Better of Living Health 50 & Over

Wednesday, May 16, 2012

Dementia Treatments of Dementia Associated with Parkinson's Disease In Conventional Medicine Perspective

I. Dementia
A. About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability that is severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people. American typical diet contains high amount of saturated and trans fat, artificial ingredients with less fruits and vegetable which can lead to dementia and other kind of diseases.

B. Dementia associated with Parkinson's disease
Parkinson disease (PD) is a disabling, progressive condition. It is a cognitive deficits due to the interruption of frontal-subcortical loops that facilitate cognition and that parallel the motor loop. Contrary to common perception, many Non-motor symptoms (NMS) of PD occur early in PD and some may even predate the diagnosis of PD that is based on motor signs. These include olfactory deficit, sleep problems such as rapid eye movement behaviour disorder, constipation and the more recently described male erectile dysfunction.(1).

II. Treatments of Dementia Associated with Parkinson's Disease
Treatments are depending to the degree of functional and cognitive impairment, but according to the suggestion of the Movement Disorder Society (MDS) Task Force on Evidence-Based Medicine (EBM)
1. Treatments for the non-motor symptoms of Parkinson's disease
The Movement Disorder Society (MDS) Task Force on Evidence-Based Medicine (EBM) Review of Treatments for Parkinson's Disease (PD) was first published in 2002 and was updated in 2005 to cover clinical trial data up to January 2004 with the focus on motor symptoms of PD, suggested the tricyclic antidepressants nortriptyline and desipramine for the treatment of depression or depressive symptoms and macrogol for the treatment of constipation.... The practice implications for these treatments are possibly useful. Methylphenidate and modafinil for the treatment of fatigue; amantadine for the treatment of pathological gambling; donepezil, galantamine, and memantine for the treatment of dementia; quetiapine for the treatment of psychosis; fludrocortisone and domperidone for the treatment of orthostatic hypotension; sildenafil for the treatment of erectile dysfunction, ipratropium bromide spray for the treatment of sialorrhea; levodopa/carbidopa controlled release (CR), pergolide, eszopiclone, melatonin 3 to 5 mg and melatonin 50 mg for the treatment of insomnia and modafinil for the treatment of excessive daytime sleepiness. There were no RCTs that met inclusion criteria for the treatment of anxiety disorders, apathy, medication-related impulse control disorders and related behaviors other than pathological gambling, rapid eye movement (REM) sleep behavior disorder (RBD), sweating, or urinary dysfunction. Therefore, there is insufficient evidence for the treatment of these indications(2). Other researchers suggested that Sildenafil citrate (50 mg) may be considered to treat erectile dysfunction in patients with Parkinson disease (PD) (Level C). Macrogol (polyethylene glycol) may be considered to treat constipation in patients with PD (Level C). The use of levodopa/carbidopa probably decreases the frequency of spontaneous nighttime leg movements, and should be considered to treat periodic limb movements of sleep in patients with PD (Level B). There is insufficient evidence to support or refute specific treatments for urinary incontinence, orthostatic hypotension, and anxiety (Level U). Future research should include concerted and interdisciplinary efforts toward finding treatments for nonmotor symptoms of PD(3).

