Dementia: Strategies for early detection and prevention
How you can detect and treat the early manifestations of dementia in your patients.
By Tony Reid
(Master TCM Hons)
The incidence of various types of dementia, including Alzheimer’s disease, is steadily increasing. The prevalence rates rise with increasing age; from 2% for people in their 60’s to over 32% for those in their 80’s and beyond; and these figures are expected to double by the year 2020. This represents a considerable burden, not only on the patients themselves but also for their families and care-givers as well as society as a whole. Indeed, the disability weight for dementia is higher than for almost any other health condition, apart from spinal-cord injury and terminal cancer.
The true dementias include: Alzheimers disease (AD), vascular dementia (VD), dementia with Lewy Bodies and fronto-temporal dementia. The most common being Alzheimer’s disease, vascular dementia and mixed (AD with VD) dementia. Patients with AD make up 50-60% all cases of clinical dementia.
Mild Cognitive Impairment
Patients with dementia syndrome exhibit the following clinical
The diagnosis and treatment of patients with dementia is only
one part of the story. The condition that leads to dementia,
referred to as ‘cognitive decline’ or ‘mild cognitive impairment’ (MCI) is much more common. Researchers have found that these
2. Impairment in at least one other cognitive domain:
early signs of dementia can be detected in individuals during their
20’s and 30’s, although they generally become more apparent in
middle age. In middle aged and elderly patients MCI represents
changes in cognition that exceed the expected age-related
decline. However, within 4 years of detection around half of
The above impairments cause significant interference with social,
these patients will end up with clinical dementia (mostly AD). In
work or daily activities and represent a marked decline from
contrast to the general average of 1-2% per year, these patients
develop dementia at a rate of 11-14% per year. Thus, patients
In general patients with AD exhibit a global decline in cognitive
function, while those with VD show defects in some areas but
There is a simple and useful screening instrument, the Folstein
Mini-Mental Status Examination (MMSE), which takes about 20
minutes to administer. This can be downloaded from:
Western pharmaceutical management of the dementias achieves
only modest results, as patients tend to progressively worsen
The maximum score is 30 points; a score of less than 24 is
and die sooner than the rest of the population. In addition these
considered abnormal. However, allowance must be made for the
patients place a very heavy burden on their caregivers, who in
patient’s level of education. Scores between 18 and 23 indicate
MCI. Scores between 0 and 17 indicate clinical dementia and the patient should be referred for Western medical assessment. The good news is that there is a growing body of evidence that patients with MCI have a good chance of receiving significant help from TCM and thus are able to reduce their risk of developing one of the dementias. We know that vascular dementia has a strong association with hypertension, hypercholesterolemia and diabetes (the three ‘highs’: blood pressure, cholesterol and blood sugar) as well as smoking. Obviously these need to be checked and corrected promptly. The cause of Alzheimer disease is unknown. Several investigators now believe that AD is the end result of several converging risk factors, including advancing age, lipoprotein E epsilon 4 genotype, obesity, insulin resistance, dyslipidemia, hypertension, and chronic inflammation.
Oxidative damage to cerebral cells due to uncontrolled production of free radicals is an important factor in all types of dementia. This mechanism is thought to be one of the prime causes of the increased cellular death as well as dysfunction seen in these patients. Indeed several clinical trials and animal studies have shown that significant improvements in cognitive function result from the ingestion of various anti-oxidant herbs and/or their active components, e.g. ginkgo biloba leaf extract (flavonglycosides), ginseng root (ginsenosides Rb1 and Rg3, ginseng saponins), Huperzine A, salvia root (tanshinone, salvianolic acid), pueraria root and leaves (puerarin), rhodiola herb (rhodosin), green tea (polyphenols).
Dementia: Strategies for early detection and prevention continued
may be used in combination for a shorter period (e.g. to resolve
According to TCM, the health of the brain is related to the Kidney
Phlegm, clear deficiency Heat, balance Kidney Yin and Yang,
Essence and the Blood; while cognitive functions are controlled by
the Heart. Furthermore, the clear Yang Qi of the mind and senses
• Wen Dan Tang (Bamboo & Hoelen)
– Phlegm retention
(poetically referred to as the ‘orifices’ of the Heart’) may become
• Stress Relief 1 (or Jia Wei Xiao Yao San )
– Liver Qi constraint
obstructed by Phlegm. Thus with increasing age, the progressive
• Empty Heat Formula (or Zhi Bai Di Huang Wan)
decline of the Kidney Essence as well as the tendency to Blood
stasis manifest in cognitive decline or impairment, along with
• Restore the Spleen (or Gui Pi Wan)
– Qi-Blood dual deficiency
various other age-related health issues. This may be worsened by
• Rehmannia Eight Vitality Formula (or Fu Gui Ba Wei Di
concurrent Qi deficiency, Blood deficiency or retention of Phlegm.
