Tuesday, 29 October 2013

Dementia Treatments -In Traditional Chinese Medicine Perspective

I. Dementia
About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability that is severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people. American typical diet contains high amount of saturated and trans fat, artificial ingredients with less fruits and vegetable which can lead to dementia and other kind of diseases.

II. Treatments
C. In traditional Chinese Medicine Perspective(1)
In the study to evaluate the effect of TCM in dementia at the Unilever R&D Shanghai, and Unilever R&D Vlaardingen, Dr. and the team of researchers indicated that Traditional Chinese Medicine (TCM) has a 3000 years' history of human use. A literature survey addressing traditional evidence from human studies was done, with key result that top 10 TCM herb ingredients including Poria cocos, Radix polygalae, Radix glycyrrhizae, Radix angelica sinensis, and Radix rehmanniae were prioritized for highest potential benefit to dementia intervention, related to the highest frequency of use in 236 formulae collected from 29 ancient Pharmacopoeias, ancient formula books, or historical archives on ancient renowned TCM doctors, over the past 10 centuries. Based on the history of use, there was strong clinical support that Radix polygalae is memory improving. Pharmacological investigation also indicated that all the five ingredients mentioned above can elicit memory-improving effects in vivo and in vitro via multiple mechanisms of action. And according to Ancient Records on TCM for Cognitive Decline. The scientists wrote that dementia is as a result of
1. Deficiency of Energy, mainly from the kidney, heart, and spleen, especially from the kidney.
Deficiency of energy is similar to “Qi” deficiency in TCM. According TCM lore Qi is the essential substance that makes up the body and maintains various physiological activities, similar to flow of energy in the body. The energy is mainly from the kidney, heart, and spleen, especially from the kidney.  In TCM, the energy from the kidney is called kidney essence which can produce marrow including cerebral marrow, spinal cord, and bone marrow. The cerebral marrow can nourish the brain and maintain the physiological functions of the brain. If the kidney essence is insufficient, the production of cerebral marrow will be reduced, leading to various symptoms, such as headache, dizziness, amnesia, and retard response.

2.  Blood Stasis
Normally the blood is pumped by the heart to flow in the vessels. If blood circulation is stagnated or slowed down by certain factors such as cold, emotional disorder, aging, consumptive disease, and overstrain, it will result in retention of blood flow in the vessels or organs, a pathological condition named blood stasis. The cognitive function will decline, due to long-term global hypo-perfusion in cerebral blood flow or acute focal stroke in memory-related cerebral parenchyma.

3.  Toxins
As the function of internal organs in the elderly decline, the balance between host defense and external toxins in the body is disrupted. Pathological or physiological products occur and form toxin including waste of “water” and “endogenous fire”, which result from the poor digestion, accumulates into phlegm and retention of fluid, and caused by mental disorder, attack from pathological factors, and imbalance within the body, respectively. If such toxins can not be eliminated quickly the blood circulation and mental acuity will be affected, eventually contributing to the onset of dementia.

Finally, the authors summarized "in TCM philosophy, AD is assumed to be induced by kidney essence vacuity and toxin (turbid phlegm).  The amnestic mild cognitive impairment in elderly population has been disclosed in a clinical investigation to correlate with kidney essence vacuity and turbid phlegm blocking upper orifices. The whole cognitive function may worsen because of the aggravation of kidney essence vacuity, deficiency of blood and qi, phlegm and heat toxin and may eventually lead to multiple cognitive domains impairment, even dementia"

Further to the article, the authors also indicated that Catalpol, an iridoid glycoside, isolated from the fresh Radix rehmanniae and existed broadly in many plants all over the world has many biological functions such as anti-inflammation, promoting of sex hormones production, protection of liver damage, and reduction of elevated blood sugar. 
Recently, catalpol has been identified as a vital active with robust cognitive potential (Figure 4). Behaviour studies exhibited that catalpol reversed brain damage and memory deficits in mice induced by lipopolysaccharide (LPS) and D-galactose and in gerbils by cerebral ischemia. The nootropic and neuroprotective efficacy of catalpol probably resulted from a variety of underlying molecular mechanisms (Table 7).
(i)Antioxidant activity: catalpol promoted endogenous antioxidant enzyme activities,  superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and antioxidant glutathione (GSH), cut down malondialdehyde (MDA) and reactive oxygen species (ROS) generation in PC12 cells and astrocytes primary cultures, exposed to oxygen and glucose deprivation  or H2O2, and in senescent mice induced by D-galactose [79–81, 86, 89, 91, 92].

(ii)Anti-inflammatory activity: catalpol significantly reduced the release of ROS, TNF-α, nitric oxide (NO) and inducible nitric oxide synthase (iNOS) expression after Aβ (1–42)-induced microglial activation in primary cortical neuron-glia cultures, and LPS-induced nuclear factor-kappa B (NF-κB) activation in mice [78, 87].

(iii)Neurogenetic activity: catalpol can enhance axonal growth of cortical neurons cultured in vitro from 24 h newly born rat, at 1–5 mg/mL and ameliorate age-related presynaptic proteins decline (synaptophysin and GAP-43), and neuroplasticity loss in the hippocampus of the aged rats, by upregulating protein kinase C (PKC) and brain-derived neurotrophic factor (BDNF) [85, 88].

 (iv)Antiapoptotic activity: catalpol not only suppressed the downregulation of Bcl-2, upregulation of Bax, and the release of mitochondrial cytochrome c to cytosol, but also attenuated caspase-3 activation, poly-ADP-ribose polymerase (PARP) cleavage, and eventually protected against H2O2-induced apoptosis in PC12 cells and in the ischemic dorsal hippocampus of gerbils subject to CCAO [82–84, 90]. (v)In addition, the function to stimulate the production of adrenal cortical hormones, which increases the production of sex hormones, is likely implicated into the cognitive benefit of catalpol in menopausal women [92]. 

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(1) http://www.hindawi.com/journals/ecam/2012/692621/

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