Fear of forgetting.

"Honey. Have you seen my keys? I've got to go to the store to get some...uh...now what was it we needed?"

"Memory does begin to slip in some people as early as their 40s," says memory expert Thomas Crook. "It's a normal part of growing older and doesn't necessarily mean you're going to develop Alzheimer's disease."

Normal? Maybe for other people. But when you can't connect that face with its name, or don't have a clue where you parked your car, it's unnerving.

Relax.

"As we age, we don't normally lose a substantial number of cells in the part of the brain essential for complex thought," says Marilyn Albert, director of gerontology research at Massachusetts General Hospital in Boston.

"Our vocabularies usually improve, and our ability to reason and solve problems is retained," points out Paul Costa, Jr., of the Baltimore Longitudinal Study of Aging. "But it's true that many of us need more time to make and execute decisions, and our memories aren't as sharp."

There's that memory thing again. Its loss seems to irk us no end. Which might explain why we spend millions each year on memory supplements. Anything to stave off that shift into the slow lane.

"It makes perfect sense to want to find something that will help restore our mental quickness and memory to what it once was," says Barry Lebowitz, chief of the Mental Disorders of the Aging Research Branch at the National Institute of Mental Health in Rockville, Maryland.

Does that something exist? Supplement makers would like you to think so. Here's a peek behind the hype that's propping up the most popular ingredients in memory pills.

NO-BRAINERS

Some are easy. Pregnenolone, DHEA, DHA, DMAE. If you see any of them in a memory tonic, don't waste your money. Most are still in the early stages of animal testing, and the results, though occasionally promising, say nothing about their ability to help you find your keys.

Other ingredients have a far longer research trail.

CHOLINE AND LECITHIN

Choline is found in a wide variety of foods, especially egg yolks, liver, soybeans, and peanuts. It's also found in popular memory supplements like lecithin, Brain Fuel, BrainStorm, and Food for Thought.

What's the memory connection?

"Choline is an essential part of the neurotransmitter acetylcholine, which relays messages from nerve cell to nerve cell in the areas of the brain responsible for memory and learning," explains neuropsychologist Paul Spiers of the Massachusetts Institute of Technology.

In fact, by using drugs to lower the brain's supply of choline in animals and human volunteers, scientists can mimic the memory disturbances that are typical of aging.

But that's a far cry from proving that taking choline can help shore up fading memories. In the only two long-term studies that tested choline or lecithin in humans, "the results haven't been promising in people with either normal or impaired memories," says Spiers.

In one, 16 healthy older people did no better on word and picture memory tests five weeks after they started taking three grams of choline a day.(1)

In the other, after taking eight grams of choline a day for three weeks, ten elderly adults with mild memory impairment were no better at remembering a list of 15 or 20 words.(2)

"Eat enough choline and you'll smell like a fish," concludes Spiers. "But that's its only effect." (Bacteria in the intestines convert excess choline into trimethylamine, a fishy-smelling compound.)

Of course it's always possible that choline keeps flunking memory tests because it never gets to where it's needed.

"We've found that, beginning in middle-age, people seem to lose their ability to transport choline from the blood into the brain," says Bruce Cohen, director of the Brain Imaging Center at McLean Hospital in Belmont, Massachusetts.(3)

"Maybe by taking enormous amounts it's possible to force choline in, but we didn't see it with even three grams or more." Cohen is exploring ways to coax aging brains into absorbing more choline, but he doesn't expect a solution soon.

The bottom line: There's no good evidence that taking choline or lecithin will help prevent or treat memory loss.

GINKGO BILOBA

"The thinking person's supplement," says a television ad for the Ginkoba brand of ginkgo. "Taken as directed, Ginkoba will help you remember where you put things," says the company's site on the World Wide Web (www.ginsana.com).

Ginkgo biloba is an herbal supplement that's extracted from the leaves of the ginkgo tree. Is there good evidence that it can help the memories of healthy people like those pictured in Ginkoba's ads?

"No," says Jerry M. Cott, director of the Psychotherapeutic Medication Development Program at the National Institute of Mental Health.

No studies have looked at what happens to the memories of healthy people who take ginkgo regularly. And only two studies have even tested short-term effects. Both gave their volunteers a single dose of ginkgo and tested their memories just an hour later.

In one, ginkgo did nothing for the memories of eight young women who took 120 mg--the usual recommended dose.(4) Only at a huge dose-600 mg--were the women better able to memorize a series of numbers. But a second study of 12 different women who also took a single dose of 600 mg of ginkgo came up empty.(5)

If that's all the evidence, how can Pharmaton, the Ridgefield, Connecticut, company that manufactures Ginkoba, claim that its product improves memory?

"We're basing this claim on what Schwabe of Germany, our source of ginkgo, says and we believe they substantiate those claims," said Pharmaton's general manager, Tom Peterson.

