Preventive measures may help maintain or even improve mental performance and may also help to minimize and slow the clinical development of memory loss, cognitive dysfunction or dementia. Regular physical exercise has been shown to delay the onset of AD.60
The regular use of intellectual powers, such as doing crossword puzzles, other games of mental skill and engaging cognitive function on a regular and challenging basis has also been reported to delay the onset of memory loss-cognitive dysfunction. Depending on which causative theory one uses, diet may also be used as a preventive measure, but the scientific evidence is still too early to know for sure. Unfortunately, there are currently no other "evidenced-based" scientific methods for prevention available. So all that remains to be done from an evidenced-based, scientific medicine perspective is to wait for symptoms to develop and then try and decide if those symptoms are statistically normal aging or the presence of an early memory loss syndrome (AD, SDAT, etc.). Since the current recommendations of experts writing in the scientific literature is also to start treatment as early as possible, a difficult task confronts the patient and physician... how does one know when and who to treat? The "evidence-based" scientific "experts" do not seem to address this question adequately.
In addition, there is no currently known specific curative treatment for academically named memory loss, cognitive dysfunction or dementia syndromes. The current methods that are being employed for treatment can be divided into two major categories:
("statistically significant" scientific) therapies and more
(Heuristic, Anecdotal) therapies. more
The evidence-based (statistical) approach relies mainly on one treatable defect being countered by one specific medication. Mainstream medicine (evidenced-based) treatment strategies thus far have targeted biochemical (neurotransmitter) defects, largely ignoring structural, regulatory, and vascular and other possible mechanisms leading to memory loss-cognitive dysfunction syndromes.
The evidenced-based establishment has settled on the pharmaceutical approach to the exclusion of all others. This has led the scientifically based pharmaceutical industry to develop pharmaceutical drugs to enhance the biochemical effect of the neuro-transmitter Acetyl Choline or selectively block the neurotoxic effects of abnormal Glutamate transmission. Thus, there are two biochemical classes of evidence-based pharmaceutical agents that have been FDA approved and are currently available for routine clinical use. That is the extent of evidence-based scientific medicine's solution to an increasingly prevalent clinical reality for the patient and clinician.
Evidence -Based Treatment:
The first group of FDA approved pharmaceuticals increases neural network content of Acetylcholine by decreasing the activity of the enzyme Acetyl-Cholinesterase. These carbamate anti-cholinesterase
neurotransmitter-enhancing drugs are actually based on the concept of pesticides! The accidental overdosing with this class of pharmaceuticals (rivastigmine or ExcelonTM
) has actually been described as pesticide-like poisoning in the peer-reviewed scientific medical literature.61
However, whether or not these pharmaceutical agents actually work is still being debated.62,63
The second group of drugs, which only has one member, acts by selectively blocking the neurotoxic effects of abnormal glutamate transmission. All pharmaceuticals currently approved by the FDA to treat AD, Cognitive Decline and/o Memory loss are expensive, potentially toxic, have significant side-effects and only treat symptoms... they do not "cure" the condition.
The following pharmaceuticals are currently FDA approved for use in AD (on label use), but are also commonly used clinically for other memory loss syndromes (off label use). Interestingly, the off-label use of evidence-based FDA approved pharmaceuticals in Non-AD syndromes is actually practicing non-evidence-based or unscientific medicine, also called anecdotal or clinical medicine:
1. Donepezil (AriceptT): Usual dose = 10 mg daily; est cost per day $4.98; no generic avaiable64
2. Galantamine (RazadyneT): Usual dose 8-24 mg daily; est daily cost $5.49; no generic available.64
3. Rivastigmine (ExelonT): Usual dose 1.5 -6 mg daily; est daily cost $5.04; no generic avail.64
4. Tacrine (CognexT): Usual dose 10 - 40 mg daily; est daily cost $11.68; no generic avail.64
N-Methyl-D-Aspartate Receptor Antagonist:
1. Memantine (NamendaJ): Usual dose 10 mg twice daily; est daily cost $4.46; no generic avail.64
Each of these FDA approved, "evidence-based" scientific medications appears to slow the progress of memory loss and cognitive decline temporarily. Typical responses appear to gain about 6 months of clinical improvement before continued clinical progression usually sets in. Several Anon-evidence-based clinical strategies have emerged using these agents. One is to change to another agent in the same class at the first sign of recurrent decline. Another is to combine more than one agent together. The only combination that makes clinical sense is to combine one of the class of cholinesterase inhibitors with the glutamate antagonist. A third strategy is to begin pharmaceutical therapy much earlier in the clinical course of the syndrome. Finally, these clinical strategies can also be combined, for example, using several agents earlier in the clinical course of memory loss. These pharmaceutical agents all treat only symptoms
and will not result in a cure. In addition, being prescription pharmaceuticals, they all have associated daily cost, side effects and potential toxicity, which may be significant.
