Olivia C. Welter, PharmD Candidate 2021

Maintenance of brain health and retention of memory function are key priorities for many aging adults. The 

 addressed how to identify patients who may be experiencing age-related memory loss and how to initiate a counseling session on the topic. The article also discussed the best exercise strategies that will maximize memory improvement and retention.

This article will shift focus toward confronting the misconceptions surrounding OTC supplements and information on what changes to the diet may be beneficial in supporting brain health. Let’s talk about some popular OTC treatments for memory loss, why many of them may actually have more risks than benefits, and how to discuss these products, as well as diet changes, candidly with your patients.

Some OTC supplements can pose great risks to the health of our patients. Most patients don’t give much thought to whether their OTCs interact with their prescription medications, but the reality is that many OTC products can cause severe adverse reactions when taken in combination with specific prescription drugs.

Take ginkgo biloba, for example, a popular OTC product that has been believed by consumers to improve memory function, despite large-scale studies not finding this to be true. Ginkgo biloba additionally is known to significantly interact with any drug product that has anticoagulant properties. The leaf extract slows blood clotting and can cause serious bleeding in patients who take medications, such as warfarin, NSAIDs, and other anticoagulants.

Vitamin E is a product that has actually been shown to have some positive effect on improving memory function. Unfortunately, a very high dose at 2000 IU is what has been shown to provide this benefit, yet there are other studies that claim doses of over 400 IU are related to increased risk for prostate cancer and are additionally risky to use in patients with cardiovascular disease.

When patients ask about these products as a supplement to improve memory function, be sure to thoroughly evaluate the risk-to-benefit ratio of these drugs for each individual patient. Fish oil and vitamin B12 are 2 supplements that are thought to have beneficial effects on memory function. Although taking them may not pose many serious health risks like what is seen with ginkgo biloba, they also may not provide any benefit depending on the circumstance.

Vitamin B12 is known to be an important vitamin for brain health, but supplementing B12 if levels are already within the normal range does nothing to improve memory. However, if a patient is clinically deficient in vitamin B12, supplementing it either on its own or through the diet could potentially lead to better memory.

Fish oil is also popular due to omega-3s playing a key role in maintaining brain health. However, taking fish oil as a supplement is not as effective as being sure that omega-3s are being consumed adequately through the patient’s diet. Many patients and physicians attribute a Mediterranean diet to being highly beneficial for many aspects of health, including memory.

Mediterranean diets heavily incorporate seafood, legumes, olive oil, and vegetables. These types of diets are packed with omega-3 fatty acids, potentially leading to an improvement in the patient’s brain health.

 Discuss with patients the benefit of including fish and other healthy fats in the diet. Also, discuss with their providers whether they could benefit from vitamin B12 supplementation.

In summary, shared decision-making between patients, pharmacists, and providers will need to be used in order to determine whether a patient could benefit from taking an OTC supplement for their brain health. Some OTCs may cause serious adverse reactions and others may cost more than they’re worth.

Understanding the patient’s goals, knowing what medications they are currently taking, and staying updated on their medical conditions are all crucial when recommending supplements to improve memory. Overall, dietary changes prove to have more benefit than taking OTC products.

Recommending that patients include seafood in their diet at least once a week may be one of the safest, most beneficial, and most cost-effective strategies for patients to achieve their desired level of memory function.

Lerner, KC. Madison Memory Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of Apoaequorin in Community-Dwelling, Older Adults. August 2016. 

https://www.prevagen.com/wp-content/uploads/2017/02/ClinicalTrialSynopsis-cmk816.pdf

Federal Trade Commission. FTC, New York, State Charge the Marketers of Prevagen With Deceptive Memory, Cognitive Improvement Claims. January 9, 2017. 

https://www.ftc.gov/news-events/press-releases/2017/01/ftc-new-york-state-charge-marketers-prevagen-making-deceptive

Mayo Clinic Staff. Ginkgo. October 12, 2017. 

https://www.mayoclinic.org/drugs-supplements-ginkgo/art-20362032

Articles

As misconceptions surround some OTC supplements, changes to the diet may be beneficial in supporting brain health in populations experiencing age-related memory loss.

Age-related Memory Loss: Dietary Changes Can Have Positive Impact

Because I’m a student pharmacist, my grandmother is constantly asking me what medication she should have her doctor prescribe to improve her memory. The tough part of discussing this with her is that she doesn’t have any type of dementia that is causing her memory loss, it is simply related to age.

