CAM and Cognition: Does It Work?

Désirée A. Lie, MD, MSEd


April 23, 2013

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The 3 patients all present for advice about cognitive function. It is likely that Mrs. Lee has already tried some CAM therapies. Each patient should be asked about current and past use of CAM. Their beliefs about conventional medicine and holistic care should be explored and negotiated before recommendations are given.

For adults with normal cognitive function, such as Mrs. Lee, omega-3 fatty acids and herbal preparations, such as ginseng or ginkgo biloba, are unlikely to prevent cognitive decline. For those with vitamin D deficiency, as determined by serum levels of 25-hydroxyvitamin D, supplementation may prevent cognitive decline. Multivitamins may enhance immediate free memory recall but not other domains of cognition. Instead, Mrs. Lee may wish to begin cognitive training exercises and to consider strategies to maintain general psychological well-being, such as mind/body techniques, to preserve her cognitive function. A moderate level of exercise has also been shown to preserve cognitive function, among many other benefits.

Mr. Ortego may benefit from omega-3 fatty acids to improve immediate recall, attention, and processing speed but not memory function.[24] There is little evidence to support the use of multivitamins or vitamin D supplementation in patients with MCI who are not deficient in vitamin D to prevent progression to AD. He may wish to engage in cognitive training and moderate levels of physical activity, because there is evidence for some benefit from these approaches.

Ms. Rosenthal already has AD for which she is receiving pharmacotherapy. Before adding medications for agitation, her caregiver may wish to consider the use of daily aromatherapy to reduce agitation and improve her engagement in daily life.

In short, advice for each patient needs to be tailored for the patient's current cognitive status, current use of medications and other CAM therapies, need for other preventive approaches, and individual beliefs and cultural and social factors.