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Dementia

Also listed as: Senile dementia

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

Dementia is a mental disorder that includes memory impairment and at least one of the following: difficulty with language, impaired movement, and inability to plan and initiate appropriate behaviors socially or at work. Dementia usually occurs in elderly people. The two most common causes are Alzheimer's disease and vascular trauma, such as a number of small strokes, resulting in a lack of blood flow to the brain.

Signs and Symptoms

• Memory impairment
• Language problems
• Motor skills impairment (such as balance and walking)
• Impaired ability to recognize objects
• Inability to think abstractly
• Inability to recognize friends and family
• Disorientation (getting lost in familiar places)
• Depression and suicidal behavior
• Personality changes and paranoia
• Uninhibited behavior
• Anxiety, mood, and sleep problems
• Hallucinations

What Causes It?

Alzheimer's disease accounts for half to two-thirds of all dementia cases. Other causes of dementia are as follows:

• Vascular disease
• General medical conditions, such as traumatic brain injury
• Parkinson's, Huntington's, Creutzfeldt-Jakob, and other diseases
• Brain tumor
• Vitamin B deficiencies
• Drug or alcohol abuse, medications, or exposure to toxic substances

What to Expect at Your Provider's Office

Your health care provider will go over your symptoms and do a physical examination. However, since there is no definitive test for dementia, your health care provider will rely greatly on interviews with you and your family, especially to discover noticeable declines in mental and physical abilities. Depression is sometimes mistaken for dementia in older people, so your doctor should ask questions to rule that out.

Treatment Options

Treatments are aimed at reversing or lessening the symptoms. Treatment may include a combination of drug and psychiatric or behavioral therapies. Your health care provider may also closely evaluate your medications if you are elderly and have dementia, since older people are extremely sensitive to drugs. Exercise, both physical and mental, can slow the progress of dementia.

Complementary and Alternative Therapies

Alternative therapies may help treat dementia without the side effects of pharmaceuticals. Treatment with nutrition can provide rapid results in some people with nutritional deficiencies. In others, nutritional therapy may slow the progression of the disease.

Nutrition and Supplements

• Phosphatidylserine (100 mg 3 times per day), a substance occurring naturally in the brain, shows promise in several studies. This supplement may increase levels of brain chemicals that deal with memory, according to several studies. Do not take phosphatidylserine if you are taking blood-thinning medication, and use caution if combining it with ginkgo for the same reason. There are great differences in quality among phosphatidylserine supplements. You should consider spending more for a more expensive brand, as they tend to be far superior to cheaper brands.
• Antioxidants may protect against the development of dementia. They may even slow the progression of dementia, especially vitamin E (400 - 800 IU per day) and vitamin C (1,000 mg three times per day) taken together. Another antioxidant, coenzyme Q10 (10 - 50 mg three times per day), may also help the brain get more oxygen. The skins of dark berries also provide valuable antioxidants. Many naturally-oriented physicians recommend eating half a cup of frozen blueberries daily -- freezing makes the antioxidants in the skin more easily absorbed.
• Vitamins: biotin (300 mcg); B1 (50 - 100 mg), B2 (50 mg), B6 (50 - 100 mg), B12 (100 - 1,000 mcg), folic acid (400 - 1,000 mcg). No evidence shows a direct impact, but B12 and folic acid lower the levels of an amino acid in the blood that is typically elevated in Alzheimer's patients. Injections of B12 may have the best results.
• Zinc (30 - 50 mg per day) is often deficient in elderly people, and may help improve memory.
• Some evidence suggests that L-arginine, an amino acid, may help in vascular dementia by increasing blood flow to the brain. The dose used was 1.6 g each day for 3 months.
• Essential fatty acids, such as those found in alpha linolenic acid (ALA), borage oil, and evening primrose oil, may help reduce the risk of Alzheimer's disease. Dietary changes include eating less animal fats and more fish.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Ginkgo (Ginkgo biloba) shows the best evidence for treating early Alzheimer's disease and other forms of dementia. It may be taken in a standardized extract of 40 - 50 mg three times per day. If you are taking blood-thinning medication, use ginkgo only under the supervision of your doctor.
• Huperzine A, a chemical made from the plant Huperzia serrata , has may improve memory in both vascular and Alzheimer's dementia, according to several studies in China. The usual dose is 200 mcg twice a day. Do not take huperzine A if you have liver disease or if you are about to have anesthesia.
• Hawthorn (Crataegus monogyna) is a circulatory tonic.
• Siberian ginseng (Eleutherococcus senticosus) and American Ginseng ( Panax quinquefolium ) increase endurance and improve cerebral circulation. Use these herbs with caution if you have high blood pressure.
• One study showed that lemon balm (Melissa officinalis) helped improve cognitive function in people with mild-to-moderate Alzheimer's. The dose used was 60 drops per day.

Homeopathy

Some of the most common remedies used for dementia are listed below. Usually, the dose is 3 - 5 pellets of a 12X to 30C remedy every 1 - 4hours until your symptoms get better.

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

Following Up

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

Special Considerations

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

Supporting Research

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

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:214, 376.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:136, 138, 197.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:967-968, 1101-1102, 1219-1220, 1229-1230.

Hofferberth B. The efficacy of EGb 761 in patients with senile dementia of the Alzheimer type: a double-blind, placebo-controlled study on different levels of investigation. Hum Psychopharmacol. 1994;9:215-222.

Kanowski S, Hermann WM, Stephan K, Wierich W, Horr R. Proof of efficacy of the Ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate dementia of the Alzheimer's type or multi-infarct dementia. Pharmacopsychiatry. 1996;29:47-56.

Le Bars, et al. A placebo-controlled, double-blind, randomized trial of an extract of Gingko biloba for dementia. JAMA. 1997;278:1327-1332.

Maurer K, et al. Clinical efficacy of Gingko biloba special extract EGb 761 in dementia of the Alzheimer type. J Psychiatr Res. 1997;31:645-655.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:17-18, 32-33, 124-125, 176-177, 248-249.

Morris JC, ed. Handbook of Dementing Illnesses. New York, NY: Marcel Dekker Inc; 1994.

Perry EK, Pickering AT, Wang WW, Houghton P, Perry NS. Medicinal plants and Alzheimer's disease: integrating ethnobotanical and contemporary scientific evidence. J Altern Complement Med. 1998;4:419-428.

Rai GS, Shovlin C, Wesnes KA. A double-blind, placebo controlled study of Ginkgo biloba extract in elderly patients with mild to moderate memory impairment. Curr Med Res Opin. 1991;12:350-355.

Werbach, M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing; 1988:149-154.

Xu SS, Gao ZX, Weng Z, et al. Efficacy of tablet huperzine-A on memory, cognition, and behavior in Alzheimer's disease. Zhongguo Yao Li Xue Bao. 1995;16:391–39

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

• Review Date: 6/30/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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