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Background |
Risk factors |
Causes |
Signs and symptoms |
Diagnosis |
Complications |
Treatment |
Integrative therapies |
Prevention |
Author information |
Bibliography
Alzheimer's disease
Alzheimer's disease (AD) is an irreversible, progressive disorder in which neurons (brain cells) deteriorate resulting in the loss of cognitive (thought) functions, primarily memory, judgment, reasoning, movement coordination, and pattern recognition. In advanced stages of the disease, all memory and mental functioning may be lost.Alzheimer's disease may cause death; it is the eighth leading cause of death in the United States. However, an individual with AD often dies from an additional illness like pneumonia.
Alzheimer's disease is the most common form of dementia. Dementia is a group of disorders that impairs mental functioning. Dementia means loss of the ability to think. Alzheimer's is progressive and irreversible. Abnormal changes in the brain worsen over time, eventually interfering with many aspects of brain function. Memory loss is one of the earliest symptoms, along with a gradual decline of other intellectual and thinking abilities, called cognitive functions, and changes in personality or behavior. Other forms of dementia include vascular dementia (due to a lack of blood flow to the brain), mixed dementia (presence of both Alzheimer's and vascular dementia), and Creutzfeldt-Jakob disease (rapidly declining memory and cognition due to consumption of cattle with "mad-cow" disease).
Alzheimer's advances in stages, progressing from mild forgetfulness and cognitive impairment to widespread loss of mental abilities. In advanced Alzheimer's, people become dependent on others for every aspect of their care. The time course of the disease varies by individual, ranging from five to 20 years. The most common cause of death is infection.
Age is the most important risk factor for AD. The number of people with the disease doubles every five years beyond age 65.
It is estimated that about five million Americans suffer from Alzheimer's disease, and about 360,000 people are newly diagnosed every year. Alzheimer's affects about 10% of people ages 65 and up, and the number doubles roughly every ten years after age 65. Half of the population ages 85 and up may have Alzheimer's.
There are an estimated 24 million people with general dementia worldwide. Every 72 seconds in the United States, someone develops Alzheimer's. By 2050, the estimated range of Alzheimer's disease prevalence will be 11.3 million to 16 million Americans, with a middle estimate of 13.2 million unless a cure or prevention is found. Medicare and other healthcare insurances help offset the costs for individuals.
It has been reported that the direct and indirect costs of Alzheimer's and other dementias amount to more than $148 billion annually in the United States alone. The financial cost of caring for someone with Alzheimer's disease can be overwhelming and is estimated to be about $50,000 per year in direct medical expenses.
There is no known cure for Alzheimer's disease, although researchers have made progress on determining the causes of Alzheimer's.
Background
Alzheimer's disease (AD) is an irreversible, progressive disorder in which neurons (brain cells) deteriorate resulting in the loss of cognitive (thought) functions, primarily memory, judgment, reasoning, movement coordination, and pattern recognition. In advanced stages of the disease, all memory and mental functioning may be lost.Alzheimer's disease may cause death; it is the eighth leading cause of death in the United States. However, an individual with AD often dies from an additional illness like pneumonia.
Alzheimer's disease is the most common form of dementia. Dementia is a group of disorders that impairs mental functioning. Dementia means loss of the ability to think. Alzheimer's is progressive and irreversible. Abnormal changes in the brain worsen over time, eventually interfering with many aspects of brain function. Memory loss is one of the earliest symptoms, along with a gradual decline of other intellectual and thinking abilities, called cognitive functions, and changes in personality or behavior. Other forms of dementia include vascular dementia (due to a lack of blood flow to the brain), mixed dementia (presence of both Alzheimer's and vascular dementia), and Creutzfeldt-Jakob disease (rapidly declining memory and cognition due to consumption of cattle with "mad-cow" disease).
Alzheimer's advances in stages, progressing from mild forgetfulness and cognitive impairment to widespread loss of mental abilities. In advanced Alzheimer's, people become dependent on others for every aspect of their care. The time course of the disease varies by individual, ranging from five to 20 years. The most common cause of death is infection.
Age is the most important risk factor for AD. The number of people with the disease doubles every five years beyond age 65.
It is estimated that about five million Americans suffer from Alzheimer's disease, and about 360,000 people are newly diagnosed every year. Alzheimer's affects about 10% of people ages 65 and up, and the number doubles roughly every ten years after age 65. Half of the population ages 85 and up may have Alzheimer's.
