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Dementia

Also listed as: Senile dementia

Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
 
Following Up
Special Considerations
Supporting Research

Dementia is a term that describes the loss of cognitive function, usually because of damaged brain cells. It includes memory loss and at least one of the following: difficulty with language, impaired movement, and inability to plan and initiate appropriate behaviors socially or at work. People with dementia may not be able to care for themselves by getting dressed or eating; they may have trouble balancing their checkbook and may get lost in familiar settings.

Signs and Symptoms

Alzheimer’s disease

  • Increasing memory loss
  • Difficulty with language (not being able to find the right word)
  • Not being able to think abstractly
  • Disorientation (getting lost in familiar places)
  • Not recognizing friends or family
  • Inability to do familiar tasks (such as cooking)
  • Loss of judgment and decision-making ability
  • Personality changes

Vascular dementia

  • Mental confusion
  • Having trouble walking; falling frequently
  • Memory loss
  • Difficulty with language
  • Becoming agitated
  • Urinary frequency or incontinence

What Causes It?

Dementia usually occurs in elderly people, although it is not considered a normal effect of aging. Some kinds of vascular dementia may be mistaken for Alzheimer’s disease, and the two often occur together.

Other causes of dementia include:

  • Vascular disease (blockage of a blood vessel to the brain)
  • Traumatic brain injury
  • Parkinson's, Huntington's, Creutzfeldt-Jakob, and other diseases
  • Brain tumor
  • Vitamin B deficiencies
  • Drug or alcohol abuse, medications, or exposure to toxic substances
  • A history of severe hypoglycemic episodes among people with type 2 diabetes

What to Expect at Your Provider's Office

Your doctor will go over your symptoms and do a physical examination. However, since there is no test to diagnose dementia, your doctor will rely greatly on interviews with you and your family, especially to discover noticeable declines in mental and physical abilities. Depression is sometimes mistaken for dementia in older people, so your doctor should ask questions to rule that out. If your doctor suspects vascular dementia, your doctor may order an MRI (magnetic resonance imaging) or CT (computed tomography) scan to look at your brain.

Treatment Options

There is no cure for either vascular dementia or Alzheimer’s disease, but there are some medications that may help slow the progression of the disease. It is important for both the person with dementia and the person’s caregiver to have a strong support system in place to deal with the emotional challenges of the disease.

Treatments are aimed at lessening the symptoms and slowing the progression of the disease. Treatment may include a combination of drug and psychiatric or behavioral therapies. If you are elderly, your doctor may pay close attention to the medications you take, because some drugs may cause confusion or delirium in older people. Exercise, both physical and mental, can slow the progress of dementia.

Drug Therapies

The following drugs have been approved to treat Alzheimer’s disease. They are also often used to treat vascular dementia. However, not everyone responds to these medications. Research is continuing to find better drugs to treat Alzheimer’s and other forms of dementia.

Cholinesterase inhibitors -- These drugs increase the amount of a brain chemical called acetylcholine, a messenger chemical that is involved in memory and judgment. Side effects can include nausea, fatigue, and diarrhea. This class of drugs includes

  • Donepezil (Aricept)
  • Rivastigmine (Excelon)
  • Galantamine (Razadyne)

Memantine (Namenda) -- This drug works by regulating glutamate, a chemical messenger involved in information storage and retrieval in the brain. Side effects can include headache, constipation, confusion, and dizziness.

Complementary and Alternative Therapies

Alternative therapies may help treat dementia. If you are deficient in some nutrients, taking a supplement or getting more of that nutrient in your diet may help slow the progression of the disease. Many of the nutrients and herbs listed are used due to their supposed effects of increasing blood flow to the brain. Not surprisingly, many of them have a blood-thinning effect and therefore can interfere or accentuate the effects of blood-thinning medications. Dementia therapies, pharmaceutical or natural, should be used under the supervision of a qualified doctor.

Nutrition and Supplements

  • Phosphatidylserine (100 mg 3 times per day), a substance occurs naturally in the brain and shows promise in several studies. This supplement may increase levels of brain chemicals that deal with memory. Do not take phosphatidylserine if you are taking anticoagulants (blood thinners), and use caution if combining it with ginkgo for the same reason. There are great differences in quality among phosphatidylserine supplements. You should consider spending more for a more expensive brand, as they tend to be better than cheaper brands. Phosphatidylserine can interact with some medications, including some typically used in treating Alzheimer's. Talk to your doctor.
  • Antioxidants may protect against the development of dementia. They may even slow the progression of dementia. In some studies, but not all, vitamin E (400 - 800 IU per day) combined with Aricept was found to slow cognitive decline in people with Alzheimer’s disease. Another antioxidant, coenzyme Q10 (10 - 50 mg 3 times per day), may also help the brain get more oxygen. The skins of dark berries also provide valuable antioxidants. Many naturally-oriented doctors recommend eating half a cup of frozen blueberries daily -- freezing makes the antioxidants in the skin more easily absorbed.
  • B Vitamins: biotin (300 mcg); B1 (50 - 100 mg), B2 (50 mg), B6 (50 - 100 mg), B12 (100 - 1,000 mcg), folic acid (400 - 1,000 mcg). These vitamins facilitate the making of several nuerotransmitters (chemical messengers) necessary for proper brain function. No scientific evidence shows a direct benefit, but B12 and folic acid lower the levels of an amino acid in the blood that is often elevated in Alzheimer's patients. Injections of B12 may have the best results.
  • Zinc (30 - 40 mg per day) is often deficient in elderly people, and correcting deficiencies may help improve memory.
  • L-arginine: This amino acid has some evidence to suggest that it may help in vascular dementia by increasing blood flow to the brain. The dose used was 1.6 g each day for 3 months. Arginine may worsen herpes infections and can interefere with some medications, including Viagra and anti-hypertention medicines.
  • Essential fatty acids, such as those found in alpha linolenic acid (ALA), borage oil, and evening primrose oil: These omega-3 fatty acids may help reduce the risk of Alzheimer's disease. Dietary changes include eating fewer animal fats and more fish.

