Alzheimer’s Disease

Alzheimer’s disease is a progressive brain disease that slowly eats away at memories and causes problems with thinking. As the degeneration progresses, it can lead to the inability to complete even simple tasks. Symptoms typically will begin to appear after the age of 60. Alzheimer’s is considered the most common cause of dementia, which means loss of cognitive functioning and the loss of some behavioural functioning.^[1] Scientists and researchers believe that the disease process involves the deposition of plaques throughout the brain. These plaques then prevent neurons from working normally, until the neurons eventually die. Alzheimer’s is usually diagnosed based on a clinical history and an observation of behaviour. Some imaging tools can also be used, like a CT scan or MRI, but these may only be helpful in the advanced stages. The National Institute of Neurological and Communicate Disorders and Stroke and the Alzheimer’s Association established criteria to diagnose Alzheimer’s, and these criteria were updated in 2007.^[2] The criteria include the presence of cognitive impairments and a suspected dementia syndrome, as confirmed by neuropsychological testing. Eight areas are typically impacted in Alzheimer’s, and they include memory, language, perception, attention, constructive abilities, orientation, problem solving, and functional abilities.

Currently, the primary treatments for Alzheimer’s aim to minimize or stabilize symptoms, but the pharmaceuticals available cannot alter the progressive loss of brain cells. The drugs that are available act by increasing the amounts of the brain chemical acetylcholine. This leads to a modest improvement in cognitive symptoms, like memory. However, side effects exist; they include diarrhea, dizziness, drowsiness, extreme tiredness, nausea, and vomiting.^[3] There are also a number of health conditions that prohibit certain people from taking these medications in the first place. For these reasons, it is worthwhile considering some of the lifestyle modifications, natural vitamins, supplements, and herbal options that could be used. They usually come with excellent safety profiles and minimal side effects. Some of the herbal options that will be discussed include the herbs Ginkgo biloba and Bacopa monnieri. We will also examine some safe lifestyle behaviours that can be tried, such as aromatherapy and music therapy. Regardless of the approach taken, it is always recommended that your care is managed by a qualified health-care practitioner like a Naturopathic Doctor, and ideally comanaged with your medical doctor.

Herbal Treatments

The first herbal treatment we will discuss is Ginkgo biloba (that’s the scientific, or “Latin”, name). Ginkgo is a herb that has been used medicinally for thousands of years. There is a reasonable amount of scientific evidence supporting the use of ginkgo for the treatment of Alzheimer’s disease.^[4] One study used a specific extract of ginkgo and tested it in outpatients with dementia of the Alzheimer’s type and other types. 216 patients were included and randomized for 24 weeks of treatment by receiving a daily dose of ginkgo or a placebo. They were assessed at the end of the trial based on three separate validated assessment tools. It was found that those who took the ginkgo responded favourably, and it was also well-tolerated.^[5] However, many of the studies that have been conducted have used poor methods, were small, and possibly suffered from publication bias (where only good results get published). More recent trials have shown inconsistent results, making ginkgo a bit unpredictable and inconsistent in terms of its expected benefit for a specific person with Alzheimer’s disease. When examining the safety of ginkgo supplementation, all sources agree it is safe and without excess side effects.^[6]

The other important herbal treatment to examine is the herb Bacopa monnieri. The leaf extract of Bacopa is used in medicine practiced in India, and is widely used for enhancing memory, pain relief, and treating epilepsy. It has also been used to enhance cognition and to provide protective effects for the brain. Bacopa’s pharmacology displays some antioxidant and cell-protective effects. There is also the suggestion that it may work similar to the medications for Alzheimer’s, by preventing the destruction of the brain chemical acetylcholine. Finally, it may also increase blood flow to the brain. In one recent animal study examining the effects of Bacopa, an alcoholic extract of Bacopa was given, and then the animals were tested using a spatial memory test. The results showed that those who had taken Bacopa performed better on the spatial memory test and also lost fewer neurons over the time frame.^[7] Unfortunately, there are no well-conducted human trials on Bacopa specifically testing its effects on Alzheimer’s disease, but there have been trials suggesting it does enhance cognition in humans as measured by performance in memory free recall.

