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Background |
Risk factors |
Causes |
Signs and symptoms |
Diagnosis |
Complications |
Treatment |
Integrative therapies |
Prevention |
Author information |
Bibliography
Dementia
Dementia refers to a loss of cognitive function (an intellectual process resulting in an understanding, perception, or awareness of one's thoughts and ideas). Dementia can be caused by changes in the brain such as those associated with disease or trauma. The changes may occur gradually or quickly.Cognition is the act or process of thinking, perceiving, and learning. Cognitive functions that may be affected by dementia include decision making, judgment, memory, spatial orientation, thinking, reasoning, and verbal communication. Dementia may also result in behavioral and personality changes, depending on the area(s) of the brain affected.
Dementia is actually a word for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. Individuals with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose the ability to solve problems or control emotions and their personalities may change. These individuals may become agitated or hallucinate.
Dementia usually results from a widespread destruction of, or interference with, brain cells. Consequently, there is a loss of mental functions previously controlled by those cells.
Many different diseases can cause dementia, including Alzheimer's disease, Huntington's disease (an inherited movement disorder), and stroke (neurological damage due to a lack of oxygen to the brain). Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve symptoms or slow down the disease.
Dementia can be progressive, such as with Alzheimer's disease, or occur for a short period of time, perhaps as the result of a head injury.
Progressive dementia is most common among the elderly. These individuals are usually termed "senile." However, dementia should not be considered a part of the normal aging process. Most individuals who reach their elderly years do not develop dementia.
Some dementia is reversible and can be cured partially or completely with a doctor's treatment. The degree of reversibility often depends on how quickly the underlying cause is treated. Irreversible dementia is caused by an incurable condition (such as in Alzheimer's disease and Huntington's disease). Individuals with irreversible dementia are eventually unable to care for themselves and may require constant care.
An estimated two million people in the United States suffer from severe dementia and another one to five million people experience mild to moderate dementia. Approximately five to eight percent of individuals over the age of 65 have some form of dementia; the number doubles every five years over age 65.
Background
Dementia refers to a loss of cognitive function (an intellectual process resulting in an understanding, perception, or awareness of one's thoughts and ideas). Dementia can be caused by changes in the brain such as those associated with disease or trauma. The changes may occur gradually or quickly.Cognition is the act or process of thinking, perceiving, and learning. Cognitive functions that may be affected by dementia include decision making, judgment, memory, spatial orientation, thinking, reasoning, and verbal communication. Dementia may also result in behavioral and personality changes, depending on the area(s) of the brain affected.
Dementia is actually a word for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. Individuals with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose the ability to solve problems or control emotions and their personalities may change. These individuals may become agitated or hallucinate.
Dementia usually results from a widespread destruction of, or interference with, brain cells. Consequently, there is a loss of mental functions previously controlled by those cells.
Many different diseases can cause dementia, including Alzheimer's disease, Huntington's disease (an inherited movement disorder), and stroke (neurological damage due to a lack of oxygen to the brain). Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve symptoms or slow down the disease.
Dementia can be progressive, such as with Alzheimer's disease, or occur for a short period of time, perhaps as the result of a head injury.
Progressive dementia is most common among the elderly. These individuals are usually termed "senile." However, dementia should not be considered a part of the normal aging process. Most individuals who reach their elderly years do not develop dementia.
Some dementia is reversible and can be cured partially or completely with a doctor's treatment. The degree of reversibility often depends on how quickly the underlying cause is treated. Irreversible dementia is caused by an incurable condition (such as in Alzheimer's disease and Huntington's disease). Individuals with irreversible dementia are eventually unable to care for themselves and may require constant care.
An estimated two million people in the United States suffer from severe dementia and another one to five million people experience mild to moderate dementia. Approximately five to eight percent of individuals over the age of 65 have some form of dementia; the number doubles every five years over age 65.
Risk factors
Age: The greatest risk factor for dementia is advanced age. Dementia is considered a late-life disease because it tends to develop mostly in elderly people. About five to eight percent of all people over the age of 65 have some form of dementia; this number doubles every five years above that age. It is estimated that as many as half of people in their 80s suffer from dementia. Research has determined that a decline in cerebral glucose metabolism commonly found in advanced aging may be a risk factor in the development of dementia.Heredity: The risk of developing dementia, such as dementia associated with Alzheimer's disease or Huntington's disease, appears to be slightly higher if a first-degree relative (a parent, sister, or brother) has the disease.
