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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, severe enough to interfere with people's every
life and Alzheimer's disease is the most common type of dementia in
aging people.
V. Treatments
A. In herbal medicine perspective
1. Ginkgo Biloba(bai Guo)
Ginkgo biloba
is oldest living tree species, genus Ginkgo, belonging to the family
Ginkgoaceae, native to China, from temperate zone to subtropical zone
and some parts of north America(592). The herb been used in traditional
herbal medicine in treating impotence, memory loss, respiratory
diseases, circulatory disorders and deafness as well as preventing
drunkenness, and bedwetting(591).
a. The memory enhancing effects
Capsules containing 60 mg of a standardised extract of
Ginkgo biloba
(GK501) and 100 mg of a standardised extract of Panax ginseng (G115)
showed significantly to improve an Index of Memory Quality(593),
including learning and
memory but not working and long-term memory(596). Its extract, in the logical
memory test and nonsense picture recognition exhibits improvement of 58.62% logical
memory in compared to baseline(594). Comercial extract
Ginkgo biloba EGb 761 enhanced certain neuropsychological/
memory processes of cognitively in older adults, 60 years of age and over(595).
b. Cognitive performance
Administration of single doses (120, 240, 360 mg) of standardised
Ginkgo biloba extract (GBE), according to Northumbria University, showed to improve
cognitive performance,
including speed of attention, accuracy of attention, secondary memory,
working memory, speed of memory, quality of memory(597). Combination of standardised extracts of
Ginkgo biloba
(GK501, Pharmaton SA) and Ginseng (G115, Pharmaton SA)
administration showed a consistent effect on mood and aspects of
cognitive performance ("quality of memory", "secondary memory", "working
memory", "speed of memory", "quality of attention" and "speed of
attention") in doeses depend-manner(598). On acute
cognitive effects,
Ginkgo biloba extract (GBE) with soy-derived phospholipids, improved secondary memory
performance and significantly increased speed of memory task
performance in comparision to post-dose testing sessions(599).
c. Cognitive impairment
Extracts of the leaves of
Ginkgo
biloba showed to improve a range of conditions including memory and
concentration problems, confusion, depression, anxiety, dizziness,
tinnitus and headache, recognition, regeneration, understanding, and
recitation(603), probably thought its action in increasing blood supply
by dilating blood vessels, reducing blood viscosity, modification of
neurotransmitter systems, and reducing the density of oxygen free
radicals(600).
EGb761, acommercuial product of
Ginkgo biloba at 240 mg/day, shawed to stabilize or slow decline in cognition, function, behavior, at 22-26 weeks (602).
Accoording to University
of Oxford, the use of v ofr treatement of cognitive impairment appeared
to be safe with no excess side effects compared with placebo, but with
inconsistent results(601).
d. Etc.
References
(591)
http://thedao.com/ginkgo.htm
(592)
http://en.wikipedia.org/wiki/Ginkgo_biloba
(593)
http://www.ncbi.nlm.nih.gov/pubmed/11140327
(594)
http://www.ncbi.nlm.nih.gov/pubmed/22704410
(595)
http://www.ncbi.nlm.nih.gov/pubmed/12404671
(596)
http://www.ncbi.nlm.nih.gov/pubmed/16740301
(597)
http://www.ncbi.nlm.nih.gov/pubmed/17902186
(598)
http://www.ncbi.nlm.nih.gov/pubmed/11842916
(599)
http://www.ncbi.nlm.nih.gov/pubmed/17457961
(600)
http://www.ncbi.nlm.nih.gov/pubmed/19160216
(601)
http://www.ncbi.nlm.nih.gov/pubmed/12519586
(602)
http://www.ncbi.nlm.nih.gov/pubmed/25114079
(603)
http://www.ncbi.nlm.nih.gov/pubmed/24758078
2. Lemon balm
Lemon Balm is a perennial plant in the genus Melissa, belonging to the family Lamiaceae, native to southern Europe and the
Mediterranean region.
