People’s Pharmacy: Could a nicotine patch help delay cognitive decline?

Q. My brother is approaching 81 and is having difficulties with his memory. His doctor has prescribed donepezil.

As far as I can tell, investigation on drugs that help with dementia and Alzheimer’s is inconclusive. I have been reading more and more about the nicotine patch.

I have great respect for your opinion. What are your thoughts about the nicotine patch? Are there any clinical trials that might establish effectiveness?

We have a family history. Our mother and many of her siblings died from Alzheimer’s.

A. You have asked a fascinating question. We have known for years that nicotine patches “caused a sustained improvement in clinical symptoms and objective computerized tests of attention” (Psychopharmacology, February 2004). This was a small study of people with age-associated memory impairment.

In 2013, Finnish researchers pointed out that “even a noxious substance may possess beneficial properties” (Duodecim, 2013). They too reported that a nicotine patch could improve symptoms of mild cognitive impairment. Other pilot studies have reinforced this observation (Neurology, Jan. 10, 2012).

The first big study of nicotine patches for patients with mild cognitive impairment is called MIND (Memory Improvement Through Nicotine Dosing). This clinical trial should be completed this year. We look forward to learning the results.

Q. I occasionally suffer from excruciating headaches at climax. My doctor said they are “normal,” but I have only developed this within the last few years. What causes this unbearable pain? I am not ready to give up sex. Is there anything I could take to prevent these horrible headaches?

A. First, we would highly recommend a thorough medical workup with a neurologist. Sudden onset sex headaches are not normal.

Years ago, we heard from an emergency physician that it is critical to rule out cerebral aneurysms when people start experiencing sex-related headaches. She warned that ignoring such symptoms could have tragic results.

Sex headaches are not necessarily a warning of something serious, though. Neurologists have a number of pre-emptive treatment options, including NSAIDs such as indomethacin or a triptan such as sumatriptan (Current Pain and Headache Reports, July 2024).

Readers can learn more about this condition and many other types of head pain in our “eGuide to Headaches & Migraines.” This online resource is located under the Health eGuides tab at www.PeoplesPharmacy.com.

Q. I am disappointed that you never mention antidepressant medications called MAOIs. This class of drugs works extremely well for me.

Doctors may be reluctant to prescribe them for fear of food-drug interactions. That’s much less of a problem now because patients can search online for foods and drugs that might be incompatible.

A. Thank you for reminding us that monoamine oxidase inhibitors (MAOIs) are a viable option against depression. Drugs such as isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate) were introduced in the late 1950s and early 1960s. They fell out of favor because of concerns about interactions. A more recent MAOI called selegiline (Emsam skin patch) was approved by the Food and Drug Administration for depression in 2006.

These drugs can be helpful, especially against treatment-resistant depression (Journal of Affective Disorders, May 1, 2025). It is crucial, however, to be aware of side effects and interactions.

Email Joe and Teresa Graedon via their website: www.PeoplesPharmacy.com.