– Kidney Yang deficiency with internal Cold
Thus the key pathodynamic factors involved in dementia are:
• Blood stasis• Kidney Essence deficiency (generally manifesting as Kidney Yin
This formula contains herbs that tonify the Kidney Essence as
well as the Heart Blood, to nourish and promote brain functions.
In addition, it contains the triple herb formula, Sheng Mai San
• Phlegm obstruction of the mind and senses
(‘Formula to Restore the Pulse Beat’ a.k.a. Ginseng & Ophiopogon Formula), which has been shown to regulate cardiac function, and
Much of the current research in China involves the use of complex
promote coronary as well as cerebral blood flow. Together with
formulations that address all of the above pathodynamic factors.
the herbs Salvia root and Curcuma tuber, which activate the Blood
Although many such studies have methodological flaws (e.g. small
and dispel stasis, this formula promotes cardiac as well as cerebral
numbers of participants, lack of blinding, not randomized), the
blood circulation. Modern research has shown that the herbs
evidence points to a better safety profile than orthodox Western
Ginkgo leaf, Curcuma tuber, Schizandra fruit, Ginseng root and
pharmacotherapy and comparable or better efficacy.
Salvia root contain a variety of potent antioxidants, which are able
Treatment using Prepared Chinese herbal Medicines
to prevent free radical damage to the highly metabolically active
While the following protocols are also suitable for patients with
cells of the cerebral cortex. In addition there is some evidence that
dementia, better results will be obtained if treatment is begun
the herbs Cuscuta seed, Atractylodes rhizome and Polygonatum
early, when the patient is manifesting the early signs of cognitive
rhizome may help to slow or prevent some of the degenerative
decline. A foundation treatment protocol for patients identified
PlusBu Yang Huan Wu Wan (Astragalus & Lumbricus Formula)
Begin with medium to high dosage and then continue long term at the label dosage, once improvement has been established (i.e. after 3-6 months).
Depending on the individual presentation, various formulas
The contents of this flyer, including the text, information, formulas and indications (the ‘Content’) are only meant to be used and applied by qualified
practitioners of Traditional Chinese Medicine (TCM). The Content is intended only as a guideline on possible treatment strategies. It is the responsibility of the treating
practitioner to use this information appropriately. Allergic and idiosyncratic reactions, although rare, are possible occurrences. The Content is not offered as medical advice
and should not be considered to be medical advice under any circumstances.
If you have a medical condition, you should always seek the advice of a qualified healthcare practitioner. Never disregard professional medical advice or delay in seeking it
because of Content in this flyer. Your reliance on any information provided by the author in this flyer is solely at your own risk.
Medical practitioners and other healthcare professionals who are considering using any of the Chinese herbal medicines, diagnostic methods or treatments as set out
in this flyer should only do so after successfully completing the required training for certification or registration according to the standards of professional associations
representing TCM and/or local government regulations.
Neither the author not the publisher can be held responsible for the improper or inappropriate use or application of any of the Content of this flyer by any person.Not for public distribution. Strictly for qualified healthcare professionals use only.
PAT/T 22 v.2 Bridging Anticoagulation: The Peri-procedural Management of Patients on Oral Vitamin K Antagonists (e.g. Warfarin) This procedural document supersedes: PAT/T 22 v.1 – ‘Bridging Anticoagulation’ Peri-opertive Management of Patients on Oral Anticoagulation Therapy. WARNING: Always ensure that you are using the most up to date approved procedural d
Clinical Review Received: October 18, 2001Accepted: April 15, 2002 Therapy of Sneddon Syndrome Agnes Flöel Tanya Imai Hubertus Lohmann Florian BethkeDepartment of Neurology, University of Münster, Münster, Germany Key Words Introduction Sneddon syndrome W Epilepsy W Cognition WAnticoagulation W Antiplatelet therapySneddon syndrome (SNS) is characterized by the asso-ciation of isc