Herbs

The use of herbs is a time honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider. Always tell your doctor about any herbs you may be taking.

  • Ginkgo (Ginkgo biloba) shows the best evidence for treating early Alzheimer's disease and vascular dementia. It may be taken in a standardized extract of 40 - 50 mg 3 times per day. If you are taking blood thinning medication, use ginkgo only under the supervision of your doctor.
  • Huperzine A, a chemical made from the plant Huperzia serrata, may improve memory in both vascular and Alzheimer's dementia, according to several studies in China. However, more studies are needed to know for sure. The usual dose is 200 mcg twice a day. Do not take huperzine A if you have liver disease or if you are about to have anesthesia.
  • Lemon balm (Melissa officinalis): One study showed that this herb helped improve cognitive function in people with mild to moderate Alzheimer's. The dose used was 60 drops per day.
  • Bacopa (Bacopa monnieri) leaf extract, called Brahmi, is used in Ayurvedic or Indian medicine to improve brain function and learning. However, no scientific studies have looked at bacopa to see whether it might help lessen symptoms of dementia. One study found that taking 300 mg of bacopa per day for 12 weeks seemed to improve cognition in healthy people.
  • Lavender may be effective in terms of alleviating agitation associated with dementia. Lavender is not used internally but rather as an aromatherapy agent.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies, based on their knowledge and experience, for treating dementia. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Some of the most common remedies used for dementia are listed below.

  • Alumina -- for dullness of mind, vagueness, slow answers to questions
  • Argentum nitricum -- for dementia with irritability, especially with lack of control over impulses
  • Cicuta -- for dementia after head injuries, especially with convulsions
  • Helleborus -- for stupefaction, when a person answers questions slowly and stares vacantly
  • Silica -- for mental deterioration with anxiety over small details

Following Up

People with dementia usually require continuous care and monitoring by both a health care provider and family members.

Special Considerations

Caregiver and patient education focusing on knowledge of the disease, health, and the patient's well being results in better patient care. Caregivers must also closely monitor patients to make sure they are taking medications appropriately.

Supporting Research

Akhondzadeh S, Noroozian M, Mohammadi M, et al. Melissa officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind, randomised, placebo controlled trial. J Neurol Neurosurg Psychiatry. 2003;74:863–866.

Akhondzadeh S, Sabet MS, Harirchian MH, Togha M, Cheraghmakani H, Razeghi S, Hejazi SSh, Yousefi MH, Alimardani R, Jamshidi A, Zare F, Moradi A. Saffron in the treatment of patients with mild to moderate Alzheimer's disease: a 16-week, randomized and placebo-controlled trial. J Clin Pharm Ther. 2010;35(5):581-8. doi: 10.1111/j.1365-2710.2009.01133.x. 

Akhondzadeh S, Shafiee Sabet M, Harirchian MH, Togha M, Cheraghmakani H, Razeghi S, Hejazi SS, Yousefi MH, Alimardani R, Jamshidi A, Rezazadeh SA, Yousefi A, Zare F, Moradi A, Vossoughi A. A 22-week, multicenter, randomized, double-blind controlled trial of Crocus sativus in the treatment of mild-to-moderate Alzheimer's disease. Psychopharmacology (Berl).2010;207(4):637-43.

Albanese E, Dangour AD, Uauy R, et al. Dietary fish and meat intake and ementia in Latin America, China, and India: a 10/66 Dementia Research Group population-based study. Am J Clin Nutr. 2009;90(2):392-400.

Chen LP, Wang FW, Zuo F, Jia JJ, Jiao WG. Clinical research on comprehensive treatment of senile vascular dementia. J Tradit Chin Med. 2011;31(3):178-81.

da Rocha MD, Viegas FP, Campos HC, Nicastro PC, Fossaluzza PC, Fraga CA, Barreiro EJ, Viegas C Jr. The role of natural products in the discovery of new drug candidates for the treatment of neurodegenerative disorders II: Alzheimer's disease. [Review]. CNS Neurol Disord Drug Targets. 2011;10(2):251-70. 

Eckert GP. Traditional used Plants against Cognitive Decline and Alzheimer Disease. Front Pharmacol. 2010;1:138.

