Complementary and Integrative Approaches to Dementia

Víctor S. Sierpina, MD; Michelle Sierpina, MS; Jose A. Loera, MD; Loretta Grumbles MD

Disclosures

South Med J. 2005;98(6):636-645. 

In This Article

Abstract and Introduction

This is a review that evaluates complementary and alternative approaches to dementia and places them into an integrative framework. While many therapies in popular use have yet to be supported by best-evidence trials or meta-analysis, conventional treatments for dementia are clearly suboptimal. This encourages both health care providers and patients' families to expand their search for options for this difficult condition. We provide an in-depth review of mind-body and biologic therapies that have been studied or are in use for Alzheimer disease to provide a context for the busy clinician along with levels of evidence supporting them. Several principles emerge: the need for holism of care, support for care providers, the importance of social engagement and behavioral interventions, and the limited role of medication, nutriceuticals, and botanicals. Without dramatic and well-proven therapies, we find there is hope for the future in clinical care and research advances based on a number of promising therapies we describe.

The rapid growth of the elderly population in our society, particularly those over 80 years of age, has been a bittersweet success for contemporary medicine and society. While people are living longer in good health, Alzheimer disease (AD) or multi-infarct dementia (MDI) significantly affects the quality of life and survival of many. It is estimated that in the United States alone, approximately four million people suffer with AD. This number is expected to double within 2 decades and reach 16 million by 2050. Although there are several other kinds of dementias, including Parkinson dementia, dementia with Lewy Bodies, Creutzfeldt-Jakob disease, and Huntington disease,[1] this review will focus solely on AD and MDI.

Unfortunately, in the face of this rising tide, contemporary medical practice often has little to offer. The title of a review article in a prominent neurology journal 5 years ago asked, Do we have drugs for dementia? No.[2] That succinct summary, while bleak, continues to reflect the field of dementia care and research. The horizon may include vaccines or drugs directed against the amyloid plaque build-up found in AD patients, but this work is quite preliminary.[3]

Ginkgo biloba, an herbal product long used in traditional Chinese medicine, has been studied extensively and found to be well tolerated with mild benefit, approximating that of the 2nd generation cholinesterase inhibitors.[4] Many other herbs, antioxidants, and nutritional supplements have been offered to support health and delay the progression of dementia. Blueberries, for example, rich in antioxidants and proanthocyanidins, have been shown to be helpful to a healthy brain and perhaps delay dementia.[5] Many products are advocated as part of comprehensive "brain longevity"[6] or "anti-aging"[7] programs ( Table 1 , Table 2 , Table 3 ). Their use is not generally buttressed by adequate prospective randomized controlled trials, though. Mind-body approaches are intrinsic to all such programs.

In the absence of pharmaceuticals, nutriceuticals, botanicals, or other substantially effective biologic medicines, prevention remains the first defense against dementia. Such measures as optimization of blood pressure, improving serum lipids, an anti-inflammatory diet rich in fruits and vegetables, regular exercise, avoidance of smoking, and reduction in alcohol consumption remain mainstays of prevention. Public health measures and a global biomedical ethic addressing the long-term impact of environmental degradation are essential in an integrally informed approach to dementia and other health problems of aging. Social interaction, stress reduction, biobehavioral, and psychosocial influences optimize functioning of the geriatric patient.

Indeed, in a thoughtful editorial, Whitehouse startlingly challenges the predominant biologic view of AD as myopic, culturally insensitive, and industry driven.[8] While many advances in functional genomics, proteonomics, pharmacology, and pathophysiology have helped in the understanding of dementia, Whitehouse argues that this is only part of the picture. In many societies, views of healthy aging, changing social roles in different life stages, specific cultural beliefs, and community practices significantly alter the way cognitive changes of aging are addressed. Tribal or village culture, unfettered by modern society's preoccupation with speed, innovation, and productivity, value the traits of long-term memory—precisely those elements of memory which are often well preserved in dementia. Ancient rituals and values, hunting and planting patterns, traditional healing lore, and archetypal stories are kept safe in the elders' minds. New roles and social expectations for elders in contemporary society can result from deconstructing the concept of cognitive loss as a pathologic state. Mental changes may be seen as a range from mild cognitive impairment, benign senile forgetfulness, aging-associated memory loss, to full-blown dementia. By re-valuing the contributions of elders in our society, much of the anxiety precipitated by the occasional senior moment can be alleviated. Indeed, stress about mildly failing abilities may precipitate a downward spiral in which the senior increasingly loses confidence and self-esteem, withdrawing into a more isolated world.

Since the current state of medical science provides few truly effective therapeutic options for dementia, creative complementary approaches are needed. These must be integrated with conventional care despite, or even because of its limitations. Mind-body and biobehavioral approaches are a subset of such therapies.

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