What are herbal approaches to treating memory loss, dementia, and Alzheimer's disease? - Ask the Herbalist

Townsend Letter for Doctors and Patients,  April, 2003  

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Dementia is a decline in mental functioning in which memory, thinking, judgement and the ability to concentrate are impaired. There also may be a change in personality. Dementia can develop suddenly when a severe injury, disease, or toxin destroys brain cells, or it can develop slowly, especially in senior citizens. Most commonly, short term memory loss and the reduction in learning ability is a response to atherosclerosis in seniors. This is not dementia. Dementia is a more serious decline in mental ability. For example, people with atherosclerosis may have an inability to recall detail from an event, whereas individuals with dementia may forget the entire event.

Dementia usually develops over time. Memory and the ability to recognize people, places, and objects diminish over time. Usually there are problems with word usage and abstract thinking.

The most common cause of dementia is Alzheimer's disease (AD). Currently there are approximately 4 million people in the US diagnosed with AD, and half of those over 85 years of age have AD. Although the cause of AD is not known, genetics play a role. Recent data suggests that those who take antioxidants in their diet, or who take anti-inflammatory medication have less AD (JAMA, 287, 24: 3223-9, 2002).

In Alzheimer's disease, parts of the brain degenerate, destroying brain cells and reducing the response of the brain's chemical messengers. Abnormal plaques and proteins can be observed by autopsy. The first sign may be forgetting recent events, though sometimes it starts with depression, fear, anxiety, or personality changes. Speech patterns may change. Over time the individual may deteriorate to the point where social interaction is very difficult. The second most common cause of dementia is successive strokes, known medically as multi-infarct dementia. Although weakness or paralysis is typically not observed, these small strokes destroy brain tissue caused by interrupted blood supply, known as infarcts. Most people with multi-infarct dementia have high blood pressure and! or diabetes, which damage blood vessels in the brain. Typically the dementia caused by small strokes may deteriorate or improve. If 'diabetes and hypertension can be appropriately controlled, the person may prevent future strokes and can sometimes partially recover.

Dementia may occur after a brain injury or cardiac arrest. For example, boxers often develop dementia pugilistica and may develop hydrocephalus, a brain fluid imbalance, which also produces incontinence and walking difficulties. It is also found in approximately 20% of those who have Parkinson's disease, an infectious brain disease known as Creutzfeldt-Jakob disease, and AIDS. Dementia is also seen in Lewy body dementia and Picks' disease, two uncommon conditions similar to Alzheimer's disease. Seniors who are depressed may have pseudodementia. Typically they have insomnia and loss of appetite and complain about their memory loss, whereas people with dementia often deny there is memory loss.

Depending upon the cause, dementia progresses at different rates for different people. Oftentimes the first symptom is forgetfulness. Some people are able to hide their condition well. They may avoid activities such as balancing a checkbook, reading, or working. They might forget to do important tasks like paying bills, turning off the light or stove, or have trouble distinguishing reality from fiction. For example, they can be conned or duped easily. One of our clients was convinced she had already won a million-dollar contest, when it was just an advertisement. In the most advanced cases, people become withdrawn and unable to control their behavior. They may have angry outbursts, mood swings, get lost even in familiar surroundings, or may lose the ability to speak.

Diagnosis and Treatment

Physicians diagnose dementia after questioning the patient and the family, taking into account the progression of the disease, as well as the presence of other diseases. It is essential that the patient's medication is evaluated since prescription drugs or drug interaction can be a causative factor. Other causes may be toxic exposure, thyroid imbalance, infections, nutrient deficiencies or depression.

MRI and CT scans may rule out brain tumor, hydrocephalus, or stroke. Unfortunately at the present time, Alzheimer's disease can only be diagnosed by dissecting the brain during autopsy.

Drugs used for the treatment of Alzheimer's disease include tacrine and donepezil; ibuprofen and other anti-inflammatory drugs may slow the progression of the disease. Dementia caused by small strokes cannot be medically treated, however treating coexisting conditions such as hypertension and diabetes can slow or stop the progression of symptoms. Drugs used to treat Parkinson's disease do not help dementia, and may in fact contribute to the problem. Similarly there is no known biomedical treatment for dementia caused by AIDS or infectious disease. On a positive note, if depression is the cause, antidepressants and counseling may help. If dementia is caused by hydrocephalus, removing excess fluid by shunting may help. Anti-psychotic drugs such as thorozine or haloperidol may be prescribed if the patient has paranoia or hallucinations. They are typically not very effective at controlling agitation, and can have serious side effects. Sleeping pills, anti anxiety drugs, antidepressants, and some cold remedies can worsen dementia.