Over 40 million people are living with dementia globally and the number is projected to double by 2050 (Aston et al., 2017; & Yiannopoulou & Papageorgiou, 2020). As dementia progresses, people with the condition become vulnerable to related problems that require medication. Dementia affects the daily well-being and quality of life; caregivers and people living with dementia need effective medications to mitigate these effects. The rapid global increase in the number of people with dementia has provoked rigorous research dedicated to the treatment of the condition. Despite the current laborious efforts in research, a definite cure for dementia has not been developed yet (Yiannopoulou & Papageorgiou, 2020). The Food and Drug Administration (FDA) has approved the use of three types of medications for dementia. The medications fall under two groups: medicines that alter the disease progression – Aducanumab – and medicines that provisionally moderate symptoms of dementia – Cholinesterase inhibitors and Memantine (Ismail et al., 2020; Capouch et al., 2018; & Vaz et al., 2022). The article reviews the three medications currently used for dementia.
Aducanumab for Alzheimer’s treatment
First, Aducanumab is a monoclonal antibody that alters the progression of dementia by clearing accumulated forms of amyloid β plaques in the brain (Vaz et al., 2022). The accumulated amyloid β plaques in the brain lead to neuroinflammation and memory loss which are associated with dementia. According to Vaz et al. (2022), researchers consider the ability of Aducanumab to clear amyloid β as a cogent mechanism to manage Alzheimer’s disease, the most common type of dementia. Its effectiveness has been evaluated in a double Phase III randomized clinical trial named ENGAGE and EMERGE (Benefit, 2021; Vaz et al., 2022). The medication should be prescribed to patients in mild stages of Alzheimer’s disease. An injection of 170 mg/1.7ml to 300 mg/3ml Aducanumab dosage is administered to patients through intravenous infusion of 10 mg/kg for approximately one hour every month.
The evidence that the clinical benefits of Aducanumab are greater than its health risks is inadequate. The drug has been associated with amyloid-related imaging abnormalities. For this reason, the drug should only be administered to carefully chosen patients by specialists and in facilities that have requisite diagnostic and supervision expertise to ensure safety (Benefit, 2021). The drug should not be used by patients with multiple mental disorders, brain hemorrhage, bleeding disorders, or unstable heart conditions (Vaz et al., 2022). There are also concerns about Aducanumab’s high cost of US$ 56,000 per person yearly. Despite its shortcomings, the drug significantly lessens amyloid β which contributes to Alzheimer’s disease in the brain. According to Vaz et al. (2022), the clinical contribution of aducanumab has the potential to empower a combined therapy approach given the intricacies of dementia pathology.
Cholinesterase Inhibitors for Lewy Bodies, Vascular, and Parkinson’s Dementia Types
Cholinesterase inhibitors are medications that provisionally treat the symptoms of dementia. They proliferate the levels of acetylcholine in the brain. Acetylcholine is critical to the general brain and cognitive functions (Capouch et al., 2018). Extensive research on Cholinesterase inhibitors as treatment for dementia has been done proving their efficacy in the improvement of cognitive functions of people with dementia (Capouch et al., 2018; Holden & Kelly, 2002; Ellis, 2005; & Raina et al., 2008). The development of Cholinesterase inhibitors is based on the cholinergic premise (Yiannopoulou & Papageorgiou, 2020). The approved Cholinesterase inhibitors for use include Donepezil, Galantamine, and Rivastigmine.
Donepezil improves the mental status and general social and cognitive functions of dementia patients. It has shown its efficacy and long-term safety through triple randomized controlled trials for the treatment of dementia (Capouch et al., 2018). The drug is commonly used for the treatment of dementia with Lewi bodies (DLB) and vascular dementia (VD). Studies indicate that Donepezil is effective for the treatment of neuropsychiatric symptoms in patients with DLB (Capouch et al., 2018; Holden & Kelly, 2002; Ellis, 2005; & Raina et al., 2008). Donepezil dosage is 5 to 10mg per day. Patients who do not portray adverse effects on lower doses should raise their doses to 10mg per day to attain optimum cognitive function (Ismail et al., 2020). According to Holden and Kelly (2002), the typical side effects of Donepezil include slight and brief episodes of nausea, diarrhea, convulsions, fatigue, and lightheadedness in the initial stages of treatment. Patients with heart conditions are advised to be cautious with the drug.
