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Can a Pill Make You Smarter?

Several drugs can improve thinking, memory, and alertness in people with Alzheimer's disease and other diseases that affect the mind. So can these drugs help healthy people, too?

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Once a drug is FDA-approved, however, doctors can prescribe the drug for "off-label" uses other than those for which it was approved. But Hausman says, "I will never recommend off-label use."

Pending approval for Phenserine in Alzheimer's patients, he says Axonyx does intend to study the drug further as a treatment for mild cognitive impairment (MCI). People with MCI have some memory loss, but they don't yet have full-blown dementia. Many, however, go on to develop Alzheimer's disease.

In addition to increasing the levels of acetylcholine, Phenserine also seems to block the gene that makes beta amyloid, a toxic protein that builds up and causes plaques in the brains of people with Alzheimer's disease. Scientists believe this protein is responsible for killing brain cells in people with Alzheimer's disease.

A New Pathway

Less far along in the development pipeline is Memory Pharmaceuticals' experimental drug, MEM 1414. It's currently in phase I trials, which are designed to test safety in people.

MEM 1414 works by blocking phosphodiesterase, an enzyme that breaks down an important brain chemical, cyclic AMP. It appears to work in the area of the brain where new memories are formed. "It's very important for facts and events," says Axel Unterbeck, PhD, president and chief scientific officer of Memory Pharmaceuticals.

"In order to be able to form new long-term memories -- which are memories lasting for more than three hours, by definition ... the [brain] also processes that information for facts and events to be stored long term, he says. "If you enhance this pathway, you get, potentially, enhancement of this very function."

A drug that blocks phosphodiesterase has potential for treating Alzheimer's and MCI, as well as age-related memory decline, which is the forgetfulness that often comes with older age but is not necessarily a sign of impending Alzheimer's disease.

Unterbeck says that while age-related memory loss is common, "it's not a necessary consequence of aging" because it doesn't affect everyone. He says he thinks it should be looked at as a medical problem that might be treated with a memory-enhancing drug.

As for whether MEM 1414 could be used to improve memory in young, healthy people, "that would be pure speculation," he says. "It is clearly not a target for us as a company."

Dystopian Fears

The possibility that memory-enhancing drugs may be as commonly prescribed in the future as Prozac and Ritalin are today raises some social and ethical questions, which Martha Farah, PhD, a professor of psychology at the University of Pennsylvania, addressed in a paper published in the May 2004 issue of Nature Reviews Neuroscience.

American employers are already squeezing more productivity out of fewer workers, so one wonders whether we might feel pressure to enhance our brainpower pharmaceutically, should the state of the art develop so far. Already, workers may be tempted to seek prescriptions for Provigil, a drug that treats daytime sleepiness. Provigil was originally approved as a treatment for narcolepsy and was subsequently approved for use by people who work swing shifts and suffer from excessive daytime sleepiness.

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