There are an estimated 24 million people with general dementia worldwide. Every 72 seconds in the United States, someone develops Alzheimer's. By 2050, the estimated range of Alzheimer's disease prevalence will be 11.3 million to 16 million Americans, with a middle estimate of 13.2 million unless a cure or prevention is found. Medicare and other healthcare insurances help offset the costs for individuals.
It has been reported that the direct and indirect costs of Alzheimer's and other dementias amount to more than $148 billion annually in the United States alone. The financial cost of caring for someone with Alzheimer's disease can be overwhelming and is estimated to be about $50,000 per year in direct medical expenses.
There is no known cure for Alzheimer's disease, although researchers have made progress on determining the causes of Alzheimer's.
Risk factors
Age: The risk for Alzheimer's disease (AD) increases with each decade of adult life. AD usually affects people older than 65 but rarely, it may affect those younger than 40. Less than five percent of people between 65-74 years old have AD. For people 85 and older, that number jumps to nearly 50%.Heredity: The risk of developing AD appears to be slightly higher if a first-degree relative (a parent, sister, or brother) has the disease. Although the genetic link of AD among families remains largely unexplained, researchers have identified a few genetic mutations that greatly increase risk in some families. A clear inherited pattern of AD exists in less than 10% of cases. In addition, one form of the apolipoprotein E (APOE) gene increases the chances of developing late-onset AD. Nearly all individuals with Down's syndrome who live into their 40s develop the disease. Down syndrome (DS) is a condition in which extra genetic material causes delays in the way a child develops and often leads to mental retardation. It affects one in every 800 babies born. Three genetic mutations in DNA are known to cause early-onset Alzheimer's.
Sex: It is thought that gender plays a role because several clinical studies suggest that women are afflicted with Alzheimer's disease more often than men. This was explained by the life span of women being usually longer than men. However, the evidence is inconsistent and some studies report that the disease is more common in men. Therefore, more research is needed to obtain conclusive evidence regarding prevalence in gender.
Lifestyle: The same factors that put an individual at risk of heart disease, including hypertension (high blood pressure) and hypercholesterolemia (high cholesterol), may also increase the likelihood that the person will develop AD. Poorly controlled diabetes is another risk factor. Exercise and diet are very important to prevent and control AD. Some clinical studies have suggested that remaining mentally active throughout life, especially in the later years, reduces the risk of AD. Mental activity can be doing crossword puzzles daily, reading the newspaper or books, and increasing social activities.
Education levels: Clinical studies have found an association between less education and the risk of developing AD. Some researchers theorize that the more an individual uses his/her brain, the more synapses are created, which provide a greater reserve as an individual ages. It remains unclear, however, whether less education and less mental activity create a risk of AD or if it is simply harder to detect AD in individuals who exercise their minds frequently or who have more education. Reading, working, puzzles, and social activities help exercise the mind.
Toxicity: Another theory is that overexposure to metals (such as lead, mercury, and aluminum) or chemicals may cause AD. For a time, aluminum was thought to increase the likelihood of developing AD. This was due to the findings that more individuals with AD have deposits of aluminum in their brains. After many years of studies, however, no true link to developing AD has been found with aluminum exposure. A study found that workers exposed to aluminum experienced neurotoxicity (nerve damage) and symptoms of early AD, such as decreased cognitive performance. More studies need to be performed to link heavy metals to AD.
Head injury: The observation that some ex-boxers eventually develop dementia suggests that serious traumatic injury to the head (for example, a concussion with a prolonged loss of consciousness) may be a risk factor for AD. Findings are mixed and more research is needed.
Hormone replacement therapy: The exact role hormone replacement therapy (HRT) may play in the development of dementia and AD is not yet clear. Early evidence seemed to report that estrogen supplements given after menopause could reduce the risk of dementia and AD. But results from the large-scale Women's Health Initiative Memory Study indicated an increased risk of AD for women taking estrogen after age 65. The verdict is not yet in on whether estrogen affects the risk of dementia and AD if given at an earlier age. More research is needed.
