Alzheimer’s Disease & Dementia Treatment

Alzheimers Disease & Dementia 

Alzheimer’s disease and Dementia are two conditions that are growing in prevalence in Australia and throughout the world. Dementia is characterised by multiple cognitive deficits, including decreased intellectual functioning, that are severe enough to cause significant impairment in social or occupational functioning. Dementia is diagnosed only if two or more brain functions, such as memory, language skills, perception, or cognitive skills such as reasoning and judgement, are significantly impaired without loss of consciousness. People with dementia may also display personality, behavioural and mood changes, such as agitation, delusions, hallucinations and lack of emotional control.

Dementia affects 5% of the population over 60 years and 30% of the population over 80 years and the incidence is increasing. Types of dementia include:

• Alzheimer’s disease (AD) is the most common cause of dementia in people aged 65 or over. It is defined as memory loss with at least one other area of cognitive impairment e.g. language, attention, orientation, self-monitoring, judgement, motor skills and inability to perform daily activities.

Alzheimers disease usually causes a gradual decline in cognitive abilities over a span of 7 to 10 years. Nearly all brain functions, including memory, movement, language, judgement, behaviour and abstract thinking are affected. Alzheimer‘s disease is characterised by various abnormalities in the brain:

• Amyloid plaques: abnormal clumps beta-amyloid protein found in the tissue between nerve cells
  • Neurofibrillary tangles: bundles of twisted filaments found within neurons, largely made up of a protein called tau. In healthy neurons, the tau protein is important for structural support and delivery of substances. In AD, the tangled tau proteins impair the functioning of the nerve cells, causing them to eventually collapse and die.
  • Cholinergic abnormalities: acetylcholine receptors are decreased in AD; medications for AD are based on acetylcholinesterase inhibitors, which effectively increase the amount of available acetylcholine in the brain
  • Glutaminergic abnormalities: increased release and activity of glutamate, an excitatory neurotransmitter
  • Zinc, copper and iron: levels are often altered in AD brain tissue

• Vascular dementia: the second most common form of dementia after AD. Caused by brain damage from cerebrovascular problems, most commonly strokes.

Causes of Alzheimer’s Disease and Dementia

• The cause of Alzheimer‘s disease is not clear. It is thought to involve genetic susceptibility, environmental factors, inflammation and oxidative stress.
• In the past, aluminium accumulation and toxicity has been implicated as a cause of AD. However, the overwhelming medical and scientific opinion is that the findings of studies do not convincingly demonstrate a causal relationship between aluminium and AD.
• Newer research shows that Alzheimers disease is a multifactorial disease that is effected by nutritional deficiencies, inflammatory conditions, blood glucose irregularities, previous head trauma and toxic exposure. (1)  A functional medicine approach addresses all of these factors.

Risk factors

• Family history and genetic predisposition
• Age: mainly occurs in people 60 years or over. 20 – 40% of those with fully developed symptoms of AD are over age 85. Early onset AD where symptoms appear before age 60 is much less common, and thought to be hereditary.  Newer research is suggested diet,lifestyle and environmental facto factors
• Female > male
• Obesity
• Long-standing hypertension and/or hypercholesterolaemia
• High homocysteine levels (Methylation imbalances)
• Poorly controlled diabetes
• Pro-inflammatory, high-GI diet
• Excessive alcohol intake
• Lack of exercise
• Smoking
• History of head trauma
• Heavy metal toxicity
• Long term gut dysbiosis, interstinal permability, bacterial overgrowth

Signs and symptoms of Alzheimers Disease & Dementia

• Dementia usually first appears as forgetfulness and gradually progresses. Eventually, it may include difficulty in many areas of mental functioning such as emotional behaviour and personality, language, memory, perception and cognitive skills (thinking and judgement). Symptoms may include:
  • Difficulty performing tasks that used to come easily
  • Getting lost on familiar routes
  • Trouble or inability finding the names of familiar objects
  • Losing interest in activities
  • Misplacing items
  • Personality changes and loss of social skills; withdrawing from social contact
  • Difficulty reading and writing
  • Change in sleep patterns
  • Delusions and agitation
  • Forgetting familiar people and events
  • Poor judgement and ability to recognise danger

Differential diagnosis

• Normal aging: mild cognitive impairment is a part of normal aging. Mild forgetfulness is not necessarily a sign of Alzheimer‘s disease or dementia
• Substance abuse
• Psychiatric disorders e.g. clinical depression, schizophrenia, bipolar disorder

TREATMENT STRATEGY FOR ALZHEIMERS DISEASE & DEMENTIA

Treatment is aimed at slowing progression of disease and reducing symptoms

• Reduce inflammation and oxidative stress
• Reduce formation of amyloid plaques
• Support cognitive functioning and healthy neurotransmitter production
• Support peripheral circulation
• Decrease homocysteine (if indicated)
• Balance gut dysbiosis and repair intestinal permeability
• Reduce stress and depression
• Prevent weight loss
• Reduce exposure to environmental toxins
• Heavy metal detoxification if indicated

