Dementia

Words: Dr Rajgopal NIDAMBOOR

Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — and, behavioural abilities to such an extent that it interferes with a person’s daily life and activities.

These include memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention.

Some people with dementia cannot control their emotions and their personalities may, as a result, change.

Dementia ranges in severity from the mildest stage — when it is just beginning to affect a person’s functioning, to the most severe, when the person is compelled to depend completely on others for basic activities of living.

Case In Point

This classic memory loss example is known in scientific literature by the pseudonym HM. HM could remember, quite literally, nothing — nothing, that is, that had happened since the loss of his brain’s temporal lobes and hippocampus during experimental surgery to reduce epileptic seizures. Until that time, HM’s memory had been quite normal. But, after the operation he was unable to recall anything for more than a few minutes, and then the memory was seemingly lost forever. He did not remember his address, or the name of the person to whom he was talking. HM would read the same magazine, or newspaper, over and over again. According to his own narrative, his life was like ‘waking from a dream’ and being unable to know where he was, or how he got there As the case of HM illustrates, a person without a normal memory faces severe difficulties. All of us who have experienced even routine instances of forgetting — such as not remembering an acquaintance’s name, or a fact on a test — recognise, or understand, the real consequences of memory failure.

  • Milner B. In: Physiologie de l’hippocampe. Centre National de la Recherche Scientifique; Paris: 1962. pp 257-272
  • Milner B. In: The History of Neuroscience in Autobiography. Vol 2. Academic Press; San Diego: 1998. pp 276-305.

Movie Connect

This is a movie based on Nicholas Sparks’ best-selling novel of the same name. The Notebook features James Garner as Noah, the affectionate husband of Allie [Gena Rowlands], who is in a nursing home due to Alzheimer’s disease. Noah attempts to rekindle her memories of their long history by reading to her from his notebook.

Signs & Symptoms 

The signs and symptoms of dementia result when the once-healthy neurons [nerve cells] in the brain stop working, or lose connections with other brain cells, and perish. While everyone loses some neurons as they age, people with dementia experience far greater loss than what may be ‘normal.’

The commonest cause of dementia is Alzheimer’s disease [AD]. AD is evidenced to be the most likely cause of memory loss in approximately 50 per cent of cases. There are other — or, non-Alzheimer — causes of dementia too, such as early-onset dementia [EOD], which occurs before age 65.

Yet, the fact is, the classification of dementia is not as simple as it appears to be, or all-encompassing. It is subject to much debate and also disagreement.

Diagnosis 

A diagnosis of dementia is based on —

  • Memory loss, both short- and long-term
  • Aphasia; language problems
  • Apraxia, or organisational problems
  • Agnosia, or unable to recognise objects, or tell their purpose
  • Disturbed executive function, personality and inhibition.

Lab tests for complete blood count [CBC], basic metabolic profile, thyroid stimulating hormone [TSH] and vitamin B12 [cobalamin] should be done. If brain injury, or tumour, is in question, your doctor will order a computerised tomography [CT], or magnetic resonance imaging [MRI]. Positron emission tomography [PET] scans are recommended for early diagnosis of dementia.

Interesting Facts 

  • Some Alzheimer’s specialists have designated AD as ‘Type-3 Diabetes.’ This is primarily because analogous to type-2 diabetes cells throughout the body become insulin-resistant, i.e., they no longer respond to insulin and glucose can no longer be absorbed to fuel energy production
  • Type-3 diabetes is an insulin-resistant condition that occurs in the brain, because approximately half of the individual with type-2 diabetes go on to develop Alzheimer’s.

Additionally, depression, delirium, agitation, hallucinations, and delusions are important factors that your doctor will also look for. Neurological issues, however, may require a referral to a neurologist [a doctor who specialises in such disorders].

The following non-medical assessments are also helpful:

  • Social activities
  • Adequate sleep
  • Adherence to a strict schedule
  • Maintenance of a proper stimulation level
  • Adequate hydration [water intake]
  • Reformatting task [occupational therapy]
  • Support of caregivers.

Preventive approaches may also include vitamin E, and other nutritional supplements, besides cognitive stimulation — such as patient education.