Trauma: Trauma to the brain can result in damage to brain cells, leading to dementia. Brain trauma can result from accidents (such as motor vehicle wrecks and falls), assaults (such as gunshot wounds or beatings), or from sports activities (such as boxing) without protective gear. Dementia caused as a result of trauma can be permanent or temporary, depending on the extent of damage and the ability of the individual's body to recover.
Infections: Infections of brain structures, such as meningitis (inflammation of the protective membranes in the brain) and encephalitis (inflammation of the brain), are primary causes of dementia. Other infections, such as human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) and syphilis (a bacterial sexually transmitted disease), can affect the brain in later stages. In all cases, inflammation in the brain damages cells. Damage to memory due to infection can be permanent or temporary, depending upon the extent of the damage and the ability of the individual's body to recover.
Normal pressure hydrocephalus: The brain floats in a clear fluid called cerebrospinal fluid. This fluid also fills internal spaces in the brain called ventricles. If too much fluid collects outside of the brain, it causes a condition known as hydrocephalus. This condition raises the fluid pressure inside the skull and compresses brain tissue from outside. It may cause severe damage and death. If fluid builds up in the ventricles (four communicating cavities filled with cerebrospinal fluid in the brain), the fluid pressure remains normal. This condition is known as normal pressure hydrocephalus, but it causes brain tissue to be compressed from within. The compression on the brain from the fluid build up causes a decrease in the delivery of oxygen to brain tissues, thus causing damage that can lead to permanent or temporary dementia.
Simple hydrocephalus: Simple hydrocephalus may cause typical dementia symptoms or lead to coma. The difference in simple hydrocephalus and normal pressure hydrocephalus is that individuals have trouble walking and become incontinent (unable to control urination) at the same time they start to lose mental functions, such as memory, in simple hydrocephalus. If normal pressure hydrocephalus is diagnosed early, the internal fluid pressure may be lowered by the placement of a shunt. A shunt is a medical device that helps drain excess cerebrospinal fluid from the ventricles, decreasing pressure. This can stop the dementia, gait (pattern of walking) problems, and the incontinence from becoming severe.
Brain tumors: Tumors can contribute to signs and symptoms of dementia in a number of ways. A tumor can press on structures that control hormone secretion in the brain, such as the hypothalamus or pituitary gland. Tumors can also press directly on brain cells, damaging them and causing cell death. Treating the tumor, with chemotherapy, radiation, or surgery, may reverse the symptoms in some cases.
Toxic exposure: Individuals exposed to toxic chemicals, such as those who pave roads or paint cars, especially without adequate protective equipment and ventilation, may develop dementia from the damage these substances can cause to brain cells. Some toxic exposures may be treatable and avoiding further exposure can prevent further damage.
Metabolic disorders: Diseases of the liver, pancreas, or kidneys can lead to dementia by disrupting the balances of substances in the blood, including minerals, vitamins, and sugars. Often, these changes occur rapidly and affect the individual's level of alertness and consciousness. This is called delirium. Although the individual with delirium, like the one with dementia, cannot think well or remember, treatment of the underlying disease may fully reverse the condition. If the underlying disease persists, however, brain cells may die and the individual may develop dementia.
Hormone disorders: Disorders of hormone-secreting and hormone-regulating organs, such as the thyroid gland, the parathyroid glands, the pituitary gland, or the adrenal glands, can lead to hormone imbalances. These imbalances may lead to dementia if not corrected with hormonal supplementation in the form of drugs and supplements.
Hypoxia: Hypoxia is a lack of oxygen in the body. Individuals who do not have enough oxygen in their blood may develop dementia because the blood brings oxygen to the brain cells. Brains cells need oxygen to survive. The most common causes of hypoxia are lung diseases, such as emphysema or pneumonia. These limit oxygen intake or transfer of oxygen from the airways of the lungs to the blood. Cigarette smoking is a frequent cause of emphysema. Smoking can increase hypoxic brain damage by damaging the lungs and also by increasing the levels of carbon monoxide in the blood. Heart disease leading to congestive heart failure may also lower the amount of oxygen in the blood. Sudden, severe hypoxia may also cause brain damage and symptoms of dementia. Sudden hypoxia may occur if an individual is comatose or has to be resuscitated. Vascular dementia, or dementia as a result of a lack of blood flow to the brain, can be caused by anemia. Anemia is the decreased capacity of red blood cells to carry oxygen to the body's tissues. This results in cell death, such as in the brain, causing temporary or permanent dementia.
