Sunday, 14 March 2010

Dementia: A review of the evidence.

To make my discussions with Health Professionals a.k.a. "experts" more effective, I need to know what they know. To help me with this task, I have been rummaging through The Cochrane Library. The results for Dementia NOT "Down Syndrome" NOT Vascular NOT Aids NOT carer and Reviews only produced 44 results. Some weren't relevant. The following are relevant and I have added the plain language summary:-

Acetyl-l-carnitine for dementia. No evidence of benefit of Acetyl-l-carnitine for dementia.
Alpha lipoic acid for dementia. No evidence of efficacy of alpha lipoic acid for dementia.
Antidepressants for treating depression in dementia. Insufficient evidence for the efficacy and safety of antidepressants for depression in dementia.
Aroma therapy for dementia. The one small trial published is insufficient evidence for the efficacy of aroma therapy for dementia.
Cannabinoids for the treatment of dementia. No evidence that cannabinoids are effective in the improvement of disturbed behaviour in dementia or in the treatment of other symptoms of dementia.
Cholinesterase inhibitors for dementia with Lewy bodies. No convincing evidence from one trial of the efficacy of cholinesterase inhibitors for dementia with Lewy bodies.
Cholinesterase inhibitors for Parkinson's disease dementia. Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD.
Donepezil for dementia due to Alzheimer's disease. Donepezil is beneficial for people with mild, moderate and severe dementia due to Alzheimer's disease.
Ginkgo biloba for cognitive impairment and dementia. There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment.
Haloperidol for agitation in dementia. No evidence has been found of any significant general improvement in manifestations of agitation, other than aggression, among demented patients treated with haloperidol, compared with controls.
Homeopathy for dementia. No evidence that homeopathy is effective in treating dementia.
Hormone replacement therapy to maintain cognitive function in women with dementia. There is no evidence of a positive effect that oestrogen replacement therapy can maintain cognitive function for a longer period of time (> five months) in women with Alzheimer's disease.
Hydergine for dementia. Uncertainty about the efficacy of hydergine in dementia.
Lecithin for dementia and cognitive impairment. Doubtful effect of lecithin as a treatment for dementia.
Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia. There is insufficient evidence to determine whether light therapy is effective in the management of cognitive, sleep, functional, behavioural or psychiatric disturbances in dementia.
Massage and touch for dementia. Insufficient evidence to draw conclusions about the possibility that massage and touch interventions are effective for dementia or associated problems.
Memantine for dementia. Some evidence of efficacy of memantine for dementia.
Music therapy for people with dementia. There is no substantial evidence to support nor discourage the use of music therapy in the care of older people with dementia.
Nicergoline for dementia and other age associated forms of cognitive impairment. Nicergoline may improve cognition and behavioural function of people with mild to moderate dementia.
Omega 3 fatty acid for the prevention of dementia. There is no evidence that dietary or supplemental omega 3 polyunsaturated fatty acid (PUFA) reduces the risk of cognitive impairment or dementia in healthy elderly persons without pre-existing dementia. This review yielded no clinical trials that could confirm or refute the utility of omega 3 PUFA in preventing cognitive impairment or dementia. This is an important area that is in pressing need of further research.
Physical activity programs for persons with dementia. There is insufficient evidence to determine the effectiveness of physical activity programs in managing or improving cognition, function, behaviour, depression, and mortality in people with dementia.
Physostigmine for dementia due to Alzheimer's disease. Limited evidence of effectiveness of physostigmine for the symptomatic treatment of Alzheimer's disease.
Piracetam for dementia or cognitive impairment. Evidence for the efficacy of piracetam for dementia or cognitive impairment is inadequate for clinical use but sufficient to justify further research.
Procaine treatments for cognition and dementia. In analysing the effect of procaine and its preparations, there was no evidence for benefit in the prevention or treatment of dementia or cognitive impairment.
Propentofylline for dementia. Limited evidence that propentofylline benefits cognition, global function and activities of daily living in people with Alzheimer's disease and/or vascular dementia.
Reminiscence therapy for dementia. Inconclusive evidence of the efficacy of reminiscence therapy for dementia.
Snoezelen for dementia. No evidence of the efficacy of snoezelen or multi-sensory stimulation programmes for people with dementia.
Statins for the prevention of dementia. There (is) good evidence that statins given in late life to individuals at risk of vascular disease have no effect in preventing dementia.
Thioridazine for dementia. No evidence to support the use of thioridazine for dementia.
Transcutaneous Electrical Nerve Stimulation (TENS) for dementia. Insufficient data to determine the efficacy of transcutaneous electrical nerve stimulation for dementia.
Trazodone for agitation in dementia. Insufficient evidence from randomized, placebo-controlled studies to support a recommendation that trazodone should be prescribed, or not prescribed, for BPSD.
Validation therapy for dementia. No new evidence of the efficacy of validation therapy for people with dementia or cognitive impairment has been identified.
Valproate preparations for agitation in dementia. No evidence of efficacy of valproate preparations for treatment of agitation in people with dementia.
Vinpocetine for cognitive impairment and dementia. Insufficient evidence of benefits of vinpocetine for people with dementia.