Causes
Genetic factors: Genetic factors are known to play a role in some cases of Alzheimer's disease (AD). A gene, called the amyloid beta precursor protein (APP) gene, has been linked to the occurrence of AD in Down's syndrome patients who survive beyond 40 years. Some families with a history of early-onset AD also have a mutation on the APP gene. Another gene, the Apo E gene, also has been implicated in the disease. Apo E is a protein found with beta amyloid (a protein found in the brains of AD patients) in neuritic (inflamed nerve) plaques. Together, these genetic mutations account for less than 10% of all AD cases.Plaques and tangles: The causes of Alzheimer's disease (AD) are poorly understood, but its effect on brain tissue has been demonstrated clearly. AD damages and kills brain cells. A healthy brain has billions of nerve cells called neurons. Neurons generate electrical and chemical signals that are relayed from neuron to neuron to help an individual think, remember, and feel (physically and emotionally). Brain chemicals called neurotransmitters help these signals flow seamlessly between neurons. Initially in people with AD, neurons in certain locations of the brain begin to die. When they die, lower levels of neurotransmitters are produced, creating signaling problems in the brain. One neurotransmitter, known as acetylcholine, has been found to be deficient in the brains of those with AD. Medication treatment is based around increasing the amount of acetylcholine in the brain.
Plaques and tangles in brain tissue are considered hallmarks of Alzheimer's disease. Studies of plaques and tangles from the brains of people who have died of AD suggest several possible roles these structures might play in the disease.
Plaques are made up of beta-amyloid, a normally harmless protein. Although the ultimate cause of neuron death in AD is not known, mounting evidence suggests that a form of beta-amyloid protein may be the cause. The plaque is responsible for memory deterioration in individuals with AD.
The internal support structure for brain neurons depends on the normal functioning of a protein called tau. In people with AD, threads of tau protein undergo alterations that cause them to become twisted or tangled. Many researchers believe that this may seriously damage neurons, causing them to die.
Inflammation: Researchers have observed inflammation in the brains of some people with AD. Inflammation is the body's response to injury or infection and a natural part of the healing process. Even as beta-amyloid plaques develop in the spaces between neurons, immune cells are at work getting rid of dead cells and other waste products in the brain. Although research has found that the inflammation occurs before plaques have fully formed, it is not known how this development relates to the disease process. There is also debate about whether inflammation has a damaging effect on neurons or whether it is beneficial in clearing away plaques.
Signs and symptoms
Because early symptoms of Alzheimer's disease (AD) progress slowly, diagnosis is difficult and often delayed. The disease's course varies from person to person. Eight years is the average length of time from diagnosis of Alzheimer's to death. Survival begins to decline three years after diagnosis, but some people live more than a decade with the disease.Stages of AD: In individuals with AD, changes in the brain may begin 10-20 years before any visible signs or symptoms appear. Some regions of the brain may begin to shrink (found during brain imaging such as positron emission tomography or PET), resulting in memory loss and the first visible sign of AD. Over time, AD progresses through three main stages including mild (early), moderate, and severe.
Mild symptoms: Individuals with mild symptoms of AD often seem healthy, but mental deterioration, such as memory impairment and confusion, are occurring. Symptoms and early signs of Alzheimer's disease may include: difficulty learning and remembering new information, difficulty with daily tasks (such as managing finances, planning meals, and taking medication on schedule), and depression symptoms (sadness, decreased interest in usual activities, loss of energy). The individual is usually still able to do most activities such as driving a car, but may get lost going to familiar places. People with early and mild symptoms of AD may exhibit mood swings. They may express distrust in others, show increased stubbornness, and withdraw socially. This may be a response to the frustration they feel as they notice uncontrollable changes in their memory. Restlessness also is a common sign. As the disease progresses, people with Alzheimer's may become anxious or aggressive and behave inappropriately.
Moderate symptoms: In individuals with moderate symptoms of AD, the damaging processes occurring in the brain worsen and spread to other areas that control language, reasoning, sensory processing, and thought. In this stage, symptoms and signs of AD become more severe and behavioral problems may become more obvious. Signs and symptoms of moderate Alzheimer's disease may include forgetting old facts, continually repeating stories, and/or asking the same questions over and over. The individual may make up stories to fill memory gaps. They have difficulty performing tasks such as keeping a checkbook, shopping for groceries, or following written notes. The individual may not shower or go to the toilet as they did previously, and help with these tasks is needed. They become agitated and restless easily. Repetitive movements, such as rocking to and fro or rubbing the hands, are seen. The individual may wander off and needs to be watched closely. Paranoia, delusions, and hallucinations may occur. Deficiencies in intellect and reasoning, along with a lack of concern for appearance, hygiene, and sleep, become more noticeable.