Since there are no prescription medications that have been approved to treat the expected memory loss that comes along with aging, many older adults struggle to find solutions they can work into their daily lives that will preserve their memory function. This series of articles aims to educate pharmacy professionals on how we can best counsel our patients who have concerns regarding their brain health.

These articles will explore the various alterations seniors can make in their daily lives that can lead to real, lasting change in their memory function.

The first step to addressing your patients’ concerns with memory loss begins with identifying the patients who might be affected by it. There are some key factors that distinguish between standard age-related memory loss and memory loss due to dementia, and it is critical that pharmacy professionals are able to differentiate between the two.

The patient would likely need to be referred to a provider for specialized dementia treatment if they have difficulty performing small tasks, such as getting dressed and maintaining hygiene, if they lack the ability to follow directions and find themselves getting lost in places that should be familiar, and struggling to make decisions or articulate thoughts.¹

Contrarily, some signs that a patient’s memory loss can be contributed to the normal aging process include being forgetful, but still able to recall specific instances in which they were forgetful, unable to immediately recall directions, but not getting lost in an area that is familiar to them, and the ability to maintain the same level of decision-making as they always have, despite having occasional bouts of forgetfulness.¹

Once you’ve identified a patient who may be experiencing age-related declining cognitive functioning, ask them whether they have any concerns with their memory. If they affirmatively respond, it’s important to ask permission to share more information.

Some older adults may find it difficult to accept the fact that their memory is not what it once was and may not be ready to discuss the ways in which they can preserve their memory and promote brain health. To deliver true patient-centered care, we must allow the patient to have full autonomy. If they would prefer not to hear the information you have to offer, accept that it is their choice and document the interaction in your pharmacy system. You can always bring it up again, but give the patient time after your first encounter to think it over and consider your offer.

If and when a patient accepts your offer to share more information on the topic, there are several different avenues you can propose to the patient. Today, we will focus mainly on the benefits of exercise on brain health, but the rest of the series will address perceived and actual benefits of other topics, such as playing brain games, learning new languages, and altering the diet as effective nondrug strategies that preserve and improve memory function.

Exercise is emphasized as a key nondrug activity in many different disease states, including diabetes, hypertension, and hyperlipidemia. What many older adults don’t realize, however, is that exercise does more than just keep their body physically healthy. It has also been shown to improve and maintain brain health by facilitating circulation of BDNF and increasing the volume of the hippocampus, the memory center of the brain.² Some exercises are better than others, however.

Aerobic exercises are the main type of physical activity that has been shown to improve memory function in older adults.² The best aerobic exercises for older adults include walking, swimming, water aerobics, dancing, and even yard work. All of these methods, at about 150 minutes per week of activity, would be suitable fitness recommendations for your patients who complain of decline in memory function.

Although aerobic exercise on its own plays a key role in improving brain health, there has been evidence pointing to an even greater improvement in memory function when aerobic activity is coupled with a cognitively-stimulating activity, such as a video game.² For seniors, video games may not be the most practical option, but senior centers and other areas in which seniors socialize may benefit from introducing a console that allows older adults to partake in a mild version of Dance Dance Revolution or a similar strategic fitness games.

One team of researchers even created a game that can be played by older adults while cycling. The game includes various memory and attention tasks that require spatial navigation to complete. Thus far, combining both standard aerobic exercises with cognitively engaging activities seems to hold promise in improving memory function for older adults complaining of declining cognition.

As pharmacists, we have an accessible platform which we can use to provide this information on exercise to our patients who have concerns about their memory function. Not only is it important to emphasize the benefits of aerobic exercise both on its own and in combination with brain-stimulating games, community pharmacists should also consider having a compiled resource on-hand for activities that seniors can engage in within their communities, such as the nearby senior centers.

Even a small change in fitness habits can create real, lasting change for your older patients. Take the time to talk with them about their memory concerns and what they can do daily to keep their memory strong.

Smith M , Robinson L, Segal R. Age-related memory loss. HelpGuide; July 2019. 

https://www.helpguide.org/articles/alzheimers-dementia-aging/age-related-memory-loss.htm

Raichlen DA, Alexander GE. Why your brain needs exercise. Scientific American; January 2020. 

https://www.scientificamerican.com/article/why-your-brain-needs-exercise/

Tips for pharmacy professionals on how to best counsel patients who have concerns regarding their brain health.