The herb has been used in traditional medicine to treat nervous
complaints(604), lower abdominal disorders(605) and as
anti-inflammatory(608), antivirus(606), antibacterial agent(607).
a. Behavioral and psychological symptoms
According to Newcastle University, lemon
balm showed to alleviate behavioral and psychological symptoms in patient with
dementia (BPSD)(609), including anxiety(614). Lozenge, containing lavender oil, extracts from hops,
lemon balm and oat showed to induce a state of relaxation and regeneration for better cope with
psychological
and emotional stress(610)(611) and attenuation of mood and
anxiety(612). In behavior symttoms, administraion of combined valerian
root and
lemon balm extracts, improved
symptoms
of poor ability to focus decreased from 75% to 14%, hyperactivity from
61% to 13%, and impulsiveness from 59% to 22% as well as general social
behavior, sleep symptoms in
children(613). On laboratory-induced psychological stress, the
standardized M. officinalis extract, a significant increase in the speed
of mathematical processing, with no reduction in accuracy were
observed(617).
b. Cognitive performance and mood
A
standardised M. officinalis preparation administered showed
significantly in eradicated mood change and cognitive impairment(614),
according to joint study lead by Swinburne University. Acute
administration of Melissa officinalis (
lemon balm)
in highest dose, cognition and mood in in both Secondary Memory and
Working Memory factors(615)(616). The effective of the herb, probably
through its function in Modulation of mood and
cognitive performance
through lowering both nicotinic and muscarinic binding in healthy
humans(616). Due to different preparations derived from the same plant
species, some researchers suggested that the effectiveness may exhibit
different properties depending on the process used for the sample
preparation(616).
c. Etc.
References
(604)
http://www.ncbi.nlm.nih.gov/pubmed/21076869
(605)
http://www.ncbi.nlm.nih.gov/pubmed/19023806
(606)
http://www.ncbi.nlm.nih.gov/pubmed/18693101
(607)
http://www.ncbi.nlm.nih.gov/pubmed/24283351
(608)
http://www.ncbi.nlm.nih.gov/pubmed/22567036
(609)
http://www.ncbi.nlm.nih.gov/pubmed/22070157
(610)
http://www.ncbi.nlm.nih.gov/pubmed/15546807
(611)
http://www.ncbi.nlm.nih.gov/pubmed/15272110
(612)
http://www.ncbi.nlm.nih.gov/pubmed/16444660
(613)
http://www.ncbi.nlm.nih.gov/pubmed/24837472
(614)
http://www.ncbi.nlm.nih.gov/pubmed/25360512
(615)
http://www.ncbi.nlm.nih.gov/pubmed/12062586
(616)
http://www.ncbi.nlm.nih.gov/pubmed/12888775
(617)
http://www.ncbi.nlm.nih.gov/pubmed/15272110
3. Lavender
Lavender
is a flower plant of the genus Lavandula, belonging to the family
Lamiaceae, native to Asia. The herb has been used in traditional
medicine as antimicrobial, anti-inflammatory and mood alleviating(618),
and burns and insect bites effects(623), as well as depression, stress
and mild anxiety(621) probably through its phytochemicals(constituents
(-)-linalool, (+)-α-pinene and (+)-limonene ) in modulation of the
immune and neuroendocrine system by interfering with metabolism of
tryptophan(618).
a. Spatial performance
Lavender extract (LE, in AD animal model showed effectively in improvement of
spatial performance, through atentuation of Aβ
production in histopathology of hippocampus(619) which involved in
memory forming, organizing, and storing. Its aqueous extract of
lavender (
Lavandula angustifolia), also significantly improved the
performance of control and reverse
spatial learning amd memory deficits(621) in AD rats(620). Inhaled
lavender
oil, oxidative stress induced rat, exhibited neuroprotective effects
through its potent antioxidant and antiapoptotic activities(622).
b. Behavioural symptoms
Lavender
aromatherapy, according to Kongju National University, is effective on
emotions and aggressive behavior of elderly with dementia of the
Alzheimer's type(624)and reduced disruptive behaviour in people with
dementia(625). In agitated behaviour in severe dementia, 2%
lavender oil
aromatherapy stream administered on the ward for a two hour period,
showed a modest effects in compared with placebo(626). The effectiveness
of the herb in reduced behaviours in individuals with
dementia potentially
provide a safer intervention rather than reliance on pharmacology
alone. The study's findings will translate easily to other countries
and cultures(627).
c. Cognitive performance and Mood disorders
Aromatherapy
applied to 28 elderly people with dementia, 17 of whom had Alzheimer's
disease (AD), showed significant improvement in personal orientation
related to
cognitive function
on both the Gottfries, Brane, Steen scale (GBSS-J)and Touch Panel-type
Dementia Assessment Scale (TDAS), according to Tottori University(628)
and emotions and aggressive behavior of elderly with dementia, according
to Kongju National University(629). In emotional parameters, lavender
essential oil also significantly enhance mood responses, including
anxiety(631)(633) and depression(632)(634) probably through its relaxing
effect(630).
d. Etc.