Severe symptoms: In the advanced stage of AD, damage to the brain's nerve cells is widespread. At this point, full-time care is typically required. The patient is generally bed-ridden. For friends, family, and Alzheimer's caregivers, this can be the most difficult stage. Individuals with severe Alzheimer's disease may have difficulty walking and they often suffer complications from other illnesses such as pneumonia. Signs of severe Alzheimer's disease may include groaning, screaming, mumbling, or speaking gibberish. They refuse to eat and may inappropriately cry out. Individuals with severe or advanced symptoms fail to recognize the faces of family members or caregivers. Apraxia (inability to perform physical tasks such as dressing, eating) and aphasia (loss of ability in comprehension of spoken or written language) are seen. They have great difficulty with all essential activities of daily life.
Diagnosis
There's no one test to diagnose Alzheimer's disease (AD). Typically, doctors start the diagnostic process by ruling out other diseases and conditions that may also cause memory loss. Small, undetected strokes, which are a lack of oxygen to the brain causing neurological damage, can cause dementia. Individuals with Parkinson's disease, a degenerative nerve disorder, also may develop dementia. Depression can also cause lapses in memory. In addition, many older adults are on multiple medications that may decrease their ability to think clearly.Medical history: Questions regarding general health and current medications will be asked. Past medical problems, including diseases and surgeries, will be discussed. Family members will usually be involved in the medical history process.
Blood tests: Blood tests to determine basic health will be used. A complete blood count (CBC) will determine thyroid problems, electrolyte (such as sodium and potassium) balances, vitamin deficiencies, and immune health.
Mental status evaluation: A Mental Status Evaluation (MSE) screens memory, problem-solving abilities, attention spans, counting skills, and language skills. Questions such as "what day is it today?" or "who is the president of the United States?" may be asked. Recall tests are another example. Doctors may list familiar objects and then ask a person to repeat them immediately and again five minutes later. The Clock Drawing Test, the Mini-Mental State Examination (MMSE), and the Functional Assessment Staging (FAST) are commonly used mental status evaluation tools for determining if AD is present. On the tests, the final score helps confirm a diagnosis of AD.
Sometimes doctors will more extensively assess memory, problem-solving abilities, attention spans, counting skills, and language. This is especially helpful in trying to detect AD and other dementias at an early stage. Doctors use formal psychological tests to determine if an individual's mental abilities are as expected for his or her age and education. The patterns of any mental deficits observed during neuropsychological testing can help doctors sort out possible causes of dementia.
Brain scans: Doctors may want to take a picture of the brain using a brain scan. Several types of brain scans are available including computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan, and positron emission tomography (PET) scan. Doctors can pinpoint visible abnormalities in the brain using these imaging techniques. A CT scan uses x-rays to take many pictures of the brain and then combines the pictures by computer that provides a detailed picture. A CT scan can often show changes in brain structure. MRI's for AD diagnosis display a cross-section of the brain using radio waves and strong magnets instead of radiation. A contrast dye may be injected, although it is used less often with MRI's. PET scans involve the injection of radioactivity into the blood that goes to the brain. Images can then be analyzed for changes in function and structure of the brain. They may take longer than CT scans and the patient is placed inside a confining tube. CT, MRI, and PET are performed at a clinic or hospital. Some individuals will be sedated with mild sedatives (such as alprazolam or Xanax® or midazolam or Versed®). These medications may cause drowsiness and it is not recommended that the individuals drive. The individual should bring a friend or family member with them to the clinic or hospital.
Genetic testing: Due to the discovery of genes that are associated with developing AD, genetic testing may be used in the future as a routine diagnostic tool for determining the chances of developing AD. Genetic testing is not approved by the U.S. Food and Drug Administration (FDA) for use in AD diagnosis.
Complications
Mental Illness: Depression is common in patients with Alzheimer's disease (AD), especially during the earlier stages when they may be aware of losing mental functions.Falls and their complications: Individuals with AD may become disoriented, increasing their risk of falls. Falls can lead to bone fractures that require hospitalization, medications, and surgery. Falls may also lead to an increase in the severity of AD symptoms, such as confusion and agitation. In addition, falls are a common cause of serious head injuries, such as brain hemorrhage (bleeding in the brain). Long-term immobilization after surgery and hospitalization may also increase the risk of a pulmonary embolism (blood clot in the lungs), which can be life-threatening.