2. Treatments for the motor symptoms of Parkinson's disease
The Movement Disorder Society (MDS) Task Force on Evidence-Based Medicine (EBM) Review of Treatments for Parkinson's Disease (PD) was first published in 2002 and was updated in 2005 to cover clinical trial data up to January 2004 with the focus on motor symptoms of PD. Piribedil, pramipexole, pramipexole extended release, ropinirole, rotigotine, cabergoline, and pergolide were all efficacious as symptomatic monotherapy; ropinirole prolonged release was likely efficacious. All were efficacious as a symptomatic adjunct except pramipexole extended release, for which there is insufficient evidence. For prevention/delay of motor fluctuations, pramipexole and cabergoline were efficacious, and for prevention/delay of dyskinesia, pramipexole, ropinirole, ropinirole prolonged release, and cabergoline were all efficacious, whereas pergolide was likely efficacious. Duodenal infusion of levodopa was likely efficacious in the treatment of motor complications, but the practice implication is investigational. Entacapone was nonefficacious as a symptomatic adjunct to levodopa in nonfluctuating patients and nonefficacious in the prevention/delay of motor complications. Rasagiline conclusions were revised to efficacious as a symptomatic adjunct, and as treatment for motor fluctuations. Clozapine was efficacious in dyskinesia, but because of safety issues, the practice implication is possibly useful. Bilateral subthalamic nucleus deep brain stimulation, bilateral globus pallidus stimulation, and unilateral pallidotomy were updated to efficacious for motor complications. Physical therapy was revised to likely efficacious as symptomatic adjunct therapy(4)

Sources
(1) http://www.helpguide.org/elder/parkinsons_disease.htm
(2) http://www.ncbi.nlm.nih.gov/pubmed/22021174
(3) http://www.neurology.org/content/74/11/924.full
(4) http://www.ncbi.nlm.nih.gov/pubmed/22021173

Dementia Treatments of Creutzfeldt-Jakob disease (CJD) In Conventional Medicine Perspective

I. Dementia
A. Dementia
About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability that is severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people. American typical diet contains high amount of saturated and trans fat, artificial ingredients with less fruits and vegetable which can lead to dementia and other kind of diseases.

B. Creutzfeldt-Jakob disease
People who have eaten contaminated beef many years may be infected without even knowing it. Creutzfeldt-Jakob disease is a quickly progressing and fatal disease that consists of dementia, muscle twitching and spasm. CJD is characterized by rapidly progressive dementia. Initially, individuals experience problems with muscular coordination; personality changes, including impaired memory, judgment, and thinking; and impaired vision. People with the disease also may experience insomnia, depression, or unusual sensations.(1).

II. Treatments of Creutzfeldt-Jakob disease (CJD)
There is no treatment that can cure or control CJD. The available treatments are to relieve the symptoms and may help slow the disease.
1. Interleukins is defined as any of a group of naturally occurring proteins that mediate communication between cells. The set of interleukins stimulated by a specific infectious agent determines which cells will respond to the infection and influences some of the clinical manifestations of the disease(2). In a study of anti-inflammatory cytokines interleukin 4 and interleukin 10 in the cerebrospinal fluid of patients with CJD, patients with other dementia, and nondemented neurological patients and controls. Dr. Stoeck K, and the team at the University Hospital Göttingen, suggested that Interleukin 10 levels were significantly elevated in the cerebrospinal fluid of CJD patients (median, 9.8 pg/mL). The elevation was significant to other dementia (median, 7.9 pg/mL, P<.05), motoneuron disease (median, 7.9 pg/mL, P<.05), normal pressure hydrocephalus (median, 7.0 pg/mL, P<.05), and controls (median, 1.3 pg/mL, P<.001). Levels of interleukin 4 were significantly elevated in cerebrospinal fluid of patients with CJD (median, 26.4 pg/mL) compared with control subjects (median, 6.2 pg/mL, P<.001) and patients with a motoneuron disease (median, 10.5 pg/mL, P<.001)(3)

2. Other medication such as Quinacrine may have a potential in treating Creutzfeldt-Jakob disease (CJD), according to a report in The Mail on Sunday, on Sunday 12 August 2001, entitled "Briton 'cured' in CJD drug trial". The article described a 20-year-old female with variant CJD who was treated in a pioneer drug trial including Quinacrine in San Francisco and in whom the family reported neurological improvement. A subsequent study on experimental animals showed no benefit from Quinacrine (Collins et al.). Further laboratory work by another scientific group (published in 2003, Barret et al.) only partly confirmed the Prusiner results and failed to show any benefit in experimental animals(4)

3. Medication to control aggressive and uncontrolled behavior, such asgamma-aminobutyric acid, dopamine and serotonin may be helpful.

