The acetylcholinesterase inhibitors have produced excellent results in patients with Alzheimer’s disease or dementia. I have heard that a lot of people, particularly students preparing for exams, take these agents twice daily for three to four days. Are there any data about this usage? — Rodolfo Gonazles, MD, Yuma, Ariz.

Interesting question! Cortical acetylcholine deficiency is thought to account for some of the cognitive impairment seen in Alzheimer’s dementia. By inhibiting cholinesterase at the synaptic cleft, drugs like donepezil or galantamine can increase cholinergic transmission and have resulted in a small improvement in cognition and activities of daily living for some patients. Given these effects, it has long been hypothesized that such drugs can also be used as so-called cognition enhancers to improve memory and cognitive performance in nondemented patients. Indeed, there are some limited data that donepezil appears to enhance the retention of complex aviation tasks in pilots training on flight simulators (Neurology. 2002;59:123-125). All that being said, I was unable to find any data on the use of these medications by students preparing for exams. Given the potential for side effects (particularly GI symptoms) and lack of data, I would strongly advise against this practice. — Daniel G. Tobin, MD (150-7)