Drugs: Some prescription and non-prescription drugs can cause temporary problems with memory and concentration as side effects, mainly in the elderly. Misuse or abuse of medications chronically (long-term), whether intentional or accidental, may lead to dementia. Illegal drugs, such as cocaine and heroin, may also lead to signs and symptoms of dementia.
Nutritional deficiencies: Deficiencies of certain nutrients, especially the B vitamins, may lead to dementia if not corrected. Homocysteine levels in the body are increased with vitamin deficiencies including folic acid, vitamin B1 (thiamin), and vitamin B12 (cyanocobalamin). Homocysteine is an amino acid, which helps build proteins in the body. An elevated homocysteine level is thought to be a risk factor for developing dementia along with increasing the risk of developing heart disease. Iron deficiency may lead to anemia, which can lead to brain cell death and eventually dementia.
Chronic alcoholism: Dementia in individuals with chronic (long-term) alcoholism is believed to be a result of other complications such as liver disease and nutritional deficiencies.
Causes
More than 50 conditions are associated with dementia, including degenerative neurological disorders (such as Parkinson's disease and Alzheimer's disease), vascular disorders (such as deep vein thrombosis), inherited disorders (such as Huntington's disease), and infectious diseases (such as human immunodeficiency virus or HIV).Alzheimer's disease: Alzheimer's disease (AD) causes 50-70% of all cases of dementia. AD is the progressive deterioration of areas in the brain essential for learning and memory.
Lewy body dementia: Lewy body dementia is similar to AD, but may progress more rapidly. Abnormal brain cells called cortical Lewy bodies occur throughout the brain and produce symptoms such as a decline in cognitive function and memory loss.
Pick's disease: Pick's disease is also similar to AD. In most patients, the frontal and temporal lobes of the brain atrophy (partial or complete wasting). This illness usually affects people between the ages of 40-60 years.
Amyotrophic lateral sclerosis: Amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease, is a progressive neuromuscular disease that weakens and eventually destroys motor neurons. Neurons are components of the nervous system that connect the brain with the skeletal muscles. Most experts believe that ALS does not affect an individual's mental processes. In most people, neither cognitive processes (such as thinking, learning, memory, and speech) nor behavior is affected. Occasionally, however, a person with ALS does experience dementia. Dementia in ALS is thought to be due to destruction of cells in the frontal lobe of the brain. Dementia is rare in ALS. It occurs in all ethnic groups and in both men and women. People aged 55-65 years are most likely to be affected.
Progressive supranuclear palsy: Progressive supranuclear palsy produces clinical features similar to Parkinson's disease and often causes severe cognitive difficulties.
Creutzfeldt-Jakob disease: Creutzfeldt-Jakob disease (CJD) is a transmissible, rapidly progressing, neurodegenerative disorder called a spongiform degeneration and is related to "mad cow disease." The initial symptom of CJD is usually a vague personality change, followed within weeks or months by rapidly progressing dementia. The dementia is often accompanied by other central nervous system problems, such as visual disturbances and involuntary jerks of the limbs termed myoclonus.
Multi-infarct disease: Multi-infarct disease is the second most common cause of irreversible dementia. In this condition, multiple strokes lead to a progressive decline in cognition. Strokes are neurological damage in the brain due to a lack of oxygen. Multiple infarct dementia is more common in men over 50 years old. A person with this condition may also experience motor weakness, urinary incontinence, and ataxia (irregular muscle coordination) and may develop hypertension, diabetes, or vascular disease.
Alcoholism: Alcoholism can lead to vitamin B1 (thiamin) deficiency, seizures, and head injuries that produce dementia. Chronic drug abuse, with drugs such as cocaine and heroin, also can cause symptoms of dementia.
Medications: Prescription and non-prescription drugs that may cause dementia include: anticholinergics, such as hyoscyamine (Levsin®) or tolterodine (Detrol®); barbiturates, such as secobarbital (Seconal®); benzodiazepines, such as alprazolam (Xanax®) and diazepam (Valium®); cough suppressants, such as dextromethorphan; digitalis (Lanoxin®); monoamine oxidase inhibitors, such as phenelzine (Nardil®); and tricyclic antidepressants (TCAs), such as amitriptylline (Elavil®), doxepin (Sinequan®), and imipramine (Tofranil®). These medications are more likely to cause signs of dementia in the elderly than in younger, healthier individuals.
