May Work By Improving Working Memory
Not too many years ago, a new medication was approved for use in treating attention deficit/hyperactivity disorder (ADHD). That drug was brand-named Intuniv, an extended release form of the drug guanfacine.
Guanfacine was originally developed as a drug that could treat high blood pressure, but adults taking doses large enough to lower their blood pressure got quite sleepy. The sedative properties of guanfacine led to it being used in lower doses to help quiet the raging behaviors of children with severely abnormal behaviors. That version of guanfacine was called Tenex and it was fashioned to last about 4-6 hours per dose. Now, children treated with Tenex often had problems with attention as well as extreme behaviors, and when they took Tenex an improvement in their ability to focus and pay attention was noted.
This led to the development of a form of guanfacine that was low enough in dosage to not sedate but enough of a dosage to improve attention and focus. That is Intuniv, and one dose tends to last 12 hours. It is a remarkably safe medication with few side effects aside from those relating to tiredness noted in many decades of use.
On October 6, 2011, the New England Journal of Medicine (365:14, p. 1346-7) published an article reviewing recent research describing what physically is causing the nearly universal loss of memory function as we get older. That is, the normal loss of memory, not dementia. What the article demonstrates is that the key type of thinking ability lost with age that explains the loss of memory is working memory. This is yet another indicator of the central power of working memory to help the mind get tasks done. Working memory is not really a type of memory, rather it refers to the ability of one's mind to hold more than one piece of information in the mind at one moment in time and do something with it.
In this article, monkeys had the parts of their brain that creates working memory wired for measurement of activity, but also to allow various medications to be administered. What they found was that when guanfacine was applied to the nerves that create working memory, older monkey's working memory was restored to that of young monkeys. This, in turn, led to better ability to remember items, and to improved ability to get tasks done.
This is the first indication I have read of a medication demonstrating the ability to improve working memory.
As such, guanfacine, or Intuniv, works in a radically different way than stimulants such as Ritalin, Concerta, Adderal, Focalin, or Vyvanse. The stimulants work by arousing the brain. As we know a brain that is more alert works better. That, after all, is what coffee is all about. But Intuniv appears to work by actually changing the ability of the brain to create working memory function.
If this impact can be proven to be reliably present on use of Intuniv, and shown to be safe, it could make Intuniv a very interesting, powerful, and safe medication to consider when seeking to improve attention and focus. It could yield changes that lie at the heart of attention deficits, without all the significant side effects of stimulants.
At the same time, it should be noted that there are interventions that have been proven to increase working memory without the use of any medication. One of the most promising of such interventions is Cogmed, the product of serious neuroscience research and development in Sweden. Cogmed, whose impact on working memory has been verified by independent laboratories, including the one, in England, that developed the concept of working memory, increases working memory significantly in 80% of those who complete the 5 week intervention.
Research into how the brain works is rapidly expanding our knowledge and our ability to help our minds work. This recent report in the New England Journal of Medicine puts working memory once again at the center of how the mind gets tasks done. It raises the possibility that a very safe medication, Intuniv, may be a specific intervention to boost working memory, and it increases the chance that interventions that require no drugs, e.g. Cogmed, are devoted to changing the right cognitive function.
Dr. Arthur Lavin
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