Diet plan guidleines for Alzheimers disease & Dementia

• Emphasis should be on Mediterranean-style or paleo style diet: studies show this is inversely related to development of AD (Scarmeas et al, 2009)
• Emphasise anti-inflammatory and anti-oxidant foods
  • Polyphenols: the antioxidants in fruits and vegetables have positive effects on cognitive function
  • Pro-anthocyanidins: in vitro studies have shown that resveratrol added to cells that produce amyloid-beta peptide reduces its production. Good sources of resveratrol are grapes (especially muscadine), blueberries, red wine and peanuts
  • Cinnamon extract: has been shown to inhibit the aggregation of tau.
  • Blueberries: 60-120 g daily has been shown to reduce cognitive decline when taken daily
  • Turmeric: contains curcumin, which has been shown to improve cognitive functioning in AD patients due to its antioxidant, anti-inflammatory and lipophilic actions
  • Flavonoid-rich foods: e.g. apples, green tea, oranges, onions and dark chocolate; lower rate of cognitive decline
  • Omega-3 fatty acids: e.g. oily fish to reduce inflammation and support cognitive function
• Increase foods and herbs that support cognitive function: eggs, oily fish, nuts, rosemary, sage
• Increase foods that support peripheral circulation: garlic, ginger, chilli, cinnamon
• Reduce pro-inflammatory and pro-oxidant foods: red meat, sugar, refined grains, trans fats, refined vegetable oils, alcohol, caffeine
• Reduce glutamate added foods – free glutamates found in MSG should be avoided and are added into many processed foods, additive number 621-630 can contain glutamates.
• Avoid aspartame (artificial sweetener): broken down into aspartic acid, which acts as an excitotoxin.
• Maintain healthy weight

Supplementary that support Alzheimer’s disease & Dementia

• Omega-3 EFAs – supports cognitive function and reduces inflammation
• Phosphatidyl serine – facilitates neuronal function; improves memory, learning and concentration; supports neurotransmitter production and function)
• Acetyl-l-Carnitine –  neuro-protective, improves neuronal energy
• Tyrosine –  improves concentration and memory
• Phosphatidyl Choline – improves memory and attention & lipid membrane integrity
• L-tryptophan – supports serotonin production

Broad-spectrum antioxidants:

• Resveratrol –  potent antioxidant and reduces formation of amyloid plaques
  • CoQ10 – also supports energy production and protects heart health
  • Vitamin E – also supports peripheral circulation
  • Selenium – antioxidant
  • Alpha-lipoic acid 250mg / day: neuroprotective and reduces insulin resistance
  • N-aceylcysteine – indicated in heavy metal toxicity
  • Curcumin: antioxidant and antiinflammatory
• B6, folate and B12: key vitamins required for methylation, one of the major comtributors to the disease when imbalnced
• Vitamin D – depending on status
• Spirulina: for heavy metal detoxification

Herbal medicine that supports Alzheimers Disease & Dementia

• Cognitive enhancing – bacopa, ginkgo, gotu kola, panax ginseng, sage, rosemary, lemon balm,schisandra, withania, Siberian ginseng, peony
• Support neurotransmitter production – lemon balm, St John‘s wort
• Circulatory stimulants – ginkgo, ginger, bilberry, hawthorn
• Reduce free-radical damage – turmeric, green tea, grape seed, rosemary, St Mary‘s thistle, ginkgo, schisandra, sage

Lifestyle / Physical measures

• Regular exercise: a planned, supervised walking program with caregiver or other reliable companion; in particular, yoga and tai chi can help prevent falls and improve quality of life.
• Regular exposure to sunshine
• Cognitive stimulating activities: reading, crossword puzzles, card games, social engagement, new skills
• Music therapy
• Pets: reduce stress and improve social behaviour
• Massage

FUNCTIONAL MEDICINE TREATMENT OF ALZHEIMERS DISEASE

Alzheimer’s disease and dementia are conditions that are becoming more prevalent in current times.  Long term deficient diets coupled with poor lifestyle choices and environmental toxins can have a major impact. 

A study published in the “Journal of Alzheimer’s disease & Parkinsonism” on the “Reversal of cognitive decline” stated that Alzheimer’s disease has many factors that play a part in the progression of the disease, these include inflammation, various chronic pathogens, trophic withdrawal, insulin resistance, vascular compromise, trauma, and exposure to specific toxins.  These affects are exacerbated and contributed to when there is long term dysfunction of the gut, methylation and detoxification. 

Alzheimer’s disease and dementia require a multifaceted treatment approach.

Patients with early signs of dementia and Alzheimer’s disease can benefit from gut repair, optimizing methylation and providing target nutrient therapy. 

At our Perth clinic of Advanced Functional Medicine we have experience with Alzheimer’s disease and dementia.  

If you or a family member are suffering from Alzheimer’s disease of dementia we would love to hear from you. 

What changes have made the biggest impact on your health?  Have you addressed your gut and/or methylation and seem dramatic improvements?  Please leave a comment below.

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