Infection: Disease caused by viral, bacterial, or fungal infection can lead to impaired cognitive function. In some cases, appropriate treatment of the underlying condition can reverse symptoms. Infections that may cause dementia-like symptoms include meningitis (inflammation of the membranes that cover the brain and spinal cord) and encephalitis (inflammation of the brain). Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are viral infections that may lead to AIDS dementia complex during late stages of the disease. Antiretroviral therapy has been reported to reduce the incidence of AIDS dementia.
Neurosyphilis dementia: Neurosyphilis dementia may result from late-stage syphilis. This disease also may cause heart problems, tremors, ataxia (loss of muscle coordination), paralysis, and blindness. Damage may be irreversible.
Structural abnormalities: Structural abnormalities that can produce dementia include brain tumors located in areas involved with cognitive function, chronic subdural hematoma (blood clot in the brain) resulting from head injury (common in the elderly and alcoholics), hydrocephalus, and normal pressure hydrocephalus. Surgical treatment may relieve symptoms.
Metabolic disorders: Metabolic disorders, such as hypothyroidism (low level of thyroid hormone or thyroid stimulating hormone), hypoglycemia (low blood sugar level), hypercalcemia (high blood calcium level), and liver disease, can affect cognitive function. Treating the underlying condition can restore function.
Signs and symptoms
Symptoms develop when the underlying condition, such as Alzheimer's disease or alcoholism, affects areas of the brain involved with learning, memory, decision-making, and language.Memory impairment is often the first symptom to be noticed. An individual with dementia may be unable to remember ordinary information, such as their birth date, phone number, and address, and may be unable to recognize friends and family members.
There is a progressive decline in cognitive function, including decision making, judgment, orientation in time and space, problem solving, and verbal communication.
Behavioral changes may be found in eating, dressing, and toileting. Dementia patients may be unable to dress without help and become incontinent or lose the ability to control urine flow. Normal interests, such as hobbies and social groups, are abandoned. Routine activities, such as driving, grocery shopping, and housecleaning, are unable to be performed. Individuals with dementia also have changes in personality, such as inappropriate responses and lack of emotional control.
Trauma may cause prolonged or permanent changes in cognition, memory, emotions, or behavior.
Diagnosis
A diagnosis of dementia requires a medical history, physical examination (including neurological examination), and appropriate laboratory tests.Medical history: Taking a thorough medical history involves gathering information about the onset, duration, and progression of symptoms. Also, any possible risk factors for dementia, such as a family history of the disorder or other neurological diseases, past medical history (conditions or diseases), and drug use (prescription, recreational, and non-prescription), will be evaluated.
The American Psychiatric Association has established two generally accepted criteria for the diagnosis of dementia: (1) a decline in recent and past memory and (2) impairment of one or more of the following functions: language (aphasia or the misuse of words or inability to remember and use words correctly); motor activity (apraxia or unable to perform motor activities even though physical ability remains intact); recognition (agnosia or unable to recognize objects, even though sensory function is intact); and executive function (unable to plan, organize, and think abstractly). Symptoms often develop gradually and show a progressive deterioration in function.
Delirium: The doctor must distinguish between delirium and dementia. Delirium is a transient (occurring over a short period of time), acute mental disturbance that manifests as disorganized thinking and a decreased ability to pay attention to the external world. Delirium is often caused by infectious disease, brain tumor(s), poisoning, drug or alcohol intoxication or withdrawal, seizures, head trauma, and metabolic disorders. It is important to treat underlying conditions promptly, as they may be life-threatening or progressive if left untreated. Symptoms of delirium include disorientation related to person, place, and time, memory impairment, rambling (irrelevant, incoherent speech), and a reduced level of consciousness.
Pseudodementia: Pseudodementia, a type of severe depression that occurs mainly in elderly people, causes many older individuals to fear that their memory and other mental abilities are diminishing as they age, even if this is not the case. A doctor will determine if the individual is suffering from this condition. The cognitive changes that resemble dementia include slow motor movements and thinking and short-term memory loss. Individuals who are depressed may be apathetic and answer questions without attempting to provide the correct response. They may exhibit poor eye contact and little spontaneous movement.
Blood tests: Blood tests to determine basic health will be used. A complete blood count (CBC) will determine thyroid problems, liver health, blood sugar levels, electrolyte (such as sodium and potassium) balances, vitamin deficiencies, and immune health. Blood tests can also determine if sexually transmitted diseases exist, such as human immunodeficiency virus (HIV) or syphilis.
Neuropsychological testing: Sometimes doctors undertake a more extensive assessment of memory, problem-solving abilities, attention spans, counting skills, and language. This is especially helpful in trying to detect 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.
