ibuprofen for the treatment of progressive memory decline. They

even went so far as to state that the risks of side effects, such as






bleeding,  outweigh  any  benefit  that  NSAIDS  could  offer  to

patients suffering loss of memory (Tabet and Feldmand 2003).






       The  last  off-label  medications  to  discuss  are  antibiotics.

The  term  “antibiotics”  is  a  very  broad  umbrella  under  which

many different classes of drugs used for treating many types of

infections are grouped. The class of antibiotics that is of interest

to us is called “chelators.” Clioquinol is an example of a chelating

antibiotic, one that crosses the blood-brain barrier and has a rela-

tively high affinity for zinc and copper ions in the brain. A study

done at Duke University Medical Center found some association

between zinc and copper levels and progressive memory decline

such  as  Alzheimer’s  disease.  Currently,  a  double-blind  clinical

trial is being conducted to study the use of clioquinol in combina-

tion with vitamin B12. This study may provide us with new infor-

mation    that   may    lead   to  new    treatments     for  memory     loss

(Finefrock  et  al.  2003).








The final part of this chapter lists medications that potentially

could affect your memory in a negative way (Physician’s Desk Ref-

erence 2001; Sabiston 1997; Preston, O’Neil, and Talaga 1999).

This  list  was  also  published  in  an  earlier  book  by  one  of  our




authors called The Memory Workbook  (Mason and Kohn 2001).

Keep in mind that these medications can have negative effects

either directly or indirectly. They are listed in alphabetic order

and their generic names can be found within the parentheses.

This list will help you check out your own medications to see

whether they might be implicated in your memory loss. It is also

very important to bear in mind this fact: Every patient is affected

differently by medication.


Medications That May Lead to Memory Impairment 

       There are medications on the market to treat specific medi-

cal conditions that have a detrimental effect on your memory. If

you  believe  a  medication  that  has  been  prescribed  to  you  is

impairing your memory, discuss this medication with your doc-

tor. It is possible that the medication or dosage can be altered.

Below is a sample of medications that may be negatively impact-

ing  your  memory.



Every patient is affected

differently by medication.

         Prescription Medications That Affect Your Memory



Blood  Pressure  Medications



    Aldactazide (spironolactone)              Hygroton (chlorthalidone)

    Aldomet (methyldopa)                      Inderal (propranolol)

    Aldoril (methyldopa)                      Inderide LA (propranolol)

    Apresazide                                Kerlone (betaxolol)

    (hydralazine/HCTZ)                        Levatol (penbutolol)

    Apresoline (hydralazine HCl)              Lopressor (metoprolol)

    Atropine                                  Lozol (indapamide)

    Blocadren (timolol)                       Metahydrin

    Bumex (bumetanide)                         (trichlormethiazide)

    Cartrol (carteolol)                       Moduretic (amiloride)

    Combipres (clonidine)                     Normodyne (labetalol)

    Coreg (carvedilol)                        Regroton (reserpine)

    Corgard (nadolol)                         Salutensin (reserpine)

    Corzide (bendroflumethiazide)             Sectral (acebutolol)

    Demadex (torsemide)                       Ser-Ap-Es (reserpine)

    Diupres (reserpine)                       Tenoretic (atenolol)

    Diuril (chlorothiazide)                   Tenormin (atenolol)

    Dyazide (triamterene)                     Visken (pindolol)

    Enduron (methyclothiazide)                Zaroxolyn (metolazone)

    Enduronyl (deserpidine)                   Zebeta (bisoprolol)

    Esidrix (hydrochlorothiazide)             Ziac (bisoprolol)

    Hydropres (reserpine)






Psychiatric  and  Neurological




   Atarax/Vistaril (hydroxyzine)           Mellaril (thioridazine)

   Ativan (lorazepam)                      Miltown (meprobamate)

   BuSpar (buspirone)                      Navane (thiothixene)

   Butisol Sodium (butabarbital)           Nembutal (pentobarbital)

   Centrax (prazepam)                      Noctec (chloral hydrate)

   Compazine (prochlorperazine)            Noludar (methyprylon)

   Dalmane (flurazepam)                    Prolixin (fluphenazine)

   Doriden (glutethimide)                  Restoril (temazepam)

   Elavil (amitriptyline)                  Serax (oxazepam)

   Equanil (meprobamate)                   Stelazine (trifluoperazine)

   Halcion (triazolam)                     Thorazine (chlorpromazine)

   Haldol (haloperidol)                    Tranxene (clorazepate)

   Klonopin (clonazepam)                   Valium (diazepam)

   Librium (chlordiazepoxide)              Xanax (alprazolam)

   Luminal Sodium




       Stomach  Medications



   Axid (nizatidine)                       Tagamet (cimetidine)

   Pepcid (famotidine)                     Zantac (ranitidine)






Medications That May Lead

to Confusion



Medications listed below may cause mental confusion. As

with  any  medication,  it  is  important  to  discuss  possible  side

effects  with  your  physician.