Infections: In advanced Alzheimer's disease, people may lose all ability to care for themselves. This can make them more prone to additional health problems such as pneumonia (a bacterial infection of the lungs and respiratory system). They may have difficulty swallowing food and liquids, which may cause individuals with AD to inhale some of what they eat and drink into their airways and lungs, which may then lead to pneumonia.
Urinary incontinence: Urinary incontinence, or the loss of bladder control causing urine leakage, may require the placement of a urinary catheter, which increases the risk of urinary tract infections (UTIs). UTIs can lead to more serious, life-threatening infections.
Treatment
The primary symptoms of Alzheimer's disease (AD) include memory loss, disorientation, confusion, and problems with reasoning and thinking. These symptoms worsen as brain cells die and the connections between cells are lost. Progressive loss of brain cells usually occurs. Although current drugs cannot alter the progressive loss of cells, they may help minimize or stabilize symptoms. These medications may also delay the need for nursing home care.Cholinesterase inhibitors: The U.S. Food and Drug Administration (FDA) has approved two classes of drugs to treat cognitive symptoms of AD. The first to be approved were cholinesterase inhibitors, which increase the amount of the brain chemical acetylcholine. Three of these drugs that are commonly prescribed include donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®). Tacrine (Cognex®), the first cholinesterase inhibitor, was approved in 1993 but is rarely prescribed today because of associated side effects including possible liver damage. About half of the people who take cholinesterase inhibitors experience a modest improvement in cognitive symptoms, such as memory. Side effects include diarrhea, vertigo (dizziness), drowsiness, fatigue (extreme tiredness), nausea, and vomiting. Individuals with liver disease, peptic ulcer disease, chronic obstructive pulmonary disease (COPD), and slow heart rate should not take these drugs.
Memantine: Memantine (Namenda®) is a drug approved by the FDA for treatment of moderate to severe Alzheimer's disease. Memantine is the first AD drug of this type approved in the United States. It appears to work by regulating the activity of glutamate, one of the brain's specialized messenger chemicals involved in information processing, storage, and retrieval. Glutamate plays an essential role in learning and memory. Excess glutamate, on the other hand, may lead to disruption and death of brain cells. Memantine may protect cells against excess glutamate by partially blocking NMDA receptors. Side effects include headache, constipation, confusion, and dizziness.
Other medications: Medications may be needed to treat the symptoms associated with AD. These symptoms interfere with normal daily activities and sleeping. Depression that occurs during the early stages is commonly treated with antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) including fluoxetine (Prozac®) and sertraline (Zoloft®), and the tricyclic antidepressants (TCAs) including amitriptyline (Elavil®). Side effects include drowsiness, fatigue, and sedation. TCAs may increase mental confusion. Agitation may be treated with antipsychotic medication, such as haloperidol (Haldol®), risperidone (Risperdal®), olanzapine (Zyprexa®), and quetiapine (Seroquel®). Antipsychotics are not FDA-approved to treat symptoms of AD and may increase the risk for death in elderly dementia patients. Side effects include sedation, confusion, and tardive dyskinesia (an irreversible movement disorder characterized by lip smacking, facial grimacing, and unsteady walking).
Prognosis: Patients may survive eight to 10 years with AD. Some have been known to live 25 years with the disease. Death usually occurs due to infections (including pneumonia), heart disease, or malnutrition.
Integrative therapies
Strong scientific evidence:Ginkgo: Ginkgo biloba has been used medicinally for thousands of years. The scientific literature overall does suggest that ginkgo benefits people with early stage Alzheimer's disease and multi-infarct dementia, and may be as helpful as acetylcholinesterase inhibitor drugs such as donepezil (Aricept®). Well-designed research comparing ginkgo to prescription drug therapies is needed. Ginkgo may cause bleeding, especially in sensitive individuals such as those taking medications for bleeding disorders (including warfarin or Coumadin®).