A Mental status evaluation 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 Alzheimer's disease or dementia are present.
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.
Electroencephalography: Electroencephalography (EEG) traces brain wave activity. Some central nervous system disorders cause distinct changes in brain wave activity. Alzheimer's disease generally reveals "slow" waves. An EEG can help distinguish a severely depressed or delirious individual whose brain waves are normal from an individual with a degenerative neurological disease.
Genetic testing: Huntington's disease is diagnosed by analyzing DNA in the blood sample to determine if the gene exists for that condition. Similarly, an analysis of DNA in the blood sample may reveal the ApoE4 gene, which is found in about one-third of Alzheimer's disease patients.
Complications
Complications depend on the underlying cause of the dementia. Complications include loss of ability to function or care for self, verbal and physical abusiveness to loved ones, loss of ability to interact, increased infections anywhere in the body, reduced life span, abuse by an overstressed caregiver, side effects of medications used to treat the disorder, and depression (common in patients with Alzheimer's disease).Infections: In severe and advanced dementia, individuals may lose all ability to care for themselves. This can make them more prone to additional health problems such as pneumonia, which is a bacterial infection of the lungs and respiratory system. The individual may have difficulty swallowing food and liquids, which may cause them to aspirate (inhale) some of what they eat and drink into their airways and lungs, which may lead to pneumonia.
Urinary incontinence may require the placement of a urinary catheter, which increases the risk of urinary tract infections. Untreated urinary tract infections can lead to more serious, life-threatening infections.
Falls and their complications: Individuals with dementia may become disoriented, increasing their risk of falls. Falls can lead to bone fractures that require hospitalization, medications, and surgery, increasing symptoms of dementia such as confusion and agitation. In addition, falls are a common cause of serious head injuries, such as brain hemorrhage (bleeding in the brain). Prolonged immobilization after surgery and hospitalization may also increase the risk of a pulmonary embolism (blood clot in the lungs), which can be life-threatening.
Treatment
In some cases, the appropriate treatment for the underlying condition can resolve dementia completely or partially. The type of treatment depends on the condition. For example, antibiotics are used to treat infection and surgery is performed to remove a blood clot or tumor.Cholinesterase inhibitors: The U.S. Food and Drug Administration (FDA) has approved two classes of drugs to treat cognitive symptoms of dementia including Alzheimer's disease. The first to be approved were cholinesterase inhibitors, which increase the amount of the brain chemical acetylcholine. The three most commonly prescribed cholinesterase inhibitors 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. 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 bradycardia (slow heartrate) 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 classified as an uncompetitive low-to-moderate affinity N-methyl-D-aspartate (NMDA) receptor antagonist, the first Alzheimer's 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 by triggering NMDA receptors to allow a controlled amount of calcium to flow into a nerve cell, creating the chemical environment required for information storage. Excess glutamate, on the other hand, over stimulates NMDA receptors to allow too much calcium into nerve cells, leading to disruption and death of 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 neurobehavioral symptoms associated with dementia. These symptoms interfere with normal daily activities and sleeping. Depression that occurs during the early stages are commonly treated with antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs) including fluoxetine (Prozac®) and sertraline (Zoloft®), and the tricyclic antidepressants (TCAs), including amitriptylline (Elavil®). Side effects include drowsiness, fatigue, and sedation. TCAs may increase mental confusion. Agitation may be treated with antipsychotic medications, such as haloperidol (Haldol®), risperidone (Risperdal®), olanzapine [Zyprexa®), and quetiapine (Seroquel®). Antipsychotics are not FDA-approved to treat symptoms of dementia and may increase the risk for death in elderly dementia patients. Side effects include sedation, confusion, and tardive dyskinesia (a movement disorder characterized by lip smacking, facial grimacing, and unsteady gait).
Long-term care: An individual with dementia may need monitoring and assistance at home or in an institution. Options include in-home care, boarding homes, adult day care, and convalescent or long-term care facilities (nursing homes).
Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may help a family care for a patient with dementia. In some communities, support groups may be available. Family counseling can help family members cope with home care.
In any care setting, there should be familiar objects and people. Lights can be left on at night to reduce disorientation. The activity schedule should be simple. Behavior modification may help some people to control unacceptable or dangerous behavior. This consists of rewarding appropriate behaviors and ignoring inappropriate ones (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may also help reduce disorientation.
Advance directives, power of attorney, and other legal actions may make it easier to decide about the care of the person with dementia. Legal advice should be sought early in the course of the disorder, before the person with dementia is unable to make such decisions.