But when we contacted Schwabe, the company couldn't produce any evidence that the regular use of ginkgo improves the memories of healthy people.

"Schwabe is naturally not responsible for statements made by any independent company and we are unable to speak to those," said Werner Busse, Schwabe's head of regulatory and scientific affairs.

And what about research on people who already have mild memory problems? Only one good study has been done.

After three months of taking 120 mg of ginkgo a day, 27 men and women aged 62 to 85 performed better on just one of 13 tests of memory and thinking ability than 27 people who were given a (look-alike but inactive) placebo.(6)

"It is nonsense to conclude from one small study--where findings on 12 of 13 tests were negative--that ginkgo improves memory," says Thomas Crook, who is a former chief of the Geriatric Psychopharmacology Program at the National Institute of Mental Health. "Further research is clearly needed before ginkgo can be regarded as even a possible treatment for memory loss."

The bottom line: There's no evidence that ginkgo helps memory in healthy people. The evidence that it helps people with mild memory loss is very preliminary. More studies are needed.

PHOSPHATIDYLSERINE (PS)

"I've tested close to a hundred compounds for their effects on human memory, and phosphatidylserine (PS) is the most impressive one I've found so far," says Crook.

Phosphatidylserine [foss-fuh-TID-ill-SEER-een] is a substance that occurs naturally in the membranes of all nerve cells.

In 1991, Crook and researchers at Stanford and Vanderbilt Universities recruited 149 volunteers aged 50 to 75 who had the "normal" memory loss of people 50 and older. Half were given 300 milligrams of PS each day for 12 weeks, and half got a placebo.(7)

"The group given PS, especially those who were most impaired, improved in their ability to learn and recall names, faces, and numbers," reports Crook. "The most memory-impaired among them reversed, in three months, an estimated 12 years of decline in being able to match a name with a face."

A much larger study in Italy found that elderly people with moderate to severe memory loss could improve their ability to store and recall verbal information after taking 300 mg a day of PS for three months.(8)

But these and other studies used PS that had been extracted from cows' brains, not exactly a hot commodity in the wake of "mad cow disease," a fatal neurological disorder that scientists think can be transmitted to humans.

PS made from soybeans is now available, "but there's no proof that it's equivalent to cow PS until a good human study is done," says biochemist Lloyd A. Horrocks of Ohio State University. The only study to use soy PS in people was inconclusive.

The bottom line: Phosphatidylserine (PS) may help shore up declining or impaired memories, but the only kind currently on the market hasn't been adequately tested.

THE WISDOM OF AGE

Not convinced that there's a magic bullet that will restore your memory? You don't need one, says memory expert Paul Costa.

"Conscientious, organized older people will beat out unorganized young people all the time," he says. Costa should know. The Baltimore Longitudinal Study of Aging tracks memory changes in 500 volunteers every two years.

"Given enough time," Costa explains, "older people can usually perform at the same levels and learn to the same levels as before."

A key "memory prosthesis," says Costa, is to write things down. "You need to set up multiple redundancies," he explains. "That means lists, reminders, tickler files that tell you to do things at certain times."

It's also important to keep in mind, says Costa, that age has no effect on the ability to think.

"Unless you've had a stroke or have Alzheimer's disease or some other condition that shouldn't be confused with aging itself, age doesn't influence the ability to reason at all. The higher mental processes aren't affected."

(1) Neurology 32: 944, 1982.

(2) Neurobiology of Aging 1: 21, 1980.

(3) J. Amer. Med. Assoc. 74: 902, 1995.

(4) Presse Medicale 15: 1592, 1986.

(5) Therapie 46: 33, 1991.

(6) Human Psychopharmacology 2: 159, 1987.

(7) Neurology 41: 644, 1991.

(8) Aging Clin. Exp. Res. 5: 123, 1993.

RELATED ARTICLE: Matching Memories

Here's a typical short-term memory test. Carefully read through this list of 15 foods just once. Concentrate on each word. Then turn the page and write down as many of the items as you can remember.

   onions        shrimp       mangoes
   plums         tonic water  pasta
   eggs          mayonnaise   ham
   blackberries  basil        brownies
   hazelnuts     zucchini     oatmeal

How'd you do? The average 18- to 39-year-old can remember ten of the items. It's nine for the average 40- to 59-year old, eight for the average 60- to 69-year-old, and seven if you're 70 or older.

Source: The Memory Assessment Clinic, Bethesda, Maryland.

RELATED ARTICLE: Who Ya Gonna Call?

Think your memory is slipping? Your first call should be to a physician, not a pharmacy or health food store.

"Many cases of memory impairment or cognitive decline are the result of conditions that can be treated," says memory expert Thomas Crook. "Nutrient deficiencies, infections, or depression can all affect memory, and each can be treated effectively with the proper medications and therapies."