Since the "cause" of most clinical memory loss-cognitive dysfunction syndromes may be "multi-factorial" (meaning more than one causative mechanism or contributing factor), simple logic would dictate that any potential treatment protocol should also be directed at "multi-factorial" factors. It is also important, from a prognostic perspective, to clearly delineate, if possible, when the individual clinical condition being treated may be preventable, curable, treatable, palliated or simply require custodial care. As previously discussed, memory loss, cognitive decline and Alzheimer's/ SDAT have been shown to be related to a number of risk factors. Included among these are diet65
, diabetes, Metabolic Syndrome and inflammation.32
In addition, vascular injury may lower the threshold for the clinical manifestation of dementia. Finally, general or specific environmental toxins, hormonal imbalances and/or immune factors have also been related to memory loss, cognitive decline and dementia syndromes. Many of these "risk factors" can be modified and/or treated. This is the underlying logic of the Clinical (Anecdotal) approach to treatment and prevention... utilizing several different but inter-related or "integrated" treatment methods simultaneously. Hence, in addition to the possible use of previously mentioned pharmaceutical therapy to enhance neuro-transmitter function,62-64
Integrative Medicine utilizes the following modalities in individualized prevention or treatment protocols to integrate lifestyle-altering, biochemical, structural and regulatory methods of therapy:
Diet and Lifestyle:
The best preventive approaches should be simple, cheap and non-toxic, so a discussion of diet and lifestyle heads this list. When parallel dietary intake studies were conducted among patients with AD versus patients with vascular dementia (VaD) the results demonstrated very similar dietary patterns. The only statistical differences between the two groups was that AD patients had higher intake of animal fat over the vascular dementia patients.65
When AD and Vascular Dementia (VaD) patient group diets were compared to matched normals there was an excess of energy (calories) and Omega six fatty acids (6 fatty acids promote inflammation
) and a deficiency of anti-oxidants (Vitamins A, C, E, selenium, etc.) and omega three fatty acids (3 fatty acids reduce inflammation
). Thus, a diet that has reduced calories, animal fat and 6 fatty acids (reduced calorie/sugar66
/carbohydrate/animal fat/trans-fats/warm weather oils [corn, safflower, etc.] and provides increased anti-oxidants and 3 fatty acids (increased fruits (low carbohydrate-low glycemic index)/vegetables/fish/fish oil/flax seed/flax oil/olive oil) should be considered. In addition, regular physical exercise and regular mental exercise (cross-word puzzles, games, reading technical literature, etc.) have been shown to delay the onset of and improve the symptoms of memory loss-cognitive dysfunction syndromes and cardio-vascular diseases.14
Certain over-the-counter (OTC) supplements may assist in preventing and/or treating memory loss-cognitive dysfunction syndromes. There is some statistically-based scientific evidence that vitamin D3,67
Niacinamide (vitamin B3)68
and the sleep-inducing natural brain hormone Melatonin69
may aid in delaying or assist in treating memory loss-cognitive dysfunction. There is also a significant data base regarding the beneficial effects of Vitamins B12 and Folic Acid on memory loss-cognitive dysfunction syndromes, especially in the elderly.70-72
In addition, there is clinical evidence that the use of a multiple B vitamin formula is beneficial for maintaining and/or improving cognitive function.73
There is also some laboratory and clinical evidence that Phosphatidyl-Choline supplementation improves memory and cognitive function.74-76
Adequate dietary or supplemental Omega 3 oil (fish oil66,75
), Acetyl L-Carnitine,77
L-Carnitine, Coenzyme Q 10 and Lipoic Acid have also been demonstrated to exert a nutritional protective and therapeutic effect.77,78
In addition, the use of specific types and forms of B vitamins (B1 or Thiamine and B6, especially as the "amine" salt of B6 or "pyridoxamine") may actually reverse the process of protein glycation
, which is evolving as a fundamental cause of Micro-Vascular
disease (see below). Finally, the herb Ginko biloba has shown some clinical benefit in memory loss-cognitive dysfunction syndromes.79
"Lipid Exchange" is the clinical European technique that involves the intravenous injection of Phosphatidyl Choline (Lipostabil®) followed by the intravenous injection of the anti-oxidant Glutathione has clinically been found to assist in neurological detoxification
Depending on patient gender, age and laboratory testing, there is good scientific evidence that hormonal supplement (low dose) or replacement ("optimal" dose) therapy may have clinical benefit using single or multiple hormones. The evidence indicates that Estrogen, Testosterone, DHEA, Pregnenolone and/or Growth Hormone have been successfully emplyed as therapy in memory loss-cognitive dysfunction and AD/SDAT syndromes.8,44-49,80
The use of Hormone Therapy requires baseline and periodic laboratory testing, including the level of hormone(s) being evaluated and any potential target organ disturbance (i.e. following the PSA level in males using bio-identical Testosterone therapy). The concept of normal versus optimal should be applied when adjusting dosage levels. All hormone preparations used should be Bio-Identical hormones whenever possible.