References
(618)
http://www.ncbi.nlm.nih.gov/pubmed/25515049
(619)
http://www.ncbi.nlm.nih.gov/pubmed/25561935
(620)
http://www.ncbi.nlm.nih.gov/pubmed/21441971
(621)
http://www.ncbi.nlm.nih.gov/pubmed/22402245
(622)
http://www.ncbi.nlm.nih.gov/pubmed/23351960
(623)
http://www.ncbi.nlm.nih.gov/pubmed/?term=lavender+burns+and+insect+bites+effects
(624)
http://www.ncbi.nlm.nih.gov/pubmed/15860944
(625)
http://www.ncbi.nlm.nih.gov/pubmed/23837414
(626)
http://www.ncbi.nlm.nih.gov/pubmed/11994882
(627)
http://www.ncbi.nlm.nih.gov/pubmed/20649945
(628)
http://www.ncbi.nlm.nih.gov/pubmed/20377818
(629)
http://www.ncbi.nlm.nih.gov/pubmed/15860944
(630)
http://www.ncbi.nlm.nih.gov/pubmed/22612017
(631)
http://www.ncbi.nlm.nih.gov/pubmed/19968674
(632)
http://www.ncbi.nlm.nih.gov/pubmed/24559818
(633)
http://www.ncbi.nlm.nih.gov/pubmed/19258850
(634)
http://www.ncbi.nlm.nih.gov/pubmed/16520572
4. Huperzine A
Huperzine A, a chemical made from the plant Huperzia serrata have been studied for its effect on patient of dementia with conflict results
1. Cognitive effects
In induced Alzheimer's
disease animal
study, Huperzine A showed a significant effect in inhibited
acetylcholinesterase, derived from forebrain, hippocampus, cortex and
cerebellum(635), through neuron protective effects and enhanced
glutamatergic functions(635). In mild to moderate vascular
dementia
(VaD) patients, The medicine also improved the cognitive function with
serious adverse events(636). But according to University of California,,
in a phase II trial of
huperzine A, regardless to doses,
huperzine A did not
demonstrate cognitive effect in patients with mild to moderate AD(637).
According to Beijing University of Chinese Medicinealthough
Huperzine A showed a beneficial
effects on improvement of cognitive function, daily living activity
in global clinical assessment in participants with Alzheimer's disease,
the findings should be interpreted with caution due to the poor
methodological quality of the included trials(638).
b. Inhibitiobn of amyloid plaque burden and oligomeric β-amyloid (Aβ)
Huperzine A, showed to reduce in Aβ levels and Aβ burden in AD brain, through activation of
Wnt signaling(regulate cell-to-cell interactions) and targeting of the Wnt/β-catenin signaling pathway
in various components in contribution to disease, (639), modulation
of amyloidogenic and nonamyloidogenic pathways(640), reduction of iron in the brain(641) via a multi-target mechanism(642).
c. Mild to moderate vascular dementia (VaD) and Alzheimer's disease
In patients with
mild to
moderate vascular dementia (
VaD), Huperzine A significantly improve the cognitive function in mini-mental state examination (MMSE), clinical
dementia rating (CDR), and activities of daily living (ADL) scores(643)(644).
In
patients with Alzheimer's disease (AD), Huperzine A also showed
improvement in memory function and cognitive enhancement at a dose of
0.4 mg using MMSE, MQ, ADAS-COG, and ADL tests(645); against
organophosphate (OP) intoxication and reduction of glutamate-induced
cell death(646). According to Georgetown University Hospital, the
antioxidant and neuroprotective properties of Huperzine A suggest that
it may be useful as a disease-modifying treatment for Alzheimer's
disease (AD)(647).
Due to data supporting its use are limited by
weak study design, theMassachusetts College of Pharmacy and Health
Sciences-Worcester/Manchester suggested that randomized,
placebo-controlled trials are necessary to establish the role of
huperzine A in the treatment of AD(648).
d. Etc.
