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- Dementia
- Brain Aging
- Cognition
| Date:
04-30-2012 | HC# 011255-447
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Re: Evidence of Benefits from Herbal Preparations for Improving Cognition and Behavioral and Psychological Symptoms of Dementia in the Elderly
Perry
E, Howes M-J R. Medicinal plants and dementia therapy: Herbal hopes for brain
aging? CNS Neurosci Ther.
2011;17(6):683-698.
Dementia
is associated with cognitive impairment, psychosis, agitation, anxiety, sleep
disorders, and depression. Cognition involves memory as well as attention,
executive function, and ability to form new memories. There are only a few
pharmaceuticals used to treat cognitive impairment in dementia; namely,
acetylcholinesterase (AChE) and/or butyrylcholinesterase (BuChE) inhibitors,
and memantine (a glutamate N-methyl-D-aspartic acid [NMDA] receptor
antagonist). Other drugs are used to treat the behavioral and psychological
symptoms of dementia, such as antipsychotics, antidepressants, tranquillizers,
and hypnotics. There are herbal remedies as well. The purpose of this review
article was to discuss the plant extracts or components with promising human
clinical evidence for treating dementia. The review does not include all herbal or phytochemical approaches.
The study inclusion criteria were not explained. The authors provide top-line
summaries of the herbal remedies, rather than in-depth study details.
Products derived from
European plants for improving cognition
Galantamine,
an AChE inhibitor, was originally derived from the snowdrop (Galanthus spp.), and is also present in
bulbs of daffodil (Narcissus spp.)
and other Amaryllidaceae plants not commonly used as medicines. It is now
synthesized, and it is a licensed drug for the treatment of Alzheimer's disease
(AD). Galantamine improves cognitive and behavioral symptoms and activities of
daily living for people with AD. It is not effective for patients with mild
cognitive impairment.
Sage
(Salvia officinalis) or Spanish sage (S. lavandulifolia), traditionally used for memory problems, has in
vitro and in vivo anti-AChE activity. Sage oil and extracts enhance memory in
studies with young and elderly normal volunteers, and have been shown to have
positive cognitive and behavioral effects in clinical studies of patients with
AD.
Lemon
balm (Melissa officinalis) has a
reputation of being used to enhance and restore memory, produce calmness, and
have antidepressant properties. In normal, young adult volunteers, the dried
leaf improved memory, calmness, and anxiety, and increased cognitive function
under experimental stress. Lemon balm standardized extract has been shown to
reduce cognitive impairment in patients with AD.
Lesser
periwinkle (Vinca minor) aerial plant
and its synthetic alkaloid vinpocetine have been shown to improve blood flow to
the brain. Vinpocetine may be able to enhance cognition in patients with
dementia, and enhanced memory and learning in patients with vascular dementia.
Herbal products
derived from traditional Chinese medicine (TCM) that improve cognition
Ginkgo
(Ginkgo biloba) leaf standardized
extract has more published dementia-related research than any other plant
species. Nonetheless, the evidence for enhancing cognition in AD is equivocal,
according to the authors. Many reviews conclude that ginkgo improves cognition,
including activities of daily living, selective attention, and executive
function, while other reviews indicate these findings are inconsistent. There may
be a risk of adverse interactions between ginkgo extract and antiplatelet or
anticoagulant drugs.
Asian
ginseng (Panax ginseng) has many in
vivo and in vitro studies that demonstrate pertinent activity for improving
dementia. However, according to the authors, though effective as an adjunct in
treating AD, robust clinical studies are lacking. The authors state that Asian ginseng
may be more effective for cognition before dementia has developed.
Huperzine
A is a potent anti-AChE alkaloid from toothed clubmoss (Huperzia serrata) that also protects neurons from β-amyloid peptide
associated with AD. According to the authors, clinical studies have only been
conducted in China. A meta-analysis of these studies concluded that huperzine A
improved cognition with minimal adverse events. The authors state that the
results need to be verified.