Cardiac  Medications



   Catapres (clonidine HCl)                Lidocaine

   digitalis diuretics                     Norpace (disopyramide

   Duraquin (quinidine)                    phosphate)

   Dura-Tabs (quinidine)                   Reserpine

   Lanoxicap (digoxin)                     Tenex (guanfacine HCl)



   Lanoxin (digoxin)






   Chibroxin (norfloxacin)                 Raxar (grepafloxacin)

   Ciloxan/Cipro (ciprofloxacin)           Symmetrel (amantadine HCl)

   Cytovene (ganciclovir)                  Urised (methenamine/

   Levaquin (levofloxacin)                 methylene blue/salol)

   Maxaquin (lomefloxacin)                 Zagam (sparfloxacin)

   Ocuflox/Floxin (ofloxacin)              Zovirax (acyclovir)



   Penetrex (enoxacin)






Diabetes  Drugs



   Amaryl (glimepiride)                    Humalog (insulin lispro)

   DiaBeta/Micronase (glyburide)           insulin

   Diabinese (chlorpropamide)              Orinase (tolbutamide)

   Dymelor (acetohexamide)                 Tolinase (tolazamide)

   Glucotrol (glipizide)



       Systemic  Medications



   Acthar (corticotropin)                  Deltasone/Meticorten

   Azmacort (triamcinolone)                (prednisone)

   Cortef (hydrocortisone)                 Diprolene/Valisone


   Cortone Acetate (cortisone)

                                           Medrol (methylprednisolone)


    (dexamethasone)                        Metreton/Pred Forte

                                           (prednisolone acetate)



Cold  and  Allergy  Medications



    Atarax/Vistaril (hydroxyzine           Myidil (triprolidine)

    HCl/pamoate)                           Optimine (azatadine maleate)

    Benadryl (diphenhydramine)             Periactin (cyproheptadine

    Chlor-Trimeton                         HCl)

    (chlorpheniramine maleate)             Seldane (terfenadine)

    Dimetane (brompheniramine              Tavist-D (clemastine

    maleate)                               fumarate)

    Hismanal (astemizole)                  Vistaril (hydroxyzine pamoate)






Pain  Medications



   Advil/Motrin (ibuprofen)                  general anesthesia

   Aleve/Naprosyn (naproxen)                 Indocin (indomethacin)

   Ansaid/Ocufen (flurbiprofen)              Lodine (etodolac)

   Arthropan (choline salicylate)            Meclomen (meclofenamate

   Ascriptin/Bufferin (aspirin)              sodium)

   Bayer/Ecotrin (aspirin)                   Nalfon (fenoprofen calcium)

   Butazolidin (phenylbutazone)              Orudis (ketoprofen)

   Clinoril (sulindac)                       Relafen (nabumetone)

   Daypro (oxaprozin)                        Talwin (pentazocine/aspirin)

   Disalcid (salsalate)                      Tolectin (tolmetin sodium)

   Doan’s Pills (magnesium                   Toradol (ketorolac

    salicylate)                              tromethamine)

   Dolobid (diflunisal)                      Trilisate (choline or

                                             magnesium salicylate)

   Duract (bromfenac sodium)

                                             Voltaren (diclofenac sodium)

   Feldene (piroxicam)



       Stomach  Medications



   Antivert (meclizine HCl)                  Lomotil (diphenoxylate HCl/

   Atropine (atropine sulfate)               atropine sulfate)

   Axid (nizatidine)                         Pepcid (famotidine)

   Bentyl (dicyclomine HCl)                  Phenergan (promethazine


   Compazine (prochlorperazine)

                                             Tagamet (cimetidine)

   Donnatal (belladonna

    alkaloids/phenobarbital)                 Tigan (trimethobenzamide


    Librax (clidinium/

   chlordiazepoxide)                         Zantac (ranitidine)







   Asendin (amoxapine)                     Norpramin (desipramine)