Prognosis: The outcome of dementia varies. Dementia usually gets worse and often results in a decreased quality of life and decreased life span. Patients may survive eight to 10 years with Alzheimer's disease. Some have been known to live 25 years with the disease. Death usually occurs due to secondary 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. Aromatherapy may also help with memory improvement, but no clinical studies support this historical use. 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 dementia 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 and is widely used in India for enhancing memory, analgesia or pain control, 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.
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 neurogenic cognitive and communication disorders. Acupuncture may be more appropriate for individuals who are not combative and who do not move around excessively. 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, happiness, peacefulness, satisfaction, and calmness. 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 essential for health. Preliminary human study reports better performance on tasks of eye-hand coordination, attention, perception, short-term memory, and long-term memory with boron supplementation. However, additional research is needed before a firm conclusion can be drawn.
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.
DHEA: DHEA (dehydroepiandrosterone) 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.
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 through cholinergic activities. 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.
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.
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, name-calling, or others.
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.
TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Acupuncturists use TENS often as a complimentary method of treatment for acupuncture. Preliminary research suggests that TENS may benefit some symptoms of Alzheimer's disease, including mood, memory, and cycles of daily rest and activity. TENS is commonly used in conjunction with acupuncture and may be more appropriate for individuals who are not combative and who do not move around excessively. Additional human studies are necessary before a firm conclusion can be drawn.
Vitamin B1: Because thiamin (vitamin B1) deficiency can result in a form of dementia (Wernicke-Korsakoff syndrome), 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 efficacy to selegiline (Eldepryl®) and superior to placebo for slowing cognitive function decline in patients with moderately severe Alzheimer's disease, but 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 dementia and related conditions, such as Alzheimer's disease, 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
Diet: Some studies indicate that a largely vegetarian diet high in vitamins and minerals may lower the risk for dementia and Alzheimer's disease. Nevertheless, eating a healthy diet that is low in saturated animal fat and not smoking tobacco can reduce the risk for stroke and other cardiovascular disorders that may lead to dementia.Lifestyle: Lifestyle habits that can reduce the risk for head injury include using seat belts, wearing a helmet when riding bicycles and motorcycles, and wearing protective headgear when playing contact sports. Avoiding substance abuse and addiction can reduce the risk for dementia resulting from disease, vitamin deficiency, seizure, and head injury. Safer sex practices can help prevent human immunodeficiency virus (HIV) and syphilis infection, reducing the risk for acquired immunodeficiency syndrome (AIDS) dementia complex and neurosyphilis dementia. The risk for dementia as a result of other metabolic or toxic conditions can be reduced by receiving prompt medical attention at the first sign of illness (such as fever, pain, swelling, heat, confusion, or other impairment of cognitive function).
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 dementia. A clinical study found that individuals with mild to severe Alzheimer's disease placed on a simple exercise program (one hour twice a week) had a significantly slower cognitive decline than those on routine medical care.
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.
Non-steroidal 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 disease (AD). This may be because inflammation appears to play a role in AD. Because NSAIDs can cause gastrointestinal bleeding and kidney problems, clinical trials need to be completed before it's clear whether individuals should take NSAIDs solely to prevent AD.
Statins: Statin drugs are used to lower cholesterol levels. They include atorvastatin (Lipitor®) and simvastatin (Zocor®). Recent studies have reported that they may also reduce the risk of AD. More studies are being done to determine exactly what role, if any, statins may have in Alzheimer's prevention.
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 AD.
Author information
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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Related Terms
Acetylcholine, agnosia, alcoholism, ALS, amyloid beta precursor protein, amyotrophic lateral sclerosis, aphasia, APOE, apolipoprotein E, APP, apraxia, bradycardia, cholinesterase inhibitor, chronic obstructive pulmonary disease, cognition, cognitive, computerized tomography, concussion, COPD, Creutzfeldt-Jakob disease, CT, delirium, dementia, eurotoxicity, hemorrhage, homocysteine, Huntington's disease, hydrocephalus, hypercalcemia, hypercholesterolemia, hypertension, hypoglycemia, hypothyroidism, hypoxia, inflammation, Lewey body dementia, magnetic resonance imaging, MRI, multi-infarct disease, neuritic, neurons, neurosyphilis dementia, neurotransmitters, normal pressure hydrocephalus, non-steroidal anti-inflammatory drug, NSAID, PET, Pick's disease, pneumonia, positron emission tomography, pseudodementia, pulmonary embolism, statin, subdural hematoma, 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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