Regulation Therapy and Detoxification:
The concept of "Regulation Therapy" is more commonly found in European and Asian medical academia and clinical practice than in the U.S. Regulation methods are utilized to treat disturbed "cybernetic" or "regulatory" system function. There are few structural or biochemical signs in "Regulatory" pathology. For example, one of the theoretical models of how acupuncture works is to re-regulate the autonomic and/or neuro-vegetative function. This has shown to be accomplished by the therapy changing or re-regulating disturbed reflex (sympathetic-para-sympathetic) autonomic neural networks, altering neuro-immune (cytokine, endorphin, enkephalin, etc.) systems locally and/or re-patterning system wide (global) cybernetic disturbances. Most regulatory disturbances cannot be detected by conventional laboratory or radiographic testing. The simplest and most elegant clinical testing methods available for detecting regulation disturbance is Chinese Pulse Diagnosis. Electro-dermal screening is also commonly used to evaluate for disordered Regulatory pathology. A more Western scientific method that can be used to detect disordered regulation utilizes Heart Rate Variability (HRV) Testing. HRV testing analyzes the pattern of the microsecond beat to beat variability in the electrocardiogram. It is an excellent tool to detect disturbed physiologic regulation. Interestingly, it has been scientifically proven that HRV testing is NOT
subject to a placebo response. In other words, a change in HRV results cannot be said to be due to "placebo effect"
, thus making it a very powerful clinical tool to "scientifically" prove that a specific regulation therapy actually works at a physiological ("regulatory") level.
Unfortunately, there are many possible causes of regulation disturbance. One of the most common causes of regulatory dysfunction encountered clinically is chronic
burdening with environmental toxic metals (Mercury, Lead, Cadmium, Aluminum, etc.). These serve to slowly and sub-clinically disrupt optimal autonomic regulation and/or chronically
poison neuro-endocrine-immune function. The "gold standard" for diagnosing chronic toxic metal burdening is the Chelation Provocative Challenge Test
. The is done by administering specific chelating agent (depending on the toxic metal being considered) of a known dose followed by the collection of a timed urine specimen, usually 6 or 12 hours, again depending on the specific toxic metal under consideration. The test is used to determine the chronic
(built up over time) burden of toxic metal(s) in the body. All chelating agents are organic acids. Some are natural (i.e. Vitamin C) and others are synthetic (EDTA). If a burden of one or more toxic metals is detected detoxification
is accomplished using therapeutic
. In addition, Chelation using the agent EDTA commonly clinically improves the Micro-Circulation
-Regulation Therapy and Sugar Toxicity ("gluco-toxicity") Therapy :
Another common clinical cause of Regulatory dysfunction relates to abnormalities within the functional and structural integrity of the cardiovascular system. In the presence of clinical Micro-Vascular disease treatment using these rather crude tools becomes increasingly difficult. In the case of memory-loss, cognitive dysfunction or dementia syndrome with documented Micro-Vascular disease causing structural dysregulation of pulsatile brain blood flow, the clinical use of External Counter Pulsation (ECP39-40
)Therapy is being shown to assist in stabilizing and reversing lost brain circulatory and cognitive-memory function. ECP appears to work by re-entraining Micro-Vascular pulsation in the brain and other vital organs with the heart. The Chinese have published the most research in this field, but the Germans have also published positive preliminary studies using ECP therapy for improving brain blood flow. ECP therapy is currently the only demonstrated clinical therapy available for effectively treating disturbed (structurally stiffened) brain Micro-Vascular
Immune, Infectious and/or Genetic Therapy: Homeopathic and Isopathic Therapy:
There is currently no therapy that scientific evidence-based medicine has developed directed at treating and/or preventing Immune, Infectious and/or genetic mechanisms of memory loss, cognitive dysfunction or dementia. Fortunately, Integrative Medical therapy
Ultra Violet Blood Irradiation (UVBI)
Isopathic Nosode Therapy, Constitutional and Miasmic Homeopathic Therapy
, Classical Acupuncture40
and Cell (Sarcode in Homeopathic language) Therapy may all be clinically useful in addressing possible dysregulation of neuro-endocrine-immune
system that manifests as increased chronic inflammation, treating chronic, low grade infections and/or dampening the effects of the external environmental trigger(s) for inherited or genetic predisposition to chronic degenerative Free Radical and/or Gluco-Toxicity pathology. When added to intense Life Style changes the individual clinical effects of these Integrative Medical therapies can range from clinically from noticeable to spectacular.
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