Good scientific evidence:
Aromatherapy: Aromatherapy is the use of essential oils from plants for healing purposes. There is suggestive preliminary evidence that aromatherapy using essential oil of lemon balm (Melissa officinalis) can effectively reduce agitation in people with severe dementia when applied to the face and arms twice daily. Other research reports that steam inhalation of lavender aromatherapy may have similar effects. However, there is a conflicting study that reports no benefits of aromatherapy using lemon balm, Lavender officinalis, sweet orange (Citrus aurantium), or tea tree oil (Malaleuca alternifolia). Overall, the evidence does suggest potential benefits. It is not clear if this is because of anxiety-reducing qualities of these therapies. Additional study is necessary. There is also preliminary research suggesting that aromatherapy used with massage may help to calm people with dementias who are agitated. However, it is not clear if this approach is any better than massage used alone.
Bacopa: Bacopa monnieri leaf extract is called brahmi in Ayurvedic medicine (medicine practiced in India) and is widely used in India for enhancing memory, pain relief, and treating epilepsy. Although bacopa is traditionally used in Ayurvedic medicine to enhance cognition, high-quality clinical trials are lacking. Two methodologically weak studies found some evidence that bacopa improves cognition. However, more high-quality and independent research is needed before bacopa can be recommended for enhancing brain function in adults or children. Bacopa may interact with medications such as calcium channel blockers (used for arrhythmias and high blood pressure), thyroid medications, phenytoin (Dilantin®), and drugs metabolized by the liver.
Ginseng: Several clinical studies report that ginseng (Panax ginseng) can modestly improve thinking or learning. Mental performance has been assessed using standardized measurements of reaction time, concentration, learning, math, and logic. Benefits have been seen both in healthy young people and in older ill patients. Effects have also been reported for the combination use of ginseng with Ginkgo biloba. However, some negative results have also been reported. Therefore, although the sum total of available scientific evidence does suggest some effectiveness of short-term use of ginseng in this area, better research is necessary before a strong recommendation can be made.
Music therapy: Music is used to influence physical, emotional, cognitive and social well-being and improve quality of life for healthy people as well as those who are disabled or ill. It may involve either listening to or performing music, with or without the presence of a music therapist. In people with Alzheimer's dementia and other mental disorders in older adults, music therapy has been found to reduce aggressive or agitated behavior, improve mood, and improve cooperation with daily tasks such as bathing. Music therapy may also be beneficial for dementia-associated neuropsychiatric symptoms, such as depression and aggressive behavior.
Sage: Early evidence suggests that sage oil may be useful in the treatment of Alzheimer's disease. Additional study is needed in this area. Use cautiously with hypertension (high blood pressure). Use the essential oil or tinctures cautiously in patients with epilepsy. Avoid if pregnant or breastfeeding.
Unclear or conflicting scientific evidence:
Acupuncture: Acupuncture has been reported to help improve memory and cognitive performance in the elderly. However, there is insufficient available evidence for the use of acupuncture in cognitive and communication disorders. More research is necessary.
Art therapy: Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. The aesthetic aspect of the creation of art is thought to lift one's mood, boost self-awareness, and improve self-esteem. Art therapy also allows the opportunity to exercise the eyes and hands, improve eye-hand coordination, and stimulate neurological pathways from the brain to the hands. Art therapy may be an effective means of improving quality of life in the elderly. There is evidence that the non-directed use of visual art (pictures) as a means of encouraging communication among elderly nursing home residents may increase well-being. It may also reduce blood pressure and improve medical health status with regard to reported dizziness, fatigue, pain, and use of laxatives.
Boron: Boron is a mineral that is essential for health. Preliminary human studies report better performance on tasks of eye-hand coordination, attention, perception, short-term memory, and long-term memory with the use of boron. Although boron has not been studied in AD, it may be beneficial in improving memory.
Coenzyme Q10: Coenzyme Q10, or CoQ10, is produced by the human body and is necessary for the basic functioning of cells. Promising preliminary evidence suggests that CoQ10 supplements may slow down, but not cure, dementia in people with Alzheimer's disease. Additional well-designed studies are needed to confirm these results before a firm conclusion can be made.
Copper: Copper is a mineral that occurs naturally in many foods including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Conflicting study results report that copper intake may either increase or decrease the risk of developing Alzheimer's disease. Additional research is needed.
Cranberry: Preliminary study results show that cranberry juice may increase overall ability to remember. Further well-designed clinical trials are needed to confirm these results. It is best not to use sweetened cranberry juice or cranberry juice cocktail due to the high sugar content. The use of 100% cranberry juice products are recommended by healthcare providers.