References
(635)
http://www.ncbi.nlm.nih.gov/pubmed/9141073
(636)
http://www.ncbi.nlm.nih.gov/pubmed/21833673
(637)
http://www.ncbi.nlm.nih.gov/pubmed/21502597
(638)
http://www.ncbi.nlm.nih.gov/pubmed/24086396
(639)
http://www.ncbi.nlm.nih.gov/pubmed/?term=Huperzine+A+Wnt%2F%CE%B2-catenin+signaling+pathway
(640)
http://www.ncbi.nlm.nih.gov/pubmed/22002568
(641)
http://www.ncbi.nlm.nih.gov/pubmed/24332448
(642)
http://www.ncbi.nlm.nih.gov/pubmed/15956816
(643)
http://www.ncbi.nlm.nih.gov/pubmed/?term=Huperzine+A+and+Mild+to+moderate+vascular+dementia+(VaD)
(644)
http://www.ncbi.nlm.nih.gov/pubmed/24639880
(645)
http://www.ncbi.nlm.nih.gov/pubmed/21766442
(646)
http://www.ncbi.nlm.nih.gov/pubmed/12895686
(647)
http://www.ncbi.nlm.nih.gov/pubmed/18230054
(648)
http://www.ncbi.nlm.nih.gov/pubmed/19240260
5. Bacopa
Commonly known as Waterhyssop or Water Hyssop, the herb is a semi-woody plants, genus of Hyssopus, belonging to the family Lamiaceae, native to the east Mediterranean to central Asia, used in traditional medicine as an antibiotic(660)(659), carminative, antispasmodic, antifungal(661), and antiseptic(661)(662) agent and to treat bronchitis(663), asthma(664), digestive ailments(665)(668), insomnia(666), diabetes(667), edema(669)(670), etc.
a. Increases Cerebral Blood Flow
In cerebral blood flow (CBF), Bacopa monnieri's promoting blood flow through its procognitive effect in comparison via dose-dependent hypotensive actions (671), with Ginkgo biloba and donepezil(671)may ne a potential attenuation of dementia, Parkinson's disease, and epilepsy(672).
b. Ethnobotanical treatment
Bacopa, ethnobotanically, may be used as brain tonification(676) and to treat various diseases(673), including Alzheimer's disease
through its phytochemicals in alleviation of AD pathology and associated symptoms(674). According to sity System HSC College of Medicine, Bacopa monniera extract (BME), administered starting at 2 months of age for either 2 or 8 months in test mice, significant lowers Abeta 1-40 and 1-42 levels in cortex by as much as 60%, and reverses Y-maze performance and open field hyperlocomotion behavioral changes(675). Its natural products (galantamine and rivastigmine), also has been used pharmaceutically for cognitive and behavioural and psychological symptoms of dementia (BPSD)(673).
c. Cognitive performance, anxiety, and depression
In olfactory bulbectomized mice, alcoholic extract of
Bacopa monnieri (L.) showed to ameliorate memory and emotional deficits(678) and enhanced cognitive performance(679) through its protection of cholinergic systems from OBX-induced neuronal damage(677). In normal healthy participants, the herb also attenuated stress reactivity and mood, through its adaptogenic and nootropic effects, probably via reduction in cortisol levels(680). According to National College of Natural Medicine, standardized dry extract of
Bacopa monnieri, promoted the improvement depression scores, combined state plus trait anxiety scores,with few adverse events, primarily stomach(681)
d. Etc.
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Sources
Herbs used in the treatment and prevention of
dementia(682)(683)
in traditional medicine, may be due to their effectiveness of
phytochemicals in attenuation of oxidative stress and neuro
inflammation via neuroglial activation(683).
According to University of Wollongong, herbs and spices, containing high
amount of phytochemicals in traditional history of use, with strong
roles in cultural heritage, may have a distinguished effect in cognitive
decline associated with ageing and the acute effects of psychological
and cognitive function(684), probably through active ingredients of
spices in modulation of neural response in the peripheral nervous
system, via interaction with TRP channel/receptors(685).
Phytochemicals have been studied intensively including
1. Cannabinoids (e.g. cannabidiol) from Cannabis sativa, may
be emerging as potential therapeutic agents for treatment of symptoms of
dementia(686)(687). In Alzheimer's disease. the phytochemicals have
found effective in against multifactorial illnesses as Alzheimer's
disease, through inhibition of BuChE(689) and AChE(690) enzymes by a
non-competitive or mixed mechanism(688).
Resveratrol (occurs in various plants) showed to improved cognition and
reduces oxidative stress, by promoting learning and memory ability in
vascular
dementia(692) and decreased
malonyldialdehyde levels(691). In Alzheimer's Disease, the phytochemical
exerted its neuroprotective effect(694)(695), in decreased A
β
accumulation, tau protein phosphorylation, oxidative stress(693), and
may be used for aging population in the prevention of various
age-related neurological disorders(694).