Freund-Levi YF, Eriksdotter-Jonhagen M, Cederholm T, et al. Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegAD Study. Arch Neurol. 2006;63:1402-1408.

Geng J, Dong J, Ni H, Lee MS, Wu T, Jiang K, Wang G, Zhou AL, Malouf R. Ginseng for cognition. [Review]. Cochrane Database Syst Rev. 2010;(12):CD007769. 

Hao Z, Liu M, Liu Z, Lv D. Huperzine A for vascular dementia. [Review]. Cochrane Database Syst Rev. 2009;(2):CD007365. 

Hsieh MT, Peng WH, Wu CR, Ng KY, Cheng CL, Xu HX. Review on experimental research of herbal medicines with anti-amnesic activity. [Review]. Planta Med. 2010;76(3):203-17. 

Hudson S, Tabet N. Acetyl-l-carnitine for dementia. Cochrane Database Syst Rev. 2003;CD003158.

Jesky R, Hailong C. Are herbal compounds the next frontier for alleviating learning and memory impairments? An integrative look at memory, dementia and the promising therapeutics of traditional Chinese medicines. [Review]. Phytother Res. 2011;25(8):1105-18. doi: 10.1002/ptr.3388.

Jung HA, Min BS, Yokozawa T, Lee JH, Kim YS, Choi JS. Anti-Alzheimer and antioxidant activities of Coptidis Rhizoma alkaloids. Biol Pharm Bull. 2009;32(8):1433-8.

Kelley R, Minagar A. Memory Complaints and Dementia. Medical Clinics of North America. 2009;93(2).

Lin PW, Chan WC, Ng BR, Lam LC. Efficacy of aromatherapy (Lavandula angustifolia) as intervention for agitated behaviours in Chinese older persons with deementia: a cross-over randomized trial. Int J Geriatr Psychiatry. 2007;22(5):405-10.

Lin Z, Gu J, Xiu J, Mi T, Dong J, Tiwari JK. Traditional Chinese medicine for senile dementia. Evid Based Complement Alternat Med.2012;2012:692621. 

Napryeyenko O, Borzenko I. Ginkgo biloba special extract in dementia with neuropsychiatric features: a randomised, placebo-controlled, double-blind clinical trial. Arzneimittelforschung. 2007;57:4-11.

Park SY. Potential therapeutic agents against Alzheimer's disease from natural sources. [Review]. Arch Pharm Res. 2010;33(10):1589-609.

Piau A, Nourhashémi F, Hein C, Caillaud C, Vellas B. Progress in the development of new drugs in Alzheimer's disease. J Nutr Health Aging. 2011;15(1):45-57.

Scripnikov A, Khomenko A, Napryeyenko O. Effects of Ginkgo biloba extract EGb 761 on neuropsychiatric symptoms of dementia: findings from a randomised controlled trial. Wien Med Wochenschr. 2007;157:295-300.

Snitz BE, O'Meara ES, Carlson MC, Arnold AM, Ives DG, Rapp SR, Saxton J, Lopez OL, Dunn LO, Sink KM, DeKosky ST; Ginkgo Evaluation of Memory (GEM) Study Investigators. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA. 2009;302(24):2663-70. 

Stough C, Lloyd J, Clarke J, et al. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology. 2001;156:481-4.

Sun Y, Lu CJ, Chien KL, et al. Efficacy of multivitamin supplementation containing vitamins B(6) and B(12) and folic acid as adjunctive treatment with a cholinesterase inhibitor in Alzheimer's disease: a 26-week, randomized, double-blind, placebo-controlled study in taiwanese patients. Clin Ther. 2007;29:2204-2214.

Thal LJ, Calvani M, Amato A, et al. A 1-year controlled trial of acetyl-l-carnitine in early-onset AD. Neurology. 2000;55:805-810.

Ven Murthy MR, Ranjekar PK, Ramassamy C, Deshpande M. Scientific basis for the use of Indian ayurvedic medicinal plants in the treatment of neurodegenerative disorders: ashwagandha. [Review]. Cent Nerv Syst Agents Med Chem. 2010;10(3):238-46.

Wang BS, Wang H, Song YY, Qi H, Rong ZX, Wang BS, Zhang L, Chen HZ. Effectiveness of standardized ginkgo biloba extract on cognitive symptoms of dementia with a six-month treatment: a bivariate random effect meta-analysis. Pharmacopsychiatry. 2010;43(3):86-91.

Weinmann S, Roll S, Schwarzbach C, Vauth C, Willich SN. Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. [Review]. BMC Geriatr. 2010;10:14.

Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP, Selby JV. Hypoglycemic episodes and risk dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301(15):1565-72.

Wu TY, Chen CP, Jinn TR. Traditional Chinese medicines and Alzheimer's disease. [Review]. Taiwan J Obstet Gynecol. 2011;50(2):131-5.

Zhang Z, Wang X, Chen Q, et al. Clinical efficacy and safety of huperzine Alpha in treatment of mild to moderate Alzheimer disease, a placebo-controlled, double-blind, randomized trial. Zhonghua Yi Xue Za Zhi. 2002;82:941-944.


Review Date: 3/2/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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