Melatonin: Melatonin is a naturally occurring hormone that helps regulate the sleep/wake cycles (circadian rhythm). There is limited study of melatonin for improving sleep disorders associated with Alzheimer's disease (including nighttime agitation or poor sleep quality in patients with dementia). It has been reported that natural melatonin levels are altered in people with Alzheimer's disease, although it remains unclear if supplementation with melatonin is beneficial. Further research is needed in this area before a firm conclusion can be reached.
DHEA: Dehydroepiandrosterone (DHEA) is an endogenous hormone (made in the human body) and secreted by the adrenal gland. DHEA serves as precursor to male and female sex hormones (androgens and estrogens). DHEA levels in the body begin to decrease after age 30 and may need to be taken as supplements.
Folic acid: Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food and folic acid is the synthetic form of this vitamin. Preliminary evidence indicates that low folate concentrations might be related to Alzheimer's disease. Well-designed clinical trials of folate supplementation are needed before a conclusion can be drawn.
Guided imagery: The term guided imagery may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Early research suggests that guided imagery of short duration may improve working memory performance. Further research is needed before a firm conclusion can be drawn.
Kundalini yoga: Kundalini yoga is one of many traditions of yoga that share common roots in ancient Indian philosophy. It is comprehensive in that it combines physical poses with breath control exercises, chanting (mantras), meditations, prayer, visualizations, and guided relaxation. Breathing exercises are an important part of Kundalini yoga. There is some evidence from studies with healthy volunteers that use of certain breathing techniques (such as breathing solely through one nostril or the other) may improve different aspects of cognitive functioning. More studies are needed to determine if these techniques can reliably be used to improve cognitive performance and possibly aid in treating cognitive and nervous system disorders.
Lemon balm: Clinical data suggest that the use of standardized lemon balm (Melissa officinalis) extract has some effect on particular self-reported measures of mood and cognition. More rigorous studies need to be conducted using patient-relevant outcomes to better assess the validity of these results as they apply to patient care.
Massage: Massage with or without essential oils has been used in patients with dementia in chronic care facilities to assess effects on behavior. There is compelling early evidence that aromatherapy with essential oils may reduce agitation in patients with dementia, although the effects of massage itself are not clear.
Pet therapy: In the institutionalized elderly, there is evidence that pet therapy may reduce depression and blood pressure, reduce irritability, reduce agitation, and increase social interaction. In Alzheimer's disease, there is evidence that the presence of a companion animal may increase social behaviors such as smiles, laughs, looks, leans, touches, verbalizations, or name-calling.
Riboflavin: Adequate nutrient supplementation with riboflavin (vitamin B2) may be required for the maintenance of adequate cognitive function. Treatment with B-vitamins including riboflavin has been reported to improve scores of depression and cognitive function in patients taking tricyclic antidepressants. This may be related to tricyclic-caused depletion of riboflavin levels.
Vitamin B1: Because thiamin (vitamin B1) deficiency can result in a form of dementia (Wernicke-Korsakoff syndrome, a neurological condition), its relationship to Alzheimer's disease and other forms of dementia has been investigated. Whether thiamin supplementation is of benefit in Alzheimer's disease remains controversial. Further evidence is necessary before a firm conclusion can be reached.
Vitamin B12: Some patients diagnosed with Alzheimer's disease have been found to have abnormally low vitamin B12 (cyanocobalamin) levels in their blood. However, vitamin B12 deficiency itself often causes disorientation and confusion and thus mimics some of the prominent symptoms of Alzheimer's disease. Well-designed clinical trials are needed.
Vitamin E: Vitamin E has been proposed and evaluated for the prevention or slowing of dementia (including Alzheimer's type), based on antioxidant properties and findings of low vitamin E levels in some individuals with dementia. There is some evidence that all-rac-alpha-tocopherol (synthetic vitamin E) is similar in effects to a commonly used drug for AD, selegiline (Eldepryl®), in slowing cognitive function decline in patients with moderately severe Alzheimer's disease. No additive effect was observed when used in combination with selegiline. Retrospective data suggests that long-term combination therapy with donepezil (Aricept®) may help slow cognitive decline in patients with Alzheimer's disease. Overall, the evidence remains inconclusive in this area. Other research suggests that vitamin E from dietary sources or supplements does not affect the risk of developing Alzheimer's disease or vascular dementia. Vitamin E may cause bleeding, especially in sensitive individuals such as those taking medications for bleeding disorders (including warfarin or Coumadin®).
