Over-the-counter drugs.Many people would like to improve their memory instantly by taking a pill. And many over-the-counter drugs and herbs- -such as choline, St. John's wort, and ginkgo biloba--are being marketed as having the ability to bolster memory. But they have not been proven to boost raw memory power.

Some of these products contain a stimulant such as caffeine. The stimulant can improve attention, and it may consequently enhance our ability to remember. Other common ingredients are antioxidants. Oxidative changes are thought to enhance the degeneration of brain cells, as seen in the brains of Alzheimer's disease (AD) patients. It has therefore been speculated that antioxidants such as vitamin E might improve the memory of AD patients and possibly that of normal elderly individuals. Studies support the idea that damage due to oxidation does play a role in AD and that antioxidants improve the independence and behavioral symptoms of AD patients. But while antioxidants may help maintain the viability of brain cells, they probably do not have any specific effect on the memory process.

Prescription drugs.Over 100 cognitive enhancers are currently being tested. Most would be used for AD patients, but some may enhance memory function in normal individuals as well. These drugs would not recover past memories that have been lost, but they would improve our ability to store new information. The tests, however, may take many years. In the case of tacrine (Cognex), the first drug approved to treat AD, it took about 15 years to go from the research lab to the doctor' s office.

One approach that is being tested is called estrogen-replacement therapy. Early evidence of estrogen's role in memory came when researchers found that the plasticity of the rat brain varied with the rat's reproductive cycle. More recently, scientists at Columbia University found that estrogen-replacement therapy was associated with a reduced risk of AD. The study involved more than a thousand women of European, Hispanic, and African ancestry. For women who did not take estrogen, the incidence rate for AD was 8.4 percent; among those who took estrogen, it was 2.7 percent. Some researchers suggest that estrogen exerts its beneficial effects by increasing the number of neuronal projections known as dendritic spines, which enhance communication between neurons. Others say that estrogen works together with compounds called neurotrophins to facilitate communication.

These and other results suggest that estrogen during and after menopause may significantly lower the risk of AD and delay the onset of memory loss. Whether it can delay memory loss due to normal aging has yet to be proven. Additional research is needed to learn the exact mechanism by which estrogen protects against memory loss, before doctors can recommend it for that purpose.

Another set of tests is being carried out with anti-inflammatory drugs. It has long been noticed that AD is less common among people with arthritis. This observation now seems related to their use of anti- inflammatory drugs. In a study by the National Institute of Aging, more than 2,000 men and women were surveyed about their use of medications. Those who regularly used nonsteroidal anti-inflammatory drugs (NSAIDs), other than aspirin, had a lower risk of developing AD than those who did not. This and other pieces of evidence suggest a relationship between brain inflammation and memory loss in cases of both AD and normal aging.

In a 3-year study of over 7,000 normal volunteers, NSAIDs were found to lower the risk of age-related loss of memory and other cognitive functions. Those taking NSAIDs showed cognitive ability equivalent to that of a person 3.5 years younger, and the risk of cognitive decline was reduced by about 20 percent. However, further testing is necessary, and the use of NSAIDs to preserve cognitive function in normal individuals is not yet advised.

In The Milk Train Doesn't Stop Here Anymore, Tennessee Williams wrote, "Life is all memory except for the one present moment that goes by you so quick you hardly catch it going." Memories are us. They are a function of our past experiences and a framework for our future selves. And what we individually choose to remember or forget is intrinsic to who we are. As demonstrated by many AD patients, without memories we are stuck in a moment in time.

Research to help prevent such tragic memory losses is praiseworthy, and efforts to enhance normal memory by improving ourselves are admirable as well. But using drugs to tinker with normal memory may not be worth it in the long run. These drugs, like most others, will take as well as give. We must think carefully about what we are giving up before we take them.

Norbert R. Myslinski is associate professor of neuroscience at the University of Maryland, past president of the Baltimore chapter of the Society for Neuroscience, and director of Maryland Brain Awareness Week.

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