Ayurveda 

Ayurveda is a medicinal science that deals with the utilisation of naturally available plant products for treatment. A wide variety of neuroprotective herbs have been reported in Ayurveda. Brahmi [Bacopa monnieri] is a nootropic Ayurveda herb known to be effective in neurological disorders from ancient times. Numerous approaches including natural and synthetic compounds have been applied against Alzheimer’s disease. Amyloid-β and tau are the hallmark proteins of several neuronal dysfunctions resulting in Alzheimer’s disease. Tau is a microtubule-associated protein known to be involved in progression of Alzheimer’s disease. The generation of reactive oxygen species, increased neuroinflammation and neurotoxicity are the major physiological dysfunctions associated with tau aggregates. This leads to dementia and behavioural deficits. Bacoside A, Bacoside B, Bacosaponins, Betulinic acid, etc., are the bioactive component of Brahmi belonging to various chemical families. Each chemical component is known have a significant role in neuroprotection. The neuroprotective properties of Brahmi and its bioactive components, includies reduction of ROS, neuroinflammation, aggregation inhibition of amyloid-β and improvement of cognitive and learning behaviour. We hypothesised the inhibitory role of Brahmi against tau-mediated toxicitybased on several other studies. We conclude that Brahmi can be used as a lead formulation for treatment of Alzheimer’s disease and other neurological disorders.

  • Tushar Dubey, Subashchandrabose Chinnathambi, “Brahmi [Bacopa monnieri]: An Ayurveda Herb against Alzheimer’s disease,” Archives of Biochemistry and Biophysics, Vol 676, 15 November 2019.

Homeopathy 

Homeopathy is a useful modality in the treatment of dementia [Alzheimer’s disease] and also delirium. Homeopathic remedies engage the vital energies of the body. This leads to restoration of a healthy physiological homeostasis [balance], activation of the immune system, and promotion of detox, or ‘purging’ of acids, toxins and metabolic waste.

What is most unique about homeopathic treatment is that it is individualised, bespoke, or personalised, for each individual/patient, based on their presentation and distinctive symptoms.  There is its science and art in the choice of the most appropriate homeopathic remedy, more so because it stipulates a careful, meticulous case history and a holistic understanding of the overall personality and temperament of the individual patient.

Important: It is imperative that dementia is, as a rule, treated by a professional homeopathic doctor, given the sensitive nature of the illness, in question, and its delicate, also complex, emotional underpinnings. 

  • Notable therapeutic outcomes with homeopathic treatment of Alzheimer’s disease was reported at the Neuroscience Conference in Washington by the National Center for Homeopathy, US
  • Dr Bernd Seilheimer, Head of Bioregulatory Development at Biologische Heilmittel Heel GmbH [Heel], the homeopathic manufacturer and research organisation, who presented studies on a multi-target, combination homeopathic remedy said that the low dose natural substances as used in ‘homeopathic mixology,’ or the use of composite homeopathic remedies, or compounds, for a specified clinical condition, instead of a single remedy for a pattern of symptoms, has proven effective in relieving symptoms of Alzheimer’s disease, while influencing the reduction of the formation of amyloid plaques in the brains of Alzheimer’s patients
  • Clinical [in vitro and in vivo] studies were conducted in France and Finland; they confirm that Alzheimer’s subjects had enhanced learning abilities, also increase in their ability to recognise objects, with improvement in memory performance after homeopathic treatment.

Nutrition 

One novel substance that is showing promising results in the treatment and prevention of dementia is curcumin. Since curcumin is lipophilic, it passes through cell membranes where it expresses a variety of effects. By entering microglia cells, curcumin reduces neuroglial and microglial proliferation and differentiation. Because chronic activation of microglia exacerbates β amyloid plaques, by reducing microglial proliferation, curcumin reduces the β amyloid plaque generation. Curcumin reduces astrocyte proliferation as well, but increases differentiation of oligodendrocytes and as such improves myelogenesis. Curcumin inhibits amyloid β aggregation through downregulating BACE1 expression. BACE1 is an enzyme which cleaves Amyloid Precursor Protein to AB. Another mechanism of AB is through GSK-3B presenilin 1 activation. Administration of curcumin reduced AB production by reducing levels of Presenilin-1 and GSK-3B. Besides lowering the production of AB, studies show that curcumin inhibits deposition of amyloid β in cell membranes. Studies also show that curcumin inhibits hyperphosphorylation of the tau protein and lowers the copper deposition in amyloid plaques in people with Alzheimer disease. Curcumin also shows immediate cognitive effects. Acute treatment with curcumin improved cognition in three subtraction tasks by 16 per cent.

  • Brockdorf Y, Morley J E, “Nutrition and Dementia.” J Nutr Health Aging; 25, 590–592 [2021].
Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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