   Aventyl/Pamelor                         Prozac (fluoxetine)

    (nortriptyline)                        Sinequan (doxepin HCl)

   Desyrel (trazodone)                     Surmontil (trimipramine)

   Elavil (amitriptyline)                  Tofranil (imipramine)

   Lithobid/Lithonate (lithium             Triavil (amitriptyline/

   carbonate)                              perphenazine)

   Limbitrol (amitriptyline/               Wellbutrin (bupropion HCl)


   Ludiomil (maprotiline)



Sleeping  Pills,  Tranquilizers,

and  Hypnotics



   Ativan (lorazepam)                      Noctec (chloral hydrate)

   barbiturates                            Noludar (methyprylon)

   BuSpar (buspirone HCl)                  Restoril (temazepam)

   Centrax (prazepam)                      Serax (oxazepam)

   Dalmane (flurazepam)                    Tranxene (clorazepate)

   Doriden (glutethimide)                  Valium (diazepam)

   Halcion (triazolam)                     Vistaril/Atarax (hydroxyzine

   Librium (chlordiazepoxide)              pamoate)

   Miltown/Equanil                         Xanax (alprazolam)












   Butisol (butabarbital)                   Nembutal (pentobarbital)








   Clozaril (clozapine)                     Reglan (metoclopramide)

   Haldol (haloperidol)                     Stelazine (trifluoperazine)

   Mellaril (thioridazine)                  Thorazine (chlorpromazine)

   Navane (thiothixene)                     Triavil (amitriptyline/

   Prolixin (fluphenazine)                  perphenazine)



Neurological  Medications



   Artane (trihexyphenidyl)                 Parlodel (bromocriptine

   Cogentin (benztropine)                   mesylate)

   Dilantin (phenytoin sodium)              Permax (pergolide mesylate)

   Ergoset (bromocriptine)                  phenobarbital

   Klonopin (clonazepam)                    Primidone (primidone)

   Larodopa (levodopa)                      Sinemet (carbidopa/levodopa)

                                            Symmetrel (amantadine HCl)



Other  Medications



   Amipaque (metrizamide)                   Elspar (asparaginase)

   Akineton (biperden)                      Lioresal (baclofen)

   Anafranil (clomipramine HCl)             Mesoridazine (serentil)

   Artane (trihexyphenidyl HCl)             Oxybutin (oxybutin chloride)

   Cytosar-U (cytarabine)                   steroids







Although it is highly unlikely that a medication with the proper-

ties of “Instamem” will ever be marketed, there are promising new

developments for treating memory-related disorders.

       The    leading     class   of   medications       is  classified    as

cholinesterase  inhibitors.  They  work  by  preserving  the  neuro-

transmitter acetylcholine, which is definitely important for your

memory and learning abilities. Tacrine, donepezil, rivastigmine,

and galantamine are all cholinesterase inhibitors. Tacrine has a

limited use because of its adverse effects on the liver. Donepezil is

the  most  widely  used  in  this  class  because  of  its  convenient

once-a-day dosing and limited effects on the liver. Rivastigmine

provides clinical benefit for up to two years, while galantamine

was found to improve cognitive and overall brain functioning.

       NMDA  receptor  antagonists,  a  newly  approved  class  of

medications,  have  relatively  few  side  effects  or  adverse  drug

interactions. This is important because it means they can be com-

bined with cholinesterase inhibitors to provide synergistic effects

to patients. Ergot alkaloids are an older class of medications used

for memory loss; however, they have been shown to have many

side  effects  and  little  clinical  benefit.

       A fair number of off-label medications have been tried for

the  treatment  of  memory  loss.  They  include  statins,  calcium

channel blockers, NSAIDs, and antibiotics. These medications,

however, have not had a sufficient number of research studies

conducted to warrant their use for the treatment of memory loss.

       While some medications may enhance your memory, there

are many that can actually cause memory decline. We have listed

the  majority  of  the  medications  that  can  affect  your  memory






     While some medications may enhance

 your memory, there are many that can  actually cause memory decline adversely. It would be a wise step to take the time to compare the

medications  you  take  regularly  with  this  list.

   It is important for you to understand that many ongoing

clinical trials are taking place today for many other medications

to help improve memory. Most of the medications listed in this

chapter have been tested on more severe forms of memory loss,

but it will be up to your physician to address your changes in

memory at this chemical level, and to decide whether you are a

good  candidate  for  a  particular  medication.







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