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Other Articles (Non CPD Accredited): General Healthcare

Alzheimer’s Disease & Dementia

Before describing Alzheimer’s disease itself, one first needs to understand the term ‘dementia’.
 

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Introduction – getting the terminology right

Dementia is an umbrella name for a group of conditions which all lead to progressive degeneration of the brain where nerve cells in the brain and brain tissue itself are affected. Irrespective of the type of dementia the symptoms produced are mainly cognitive and psychological. What does ‘cognitive’ mean you might ask? Cognition is the mental process which takes place in the brain when we gain knowledge and understanding of things. This includes thinking, knowing, remembering, making decisions and problem solving. Alzheimer’s is one of the brain conditions responsible for 60-80% of all forms of dementia.

Dementia

Common ageing vs dementia

Dementia effects one in five persons over the age of 85, so it is far more common in the elderly, but importantly, one needs to distinguish between normal age-related cognitive changes and actual dementia. In reality, people start to experience some mild cognitive symptoms, most commonly memory loss even in their 50’s. These are often very gradual in onset and usually very mild.

So, what could be considered ‘normal’ cognitive symptoms in an elderly patient?

  • Recalling information slower
  • Decreased or slower problem-solving ability
  • Reacting slower than usual
  • Decreased attention span
  • Less ability to concentrate
  • Decreased learning speed.

Typically, where a patient is beginning to experience symptoms beyond that which is age appropriate but is not fully diagnosed with dementia, doctors will call this ‘mild cognitive impairment (MCI)’ – this is an ‘in between’ stage.

How does dementia present?

In actual dementia, symptoms are typically more obvious and can develop at a more rapid rate and consist of both cognitive and psychological symptoms. These symptoms are highly variable from person to person and very much on the severity of the condition. Like most diseases, dementia has various stages ranging from Stage 1 which is the mildest version thereof, all the way to stage 7 at which patients are totally dependent on full-time carers.

The cognitive symptoms of dementia often include varying degrees of:

  • Disorientation and confusion – even in known situations or places.
  • Memory loss – losing things, forgetting names, forgetting recent conversations, even not recognising familiar persons.
  • Communication problems – difficulty explaining oneself or understanding others, difficulty in social settings or following conversations.
  • Struggling with complex tasks – familiar known tasks become challenging to initiate or complete.
  • Poor concentration – difficulty taking in new information or focussing on a task.
  • Poor coordination – clumsiness, changes in gait, loss of balance.

The psychological symptoms may include:

  • Mood fluctuations – with agitation and often anxiety.
  • Personality changes – often with withdrawal from activity.
  • Poor reasoning – often leads to poor hygiene, careless actions, poor judgement.
  • Paranoia and even hallucinations – in advanced stages of illness.
  • Inappropriate behaviour.

Alzheimer’s Disease

What causes or increases the risk of Alzheimer’s disease?

Alzheimer’s disease is the most common form of dementia, in fact 60-80% of all dementia patients have Alzheimer’s disease. Like dementia in general, the origin is complex and not fully understood but there seems to be a combination of various factors, with only around 1% thought to be purely genetic in origin.

Lifestyle risks and contributing factors include:

  • Poor diet – excessive saturated fats, processed and refined food and sugar, and insufficient antioxidants.
  • Heavy alcohol consumption.
  • Smoking.
  • Lack of exercise.
  • Increasing age.
  • Lack of mental stimulation (socially and intellectually).

Related conditions which increase risk:

  • Cardiovascular disease (poor heart and circulation) e.g. arteriosclerosis specifically poor circulation to the brain.
  • Diabetes.
  • High blood pressure.
  • Chronic insomnia and lack of sleep.

Other risk factors:

  • History of head trauma.
  • Genetics and family history.
  • Mild cognitive impairment (MCI) early in life.

Sleep deprivation is an interesting potential threat to brain health. The brain toxin called beta amyloid is typically cleared from the brain during restful, good quality sleep, so long-term poor sleep quality is thought to cause increased levels of this damaging toxin. All the more reason why we need a good night’s rest!

The other system in the body which is closely related to the development of dementia is the circulatory system, around 20-30% of dementia patients have what is called ‘vascular dementia’ this is where due to poor circulation to the brain the person has repeated ‘mini/silent’ strokes each damaging brain tissue when they occur, over time and multiple events, vascular dementia occurs. Some Alzheimer’s patients have a combination of both Alzheimer’s and Vascular dementia.

Diagnosing and assessment

If you or a family member may be at risk or are starting to show potential symptoms, see your healthcare provider for a referral to a neurologist, psychiatrist or a gerontologist (a doctor specialising in geriatric health) for further specialised testing. Specialists will do a variety of cognitive tests to measure cognitive function as well as a variety of neurological tests for the nervous system, blood tests and brain scans are also used to make an accurate diagnosis.

Treatment and management of dementia and Alzheimer’s disease

All forms of dementia including Alzheimer’s disease require a holistic management plan. There are medicines which can help but these need to be complemented by various lifestyle, social and dietary interventions for the best outcomes. There are also several effective complementary medicines with supporting scientific evidence.

Dietary interventions:

The MIND diet i.e. Mediterranean DASH Intervention for Neurodegenerative Delay is a specific, scientifically researched eating plan designed to support brain health. [1-3]

The MIND diet

This diet is a basic Mediterranean Diet which is probably the most researched and scientifically proven dietary intervention, with a few specific additions and requirements for brain health.

The MIND diet requires specifically the following:

  • Green leafy vegetables – at least one serving daily.
  • All other vegetables – at least 2 servings daily.
  • Berries – 1 serving more than twice weekly.
  • Wholegrains – 3 or more servings daily.
  • Nuts – 5 servings per week.
  • Olive oil – daily.
  • Fish – more than one serving per week.
  • Beans – more than 4 servings per week.
  • Poultry – 2 servings per week.
  • Red meat and dairy products are limited.
  • Fried, processed food and sugar is limited.
  • Pastry, sweets and sugar is limited.

