A. Chatterjee et al., CHOLINERGIC TREATMENT OF AN AMNESTIC MAN WITH A BASAL FOREBRAIN LESION - THEORETICAL IMPLICATIONS, Journal of Neurology, Neurosurgery and Psychiatry, 56(12), 1993, pp. 1282-1289
Cholinergic deficient states, such as in Alzheimer's disease, are asso
ciated with amnesia. Therapeutic trials with cholinergic augmentation
in Alzheimer's disease have had only equivocal results, but mechanisms
other than cholinergic deficiency may contribute to the memory defici
t. Normally the diagonal band of Broca provides much of the hippocampa
l cholinergic input. To learn if amnesia secondary to cholinergic defi
ciency can be ameliorated by cholinergic augmentation, we treated an a
mnestic man who had a lesion located primarily in the right diagonal b
and of Broca with physostigmine and lecithin. During the initial best-
dose-finding phase, he demonstrated an inverted U-shaped curve for imm
ediate recall of word lists, with peak performances at 3.0 and 3.5 mg
of physostigmine. Single photon emission tomography showed decreased b
lood flow in the medial temporal region ipsilateral to the lesion at b
aseline, with a reversal of the asymmetry on 3.5 mg of physostigmine.
A follow-up double-blind, placebo-controlled study on 3.5 mg of physos
tigmine, however, failed to demonstrate that cholinergic treatment imp
roved memory.