The nicotine patch may present a treatment for Mild Cognitive Impairment and early Alzheimer’s disease. This study is new but the idea is old and there are other studies. Before you run off and ask for the patch or chew nicotine gum, let’s put this in the context of current medical treatment.

The only FDA approved treatments for Mild Cognitive Impairment and Alzheimer’s disease are medications known as cholinesterase inhibitors (Namenda is not approved for early changes and works through an entirely different neurotransmitter). These medications have been available since 1993. They work by increasing the amount of the neurotransmitter acetylcholine in the brain. Acetylcholine has important actions on cognitive functions such as attention and some forms of memory. It is one of the neurotransmitters that act on the frontal cortex, amygdala, and hippocampus – structures very important to attention, planning, reasoning, memory, and emotion.

There are four medications available that work by this mechanism: Tacrine (not used because of side effects), Aricept (available in generic form as donepezil), Exelon (rivastigmine in generic form and available as either oral medication or a patch), or Razadyne (galantamine in generic form and available as standard or extended release forms). All three work by increasing acetylcholine.

Choosing which medication is based on convenience and tolerability. There are no proven clinical differences in efficacy. Side effects are similar. It would be convenient if acetylcholine only acted in the brain. However, it also acts elsewhere. For example, it medicates the activity of the gastrointestinal system producing in some symptoms such as loss of appetite, loss of weight, heartburn, nausea, or worse. Acetylcholine also works to regulate neuromuscular (can cause unwanted movement or cramps) and cardiac function (can cause low heart rate and fainting). There are more side effects but the good news if that as many as 70% who take these medications will tolerate them. The only way to know is to swallow the pill and be followed closely by your physician. They help many with progressive disorders such as Alzheimer’s disease function much better for longer.

Where does nicotine fit in? Nicotine also makes acetylcholine more available but by a different mechanism of action. In other words it may do the same thing as cholinesterase inhibitors but also may produce the same risks. The studies so far available are comparing nicotine to a placebo. My question is how does it compare to any of the cholinesterase inhibitors? They are much more widely studied than nicotine in progressive memory loss. I eagerly await the needed studies that may help guide us in making informed choices.