Other traditional
Chinese and Japanese herbal medicines
In
TCM and traditional Japanese medicine (TJM), combinations of herbs are
prescribed. This makes it difficult to interpret the efficacy of individual
herbs. Several herbal combinations used in China or Japan show promise in
preliminary research. The authors conclude that additional controlled trials
are needed.
Herbal products for behavioral
and psychological symptoms
For
behavioral and psychological symptoms of dementia, the authors highlight certain
herbs. They conclude that galantamine needs additional research in this arena
because clinical trials did not include patients primarily affected by
behavioral and psychological symptoms of dementia. There is substantial
evidence in favor of ginkgo for treatment of behavioral and psychological
symptoms of dementia, with studies showing ginkgo-related improvement in
apathy/indifference, anxiety, irritability/lability, sleep/nighttime behavior
and depression/dysphoria. The authors also highlight the TJM yokukansan, which
is composed of cang-zhu atractylodes (Atractylodes
lancea) rhizome, cnidium (Cnidium spp.)
rhizome, Uncaria spp. twig/branch, angelica
(Angelica spp.) root, bupleurum (Bupleurum spp.) root, licorice (Glycyrrhiza spp.) root, and poria (Wolfiporia cocos syn. Poria cocos) fungus. Yokukansan improved
psychiatric symptoms, daily living, and sleep structure in small, open-label
studies.
The
following herbs have efficacy for behavioral and psychological symptoms in
patients without dementia, and therefore should be evaluated in patients with
dementia: St. John's wort (SJW; Hypericum
perforatum) for depression and generalized anxiety, kava (Piper methysticum) for generalized anxiety, passionflower (Passiflora incarnata) for generalized
anxiety, lavender (Lavandula angustifolia)
for sleep, valerian (Valeriana
officinalis) for sleep, and chamomile (Matricaria
recutita) for sleep. Kava and SJW can have potential adverse effects. SJW
can interfere with prescription medications; therefore, doctors who provide
medication prescriptions should be informed of SJW use.
Agitation
The
authors highlight some herbs that benefit agitation of dementia. Aromatherapy
with lavender or lemon balm essential oils has been shown to be helpful. They
also state that cannabis (Cannabis sativa)
is frequently associated with psychosis, but the constituent cannabidiol (CBD),
the constituent Δ9-tetrahydrocannabinol (THC), and the synthetic
cannabinoid receptor agonist nabilone, may help dementia-related agitation.
Cannabis constituents may produce adverse side effects.
Botanical substances
for dementia prevention/stabilization
The
authors describe studies evaluating ginkgo, curcumin (from turmeric [Curcuma longa]), coffee, caffeine, red
wine (from grapes [Vitis vinifera]),
and nicotine that show some benefit for dementia prevention/stabilization, but
the results are inconclusive. Increased consumption of fruits and vegetables,
especially as part of a traditional Mediterranean diet including use of olive (Olea europaea) oil, is associated with a
decreased risk of AD and other forms of dementia, though the degree of
protection is uncertain.
Conclusion
The
authors conclude that herbal remedies for dementia are promising. They explain
that two of the four drugs licensed to treat cognitive treatments in dementia
are derived from plants. However, it may be too simplistic to create drugs from
single plant constituents; rather plants more than likely have numerous
components that work together to produce a beneficial effect. The authors
recommend that future research should focus on normal, elderly populations
rather than populations with established dementia, since this reflects the
traditional use and has a much wider potential application that could
contribute to delaying dementia progression in the early stages. They also
advocate for an accessible, authoritative database on herbal applications for
dementia to provide practitioners and caregivers with a resource describing
clinical evidence, specific herbal preparations, dosage, and quality sources,
and addressing safety issues and potential for interactions.
—Heather
S. Oliff, PhD
Peer
Reviewer's Comments:
The benefits of galantamine and huperzine A are
stronger than the other herbs. The evidence base for them is also more solid.
In clinical practice, the natural Galanthus
spp. extract is more effective and better tolerated than the synthetic galantamine.
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