Non-medicinal interventions

Unfortunately, dementia sufferers tend to withdraw from social activity as they begin to feel more anxious in public, insecure, and loose self-confidence. They tend to avoid company, stay home and indoors, and stick to ‘safe’ activities like watching TV, which unfortunately further reduces brain stimulation and may worsen the condition.

These additional interventions are important and are aimed at keeping the brain stimulated and engaged, supporting the patient psychologically and improving quality of life:

  • Relaxation techniques – to help reduce agitation and anxiety
    • Meditation, assists with intentional self-regulation of attention.
    • Guided imagery – evoking images, sensory or affective.
    • Breathing exercises.
  • Lifestyle changes – to reduced factors that compromise brain health
    • Nutritional changes, improving sleep quality, promote exercise activity, and elimination of alcohol and smoking.
  • Social support – stimulates brain function and provides emotional support
    • Prevents isolation and withdrawal, group activities, games etc.
  • Movement – prevents apathy, stimulates brain function and co-ordination
    • Yoga, walking, Tai Chi (group activities).
  • Environmental interventions – stimulates brain function, prevents apathy
    • Light, nature, sound, animals.
  • Recreation and education – stimulate cognitive functioning
    • Talks, shows, group activities, courses, therapeutic recreation, seminars.
  • Creative expression and creative therapy
    • Story, art, memory, theatre, crafts.
  • Music – promotes relaxation and also stimulation and co-ordination
    • Listening or playing an instrument.

Support groups for patients, family, and carers

Understanding one’s condition, what to expect and how to deal with it is essential not only for dementia sufferers themselves but for their family and care givers. There are various good resources of information available as well as support groups such as:

Supplements

Bio-Strath

Bio-Strath is a plasmolysed herbal yeast product providing nutritional support which contributes to normal mental performance, supports memory and concentration, assists with focus and attention, and reduce fatigue and stress.

Bio-Strath has been shown in clinical trials[4, 5] in prematurely aged and pre-Alzheimer’s patients to increase short term memory, and improve geriatric symptoms such as fatigue, giddiness, mental alertness, emotional stability and apathy.

A. Vogel Ginkgoforce – a herbal extract of fresh Ginkgo biloba leaves

A.Vogel Ginkgoforce is produced from fresh Ginkgo leaves and as a Western Herbal medicine it supports peripheral circulation, cognitive health and memory in adults.

Ginkgo has a fascinating history; this tree has not changed very much in the last 150 million years, meaning it was around when the dinosaurs roamed the earth and was described by Charles Darwin as ‘a living fossil’. As a herbal medicine, extensive research confirms that it has a powerful anti-oxidant action and improves circulation, especially in the smallest blood vessels of the brain. It is known to be ‘neuroprotective’ meaning it has a protective effect on the brain and nervous system, as well as being one of the most well-known herbal ‘nootropic’ substances, ‘nootropic’ meaning a supplement which supports cognitive function e.g. memory, attention, creativity and motivation.[6] What’s even more fascinating is the undeniable resemblance between the lobed ginkgo leaf and the shape of the human brain… coincidence, or is it possibly nature trying to point out the link for us?

A.Vogel Ginkgoforce

A. Vogel VegOmega-3

A.Vogel VegOmega-3 capsules are a vegan source of the omega-3 essential fatty acids docosahexaenoic acid (DHA), alpha-linolenic acid (ALA) and eicosapentaenoic acid (EPA) that are essential for the maintenance of good health and must be included in the diet as the body does not produce them.
DHA contributes to the maintenance of normal brain function and together with EPA helps support the development of the brain as well as normal heart/cardiovascular health.

DHA supplementation[7, 8] is particularly important as it is thought to be protective directly against dementia and Alzheimer’s disease, as well as some of the other diseases which can contribute to it such as cardiovascular disease and diabetes. Interestingly, there is some evidence which suggests that DHA possibly inhibits the formation of beta amyloid, the brain toxin associated with Alzheimer’s disease.

This article originally appeared on Living Naturally and can be found here.

References and additional reading:

  1. de Crom, T.O.E., et al., MIND diet and the risk of dementia: a population-based study. Alzheimer’s Research & Therapy, 2022. 14(1): p. 8.
  2. Morris, M.C., et al., MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement, 2015. 11(9): p. 1007-14.
  3. Morris, M.C., et al., MIND diet slows cognitive decline with aging. Alzheimer’s & Dementia, 2015. 11(9): p. 1015-1022.
  4. Pelka, R. and H. Leuchtgens, Pre-Alzheimer-Study – Action of herbal yeast preparaiton (Bio-Strath®) in a randomised double-blind trial Ars Medici, 1995. 85(1).
  5. Pelka, R.B., Pre-geriatric Study – Results of a randomised double-blind study with Bio-Strath involving 184 prematurely aged patient. Notabene Medici Journal für Ärzte, 1990. 3 & 4.
  6. Yang, G., et al., Ginkgo Biloba for Mild Cognitive Impairment and Alzheimer’s Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Curr Top Med Chem, 2016. 16(5): p. 520-8.
  7. Chu, C.-S., et al., Higher Serum DHA and Slower Cognitive Decline in Patients with Alzheimer’s Disease: Two-Year Follow-Up. Nutrients, 2022. 14(6): p. 1159.
  8. Cole, G.M. and S.A. Frautschy, DHA May Prevent Age-Related Dementia. The Journal of Nutrition, 2010. 140(4): p. 869-874.