Other supplements that have unclear or conflicting scientific evidence include black and green tea (Camellia sinensis), iodine, iron, omega-3 fatty acids (fish oils), policosanol (sugar cane wax), soy (Glycine max), and yoga.
Historical or theoretical uses lacking sufficient evidence:
Integrative therapies used in Alzheimer's disease treatment that have historical or theoretical uses but lack sufficient clinical evidence include: 5-HTP (5-hydroxytryptophan), ashwagandha (Withania somnifera), astaxanthin, cat's claw (Uncaria tomentosa), cordyceps (Cordyceps sinensis), garlic (Allium sativum), gotu kola (Centella asiatica), hypnosis, muira puama (Ptychopetalum olacoides), rosemary (Rosmarinus officinalis), taurine, turmeric (Curcuma longa), and zinc.
Prevention
Healthy aging: Some of the most recent research indicates that taking steps to improve cardiovascular (heart) health, such as losing weight, exercising, and controlling hypertension (high blood pressure) and high cholesterol, may also help prevent Alzheimer's disease (AD).Nonsteroidal anti-inflammatory drugs (NSAIDs): Several clinical studies have reported that the NSAIDs ibuprofen (Advil® or Motrin®), naproxen sodium (Aleve®), and indomethacin (Indocin®, a prescription drug) may reduce the risk of developing Alzheimer's. This may be because inflammation appears to play a role in Alzheimer's. Because NSAIDs can cause stomach and intestinal bleeding and kidney problems, clinical trials need to be completed before it's clear whether individuals should take NSAIDs solely to prevent Alzheimer's.
Statins: Statin drugs are used to lower cholesterol levels. They include atorvastatin (Lipitor®) and simvastatin (Zocor®). Recent studies have reported that "statin" drugs may reduce the risk of AD. More studies are being done to determine exactly what role, if any, statins may have in Alzheimer's prevention. Researchers believe that statins help improve blood flow to the brain by decreasing particles in the blood such as cholesterol and triglycerides.
Selective estrogen receptor molecules (SERMs): A drug called a selective estrogen receptor molecule (SERM, including raloxifene or Evista®) is used to protect against the bone loss associated with osteoporosis. It also appears to lower the risk of developing mild cognitive impairment, a memory disorder that often precedes Alzheimer's. The mechanism is not known.
Mental fitness: Maintaining mental fitness may delay onset of dementia. Some researchers believe that lifelong mental exercise and learning may promote the growth of additional synapses, the connections between neurons, and delay the onset of dementia. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure dementia. Doing crossword puzzles, reading books, and increasing social activities are recommended by healthcare providers.
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Natural Standard is an international research collaboration that aggregates and synthesizes data on complementary and alternative therapies. Using a comprehensive methodology and reproducible grading scales, information is created that is evidence-based, consensus-based, and peer-reviewed, tapping into the collective expertise of a multidisciplinary Editorial Board. The mission of this collaboration is to provide objective, reliable information that aids clinicians, patients, and healthcare institutions to make more informed and safer therapeutic decisions. Natural Standard is widely recognized as one of the worlds premier sources of information in this area.Bibliography
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The Family Caregiver Alliance. www.caregiver.org.
Fisher Center For Alzheimer's Research Foundation. www.alz.org.
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National Association of Neurological Disorders and Stroke. www.ninds.nih.gov.
National Institute on Aging. www.nia.nih.gov.
National Institutes of Mental Health. www.nimh.nih.gov.
Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2009.
Polizzi S, Pira E, Ferrara M, et al. Neurotoxic effects of aluminium among foundry workers and Alzheimer's disease. Neurotoxicology. 2002;23(6):761-74. View Abstract.
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Related Terms
Acetylcholine, amyloid beta precursor protein, APOE, apolipoprotein E, APP, bradycardia, cholinesterase inhibitor, chronic obstructive pulmonary disease, cognition, cognitive, computerized tomography, concussion, COPD, Creutzfeldt-Jakob disease, CT, dementia, eurotoxicity, hemorrhage, hypercholesterolemia, hypertension, inflammation, magnetic resonance imaging, MRI, neuritic, neurons, neurotransmitters, non-steroidal anti-inflammatory drug, NSAID, PET, pneumonia, positron emission tomography, pulmonary embolism, statin, tau, vascular dementia.
Natural Standard Bottom Line Monograph, Copyright © 2009 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intendedfor informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
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