Here's what else affects memory:

* High blood pressure that goes untreated for years may lead to fuzzy thinking later in life. Hawaiian men with systolic blood pressure (the first of the two numbers) above 159 in middle-age were more likely to do poorly on memory and other cognitive tests 30 years later.(1) "The men seem to have suffered small strokes along the way because of their hypertension," says Kamal Masaki of the University of Hawaii. Other studies agree.(2)

* A deficiency of vitamin B-12 can lead to irreversible memory loss and other neurological problems if it persists long enough without treatment.

"Anywhere from seven to 15 percent of older people suffer from B-12 deficiency," says Michael Freedman, Director of Geriatrics at New York University Medical Center.

The solution? "Older people with memory loss should get their B-12 levels checked," says Robert Russell of the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston. "Even if they don't have memory loss, it's not a bad idea for them to take a multivitamin with about 25 micrograms of B-12."

* Too many medications can cause confusion, memory loss, and other cognitive problems. "Drugs can impair thinking ability, especially when you're taking more than one," says Paul Costa, Jr., of the Baltimore Longitudinal Study of Aging. "Consider any drug, including over-the-counter medications and alcohol, as potentially suspect."

(1) J. Amer. Med. Assoc. 274: 1846, 1995.

(2) Amer. J. Epidem. 138: 353, 1993.

RELATED ARTICLE: When to Worry

There's memory loss...and there's memory loss.

While most lapses aren't signs of Alzheimer's disease or other forms of dementia, the symptoms listed below could be early warning signs. They're from a checklist that the Department of Health and Human Services gives health professionals to help evaluate patients. A "yes" answer to any category "generally indicates the need for further assessment for the presence of dementia."

Does the person have increased difficulty with any of these activities:

* Learning and retaining new information. Is more repetitive; has trouble remembering recent conversations, events, appointments; frequently misplaces objects.

* Handling complex tasks. Has trouble following a complex train of thought or performing tasks that require many steps, such as balancing a checkbook or cooking a meal.

* Reasoning ability. Is unable to respond with a reasonable plan to problems at work or home, such as knowing what to do if the bathroom is flooded. Shows uncharacteristic disregard for rules of social conduct.

* Spatial ability and orientation. Has trouble driving, organizing objects around the house, finding his or her way around familiar places.

* Language. Has increasing difficulty with finding the words to express what he or she wants to say and with following conversations.

* Behavior. Appears more passive and less responsive; is more irritable than usual; is more suspicious than usual. Misinterprets [what he or she sees or hears].

The clinician can also look for failure to arrive at the right time for appointments, difficulty discussing current events in an area of interest, and changes in behavior or dress.

Source: Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias, AHCPR Publication No. 97-0702, November 1996, U.S. Dept. of Health and Human Services.

RELATED ARTICLE: What Stays... and What Slips Away

As we age, it seems that remembering faces is what matters most. For example, by age 70 we've still got more than 80 percent of our ability to recognize a face (line 5). But we've lost almost half of our ability to associate someone's first name with his or her last name (line 2).

In this graph, which is based on memory expert Thomas Crook's tests of 4,100 men and women, the scores of 18- to 39-year-olds on five memory tests have been set at 100 percent. Scores for other age groups are shown as a percentage of how well the 18- to 39-year-olds did.

1 Name that Face.

You see six people on videotape who tell you their first names at one-second intervals. Ten seconds later the people appear again, one by one, but in a different order, and you're asked to name them. The average 18- to 39-year-old can recall an average of four of the six names. The average 60- to 69-year-old recalls about two.

Brit. J. Psych. 81: 335, 1990.

2 First and Last Names

You're asked to read aloud six first and last names. Then you're given each last name and asked to recall the first name. The order of the last names is scrambled and you again have to come up with the first names. The scrambling is repeated three more times. Out of a total of 30 chances to match first names with last names, the average 18- to 39-year-old can do it correctly 21 times. The average 70-year-old can do it 12 times.

Arch. Clin. Neuropsych. 6: 287, 1991.

3 One Ringy Dingy

You read aloud a phone number with area code, you dial it from memory, then you re-dial it after hearing a busy signal. How many of the ten digits can you remember? The average 18- to 39-year-old recalls six. The average 70- to 85-year-old manages three.

Psych. Aging 5: 520, 1990.

4 Listing Badly

You're given the same 15-item grocery list five different times over the course of half an hour. Thirty minutes later, you try to recall as many items from. the list as You can. The average 18- to 39-year-old can remember 13 of the 15. The average 70-year-old can remember ten.

Arch. Clin. Neuropsych. 6: 287,1991.

5 Your Fabulous Face

You're shown a photo of a face on a computer screen. Every eight seconds another new face appears, the faces are rearranged, and you have to pick out the new one. The test stops when there are a total of 25 faces on the screen. The average 18- to 39-year old manages to pick out the new face 21 of 25 times. The average 70-year-old does it 17 of 25 times.

J. Gerontol. 47: P138, 1992.