2. Curcumin (from turmeric [Curcuma longa]), in pharmacological
activities, besides promoted cognition and mood in a healthy older
population(695), it also exhibited beneficial role in several
neurodegenerative disorders(696) against administered streptozotocin
(STZ)induced
dementia model(696)(698),
probably through its antioxidant effect(697). In Alzheimer's Disease,
The herb showed in reversed cognitive deficits, through its function in
decreased GSK-3β levels related to Alzheimer's Disease(
Glycogen synthase kinase 3, a protein(699)),
and increased promoter activity of the TCF/LEF in binding DNA(600) and
cyclin-D1(a protein) in regulating cell cycle progression(701).
3. Crocetin, a phytochemical found in Saffron (Crocus sativus), showed
to protect cerebrocortical and hippocampus neurons against ischemia, by
improving spatial learning memory after chronic cerebral hypoperfusion
in animal study(703) through its antioxidant effects(704) in decreased
oxidative stress(704). According to The University of Tokyo, the
effectiveness of the herbal phytochemicals also crocetin and crocin,
enhanced learning behaviour and promoted memory recall(705). In severe
Alzheimer's Disease and mild-to-moderate
Alzheimer's disease patients,
saffron
extract showed to be comparable with memantine in reducing cognitive
decline in 1 year(706) and reduce cognitive decline in 22 weeks
administration(707), respectively.
4. Ginseng (Panax species), showed to be beneficiary on age-related cognitive impairments
through the activities of its number of ginsenosides(708) and Non-ginsenoside nicotinic agents(709).
5. Sage (Salvia species), may also be used as a potential novel natural treatments for the relief of some diseases including
dementia, according to Shahid Beheshti University of Medical Sciences(710).
But according to Jodrell Laboratory, the use of such remedies
in complex mixtures of different plants in traditional folk medicine may
induce complication in interpretation of pharmacological activity and
challenges for quality control(702).
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Sources
(682)
http://www.ncbi.nlm.nih.gov/pubmed/23055633
(683)
http://www.ncbi.nlm.nih.gov/pubmed/20657497
(684)
http://www.ncbi.nlm.nih.gov/pubmed/17022438
(685)
http://www.ncbi.nlm.nih.gov/pubmed/25359561
(686)
http://www.ncbi.nlm.nih.gov/pubmed/24828945
(687)
http://www.ncbi.nlm.nih.gov/pubmed/24624670
(688)
http://www.ncbi.nlm.nih.gov/pubmed/24378710
(688)
http://www.medscape.com/viewarticle/424604_5
(689)
http://www.ncbi.nlm.nih.gov/pubmed/24378710
(690)
http://www.ncbi.nlm.nih.gov/pubmed/25206513
(691)
http://www.ncbi.nlm.nih.gov/pubmed/25206513
(692)
http://www.ncbi.nlm.nih.gov/pubmed/24660032
(693)
http://www.ncbi.nlm.nih.gov/pubmed/25525597
(694)
http://www.ncbi.nlm.nih.gov/pubmed/19090994
(695)
http://www.ncbi.nlm.nih.gov/pubmed/25315300
(694)
http://www.ncbi.nlm.nih.gov/pubmed/25281824
(695)
http://www.ncbi.nlm.nih.gov/pubmed/25277322
(696)
http://www.ncbi.nlm.nih.gov/pubmed/20026275
(697)
http://www.ncbi.nlm.nih.gov/pubmed/19705549
(698)
http://www.ncbi.nlm.nih.gov/pubmed/21195590
(699)
http://en.wikipedia.org/wiki/GSK-3
(700)
http://en.wikipedia.org/wiki/TCF/LEF_family
(701)
http://en.wikipedia.org/wiki/Cyclin_D1
(702)
http://www.ncbi.nlm.nih.gov/pubmed/21639405
(703)
http://www.ncbi.nlm.nih.gov/pubmed/23988025
(704)
http://www.ncbi.nlm.nih.gov/pubmed/21774008
(705)
http://www.ncbi.nlm.nih.gov/pubmed/10815004
(706)
http://www.ncbi.nlm.nih.gov/pubmed/25163440
(707)
http://www.ncbi.nlm.nih.gov/pubmed/19838862
(708)
http://www.ncbi.nlm.nih.gov/pubmed/10189953
(709)
http://www.ncbi.nlm.nih.gov/pubmed/21639405
(710)
http://www.ncbi.nlm.nih.gov/pubmed/24860730