Rivastigmine, another cholinesterase inhibitor, is used for the treatment of DLB, VD, and Parkinson’s disease dementia (PDD). The efficacy of the drug has been shown in randomized controlled trials for the treatment of dementia (Capouch et al., 2018). Rivastigmine treatment is initiated with a 1.5 mg dose taken twice a day for two weeks. It is then increased to 3 mg twice a day for another two weeks, after which it is increased to 6-12 mg daily, depending on the patient’s endurance, to attain optimal improvement in cognitive and daily functions (Holden & Kelly, 2002). The drug’s side effects include anorexia, nausea, and vomiting which mostly occur during the initial treatment phase. Caution is recommended for patients with heart conditions and gastrointestinal ulcers.
Galantamine is the third Cholinesterase inhibitor used for the treatment of DLB and Alzheimer’s disease. The extensive research on the drug shows that it substantially improves cognition discrepancies and optical deliriums in Alzheimer’s disease and DLB patients six months after initiating treatment (Capouch et al., 2018). Although Galantamine is associated with an eating disorder, weight loss, and lightheadedness, its positive cognitive impacts substantially improve the perception, behavioral patterns, and daily performance of patients (Raina et al., 2008). Holden and Kelly (2002) enlighten that the side effects are distinct, and patient tolerance to the drug can be enhanced by slowly escalating the dose.
All three Cholinesterase inhibitors attempt to offset the neurotransmitter imbalance created in dementia. They increase the level of acetylcholine which contributes to the improvement of the cognitive function of the patients (Yiannopoulou & Papageorgiou, 2020). Discontinuation of Cholinesterase inhibitors used for Alzheimer’s disease, PDD, DLB, or VD should be considered after 12 months if the cognition function continues to deteriorate, no clinical improvement is recorded during treatment, unbearable side effects, or the patient portrays poor adherence to medication (Ismail et al., 2020). The impact of the inhibitors is similar, however, one may be more effective in a particular patient than another. Yet, it is suggested that Donepezil, which is currently the most affordable, be tried first.
Memantine for the treatment of dementia
Memantine is the third type of medication used for various kinds of dementia. It is a low-attraction voltage-reliant noncompetitive rival of N-methyl-d-aspartate receptors presently approved for the treatment of dementia (Folch et al., 2018). Memantine blocks N-methyl-d-aspartate receptors and moderates glutamate levels (Yiannopoulou & Papageorgiou, 2020). According to Folch et al. (2018), it is however expatriated very fast from the receptors to circumvent prolonged obstruction which may potentially deteriorate memory and learning. Several clinical studies indicate that Memantine improves the cognition and performance of dementia patients (Orgogozo et al., 2002). In addition, it reduces amyloid β levels in the brain. A Memantine dose of 10 mg per day is recommended. When used together with Cholinesterase inhibitors, it contributes to memory improvement. Use of Memantine for the treatment of Alzheimer’s disease, PDD, DLB, or VD should be discontinued after the first 12 months if dementia symptoms worsen, no observable cognitive and behavioral improvement, unbearable side effects develop, or the patient is unable to adhere to medication.
Extensive research and clinical trials to develop new medications for dementia are continuing. Since a definite cure has not been developed yet, raising awareness about dementia among patients, the community, and general practitioners remains vital (Capouch et al., 2018). The medical community is currently responsible for availing resources necessary for the management of dementia to patients and caregivers. This is because dementia patients risk developing medication-linked problems and routine drug adherence. Contributing factors may include the lack of medication knowledge, access or availability, and adherence.
Which plant-based oils, herbs, and diet modifications can be used to manage dementia?
Diet
Most will agree that the best form of medication is prevention. A Mediterranean-style diet has been touted in most healthy diet outlets as preventative of many disease conditions.. One of the benefits of the Mediterranean diet has been observed as slowing down of cognitive decline after midlife. The diet has also been associated with a lower risk of Alzheimer’s disease and is recommended by the US National Institute of Health. Adopting a diet high in vegetables and fruits, legumes, whole grains, seafood, and unsaturated fats is a preventative measure for dementia.