Aromatherapy and Music Therapy

Aromatherapy is the use of essential oils from plants for therapeutic purposes. There is a clinical study that examined using the essential oil of lemon balm to reduce the severe agitation in dementia. It was applied to the face and arms of patients twice daily, and compared to active medication and placebo.^[8] Agitation was measured using validated assessment tools. One is called the Pittsburgh Agitation Scale (which means raters observed the patients) and the others included a neuropsychiatric inventory. The patients were followed-up for twelve weeks and assessed. They found that patients received better scores, and thus had decreased agitation. As a caution in terms of interpreting results, they did find that touch and interaction may have contributed to the benefit, as the other groups that were tested also improved. Another study on aromatherapy used lemon balm, sweet orange, or tea tree oil, but showed no benefit. It is possible that aromatherapy may be particularly useful at decreasing anxiety in Alzheimer’s patients, and so may be useful only in specific individuals.

Music has been shown to improve quality of life for both healthy people and those with medical conditions. It sometimes involves listening to music, but can also involve performing music, with or without a music therapist. In people with Alzheimer’s, music therapy was found to reduce aggression and agitated behaviour, improve mood, and improve cooperation with daily tasks.^[9] In this study, participants used a switch to activate music stimulation periods. They could do this actively, and in other sessions it was prearranged passively. Both setups showed increases in patient indices of positive participation. Social rates favored the active setup on a questionnaire. Another study attempted to evoke autobiographical memories in Alzheimer’s patients by playing a variety of sounds.^[10] These included music that was happy, sad, lacking emotion, ambient noise in a coffee bar, and no sound. The results showed that emotional music, especially sad music for remote memories, was the most effective kind for recall of autobiographic experiences. The factor evoking the memory is not the music itself, but rather the emotion associated with it.

Integrating Various Therapies

As we’ve discussed, Alzheimer’s disease is the most common form of dementia. It develops differently in each person, and can be difficult to identify in the early stages. The most common symptom is difficulty remembering recent events. As the condition progresses, there are many potential symptoms, but ones to look out for include confusion, irritability, mood issues, and memory loss. The pharmaceuticals that are available typically act by increasing the amounts of the brain chemical acetylcholine. This leads to a modest improvement in cognitive symptoms, like memory. However, many of the drugs carry with them a long list of potential side effects. Even at their best, the pharmaceutical options only slow progression of the disease or help decrease the symptoms. Natural therapies can be quite helpful in some patients, and usually with much better safety profiles. We found the evidence on ginkgo was mixed, but that there are studies that show positive effects as assessed by validated assessment tools. Ginkgo is also extremely well-tolerated. Bacopa was the second herb we examined. In India, it is used for enhancing memory, pain relief, and treating epilepsy. Bacopa is an antioxidant and protects brain cells. Bacopa has been tested and has shown benefit in improving cognition and memory in humans, but no trials have been specifically conducted for Alzheimer’s disease. It has shown specific benefits in animal studies and is well-tolerated.

We examined aromatherapy using the essential oils of various plants, including lemon balm. The evidence suggests that aromatherapy can reduce the severe agitation symptoms of dementia. It is also suggested that aromatherapy may decrease anxiety symptoms. Finally, we examined music therapy. In people with Alzheimer’s, music therapy was found to reduce aggression and agitated behaviour, improve mood, and improve cooperation with daily tasks. Certain types of music may also directly help with memory recall by eliciting specific emotions. Most of the therapies we’ve discussed can be used either alone or in conjunction with conventional medications. There are additional natural approaches with supportive evidence that we have not discussed that could also be considered, such as acupuncture.^[11] Regardless of the approach taken, it is always recommended that your care is managed by a qualified health-care practitioner like a Naturopathic Doctor, and ideally comanaged with your medical doctor.