So there you have it. Virtually everything that's been thoroughly tested is ineffective for the treatment of dementia.
There are a whole load of things that haven't been properly tested yet e.g. Omega-3, Vitamin D3, Vitamin K2, Curcumin, Berberine, Trans-dermal Progesterone, Sub-lingual B12, S-Adeno-Methionine and The Ketogenic Diet. What is The Alzheimer's Society doing with all of the money that they get?

Finally, I accept that mum is on her last legs and won't be around for much longer, so here's a song. I normally hate raps, but the Pinky & Perky backing vocals are kinda quirky and the lyrics are poignant. So here's Stay with Me by DJ Ironik. Listen to the words!


Anonymous said...

The Alzheimer Society is doing what every other charitable health agency is doing "looking for a miracle drug." I mean, drugs is the only answer right?


Nigel Kinbrum said...

Hi Jaz.

Sadly, I have to agree.


Anonymous said...

I have just read the Omega 3 study and find it contradictory - is Omega 3 useful for dementia or is it not? I'm a bit of a lay person I'm afraid!

Nigel Kinbrum said...

Hi Anonymous.

Omega-3 looks promising but until the results of RCTs are published, there's insufficient evidence to support it. Doctors have to wait for positive RCT results before they can prescribe omega-3 for dementia.

My personal experience of the effect of smoked salmon on my mum's mental faculties is that EPA & DHA are beneficial.


Anonymous said...

Ah, yes, thank you, I reread your March 12 blog entry which explained Omega 3s and Dementia in more detail. Btw, I took you up on your suggestion for shopping for Vitamins at iHerb. My 4kg box of assorted supplements arrived within 3 days - Los Angeles, USA to South Africa via Leipzig, Germany - excellent service and excellent value for money!


Nigel Kinbrum said...

Nice one! iHerb was quite a find.

Neonomide said...


Regarding medium chain triglyserides and Alzheimer, you might find this one interesting:

Nigel Kinbrum said...

Hi Neo,

There's a link to Dr Mary Newport in Look after your brain, Part 4.

Unfortunately, I have virtually zero control over mum's diet (apart from the smoked salmon that I bring her) and have not been allowed to give her any supplements since 31st Jan 2010, so she only gets what Evidence Based Medicine allows her to have.


Galina L. said...

Probably, it is too late to comment, but I want to add magnesium to your list of supplements. It is generally extremely beneficial to many conditions, Alzheimer included. Here is the Pub Med article As far as I know, injections (intravenous or intro muscular )would be much more beneficial then oral supplements with all that absorbency issues.
It is not necessary to do it all the time, ten every other day every 2 -3 months could be enough.


Nigel Kinbrum said...

I'm just off to bed, now. It's 02:38!

Good find. I'll add Magnesium to the "Look after your brain" series.