Plant-based oils
While there is no specific plant-based oil that is known to cure or prevent dementia, certain oils have been associated with potential cognitive benefits. These oils may contribute to brain health and support cognitive function.
Coconut oil, derived from the flesh of coconuts, may have positive effects on brain function. It contains medium-chain triglycerides (MCTs) that can be converted into ketones, serving as an alternative energy source for the brain.
Olive oil, particularly extra virgin olive oil, is rich in monounsaturated fats and polyphenols. This oil has been linked to brain health benefits. Combined with a Mediterranean-style diet, it has been associated with a reduced risk of cognitive decline.
Avocado oil is a good source of monounsaturated fats, which may contribute to improved cognitive function. It also contains vitamin E, an antioxidant that plays a role in preserving brain health.
Flaxseed oil is high in omega-3 fatty acids, specifically alpha-linolenic acid (ALA). Omega-3 fatty acids are essential for brain health and have been linked to improved cognitive function. Flaxseed oil can be used as a supplement or added to foods.
Walnut oil is another source of omega-3 fatty acids, along with other beneficial nutrients like antioxidants and vitamin E. Some studies have suggested that walnuts and walnut oil may have protective effects on brain cells and general brain health.
Herbal remedies
Several herbal extracts have been studied for their potential effects on dementia. However, it’s important to note that the scientific evidence regarding their efficacy and safety is often limited and further research is needed. Here are some herbal extracts that have been explored in the management of dementia:
Ginkgo biloba extract is derived from the leaves of the Ginkgo biloba tree. It has been studied for its potential benefits in improving cognitive function and memory. Some studies suggest that Ginkgo biloba may have a modest effect in slowing down cognitive decline in certain individuals with mild to moderate dementia.
Huperzine A is derived from the Chinese club moss plant (Huperzia serrata). It has been investigated for its potential role in enhancing memory and cognitive function. Some studies suggest that Huperzine A may have a positive impact on cognitive decline associated with Alzheimer’s disease..
Sage (Salvia officinalis) extract has been traditionally used for its medicinal properties and has been investigated for its potential effects on memory and cognitive function. Some studies suggest that sage extract may have a positive impact on cognitive performance, particularly in individuals with mild to moderate Alzheimer’s disease.
Turmeric (Curcuma longa) contains a compound called curcumin, which has antioxidant and anti-inflammatory properties. Curcumin has been studied for its potential effects on cognitive function and Alzheimer’s disease. Some research suggests that curcumin may have neuroprotective properties and could potentially reduce the risk of cognitive decline.
Ashwagandha (Withania somnifera) is an adaptogenic herb traditionally used in Ayurvedic medicine. It has been studied for its potential neuroprotective effects and ability to reduce stress. While some animal and preliminary human studies suggest that ashwagandha may have cognitive benefits, more research is needed to determine its effectiveness and safety in dementia.
It is important to note that these plant-based oils should be part of a broader approach to brain health, including a balanced diet, regular exercise, cognitive stimulation, and overall healthy lifestyle habits. In regards to herbal remedies, they may have adverse effects and interact unfavorably with medications. Moreover, the quality and potency of OTC herbal supplements are not regulated. Incorporating herbal remedies that have been traditionally consumed as part of a regular human diet such as turmeric is a good cautionary approach. Consulting with a healthcare professional for personalized advice is always recommended for individuals with dementia or concerns about brain health.
Takeaway Messages
Treatment strategies for dementia are still under research. Aducanumab, three cholinesterase inhibitors, and Memantine are the current FDA-approved medications for the treatment of various types of dementia. The medications attempt to offset the neurotransmitter disturbance created by dementia and play a critical role in relieving clinical symptoms. The choice of medication depends on the side effects, cost, and dosing. However, where necessary, the type of treatment is influenced by the clinician’s guidance or decision. Alternatives to medications include a Mediterranean-style diet, plant-based oils such as olive and avocado, and herbal remedies such as turmeric, in combination with a healthy lifestyle.