Creutzfeldt-Jakob disease is progressing rapidly In the article of Creutzfeldt-Jakob disease (CJD), the writer wrote that people with this condition may need help controlling unacceptable or dangerous behaviors. This involves rewarding positive behaviors and ignoring negative behaviors (when it is safe). They may also need help getting oriented to their surroundings. Getting legal help with advance directives, powers of attorney, and other legal actions early in the disorder can make it easier to make ethical decisions about the CJD patient's care(5). Since the outcome of the disease was very poor, most patient can not care for themselves in the period of less than 6 months after symptoms begin and most of them die in a short time, usually within 1 year or less.

Sources
(1) http://www.ninds.nih.gov/disorders/cjd/detail_cjd.htm#186463058
(2) http://www.britannica.com/EBchecked/topic/290335/interleukin-IL
(3) http://www.ncbi.nlm.nih.gov/pubmed/16216944
(4) http://www.cjd.ed.ac.uk/TREAT.htm
(5) http://www.hamiltonhealth.com/adm/content.asp?Path=HIE+Multimedia\1\000788.htm

Dementia Treatments of Subdural hematoma In Conventional Medicine Perspective

I. Dementia
A. Dementia
About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability that is severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people. American typical diet contains high amount of saturated and trans fat, artificial ingredients with less fruits and vegetable which can lead to dementia and other kind of diseases.

B. Subdural hematoma
It is the accumulation of blood beneath the outer covering of the brain that result from the rupture of blood vessel. Subdural hemorrhages may cause an increase in tracranial pressure, which can cause compression of and damage to delicate brain tissue. Acute subdural hematoma has a high mortality rate.

II. Treatments of Subdural hematoma
1. Emergency treatment
An acute subdural hematoma (SDH) is a rapidly clotting blood collection below the inner layer of the dura but external to the brain and arachnoid membrane (see the first image below). Two further stages, subacute and chronic, may develop with untreated acute subdural hematoma (SDH)(1). There is always important to maintain survival of the patient with acute subdural hematomas. Emergency treatment be be necessary to reduce pressure and to allow blood to drain by drilling a small hole in the skull and inserting a temporary small catheter through a hole drilled through the skull and sucking out the hematoma. . Although hematoma resolution has been reported, it cannot be reliably predicted, and no medical therapy has been shown to be effective in expediting the resolution of acute or chronic subdural hematomas(2)

2. Medication
Inn case of chronic subdural hematomas, mannitol may be used to reduce intracranial pressure (ICP) as it produced a significant reduction in ICP and improved cerebral perfusion pressure(3).
a. Corticosteroids for brain oedema
Methylprednisolone is a synthetic glucocorticoid or corticosteroid drug. Researchers at the suggested that Methylprednisolone can effectively reduce myelin changes accompanying brain oedema induced by blood-brain barrier opening with an osmotic insult(4).

b. Prophylactic antiepileptic drug for patient with seizures
In the study of a total of 129 patients treated for chronic subdural haematoma. None of 73 patients who were given prophylactic antiepileptic drug treatment developed seizures. Only two of 56 patients not given prophylaxis, developed early postoperative seizures(5).

c. Rifampicin for bacterial infection
Rifampicinis a naturally made, non-peptide antibiotic. It is bactericidal, killing by disabling the protein expression system universally conserved by all bacterial causes of infection, but it can induce thrombocytopenia(6) in acute Subdural hematoma treatment.

3. Surgery
Large or symptomatic hematomas require a craniotomy, as a bone flap is temporarily removed from the skull to access the brain for removal of blood clot with suction or irrigation. Dr. Santarius T, and the research team at the University of Cambridge, Cambridge, UK. showed that Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months(7).

Sources
(1) http://emedicine.medscape.com/article/828005-overview

(2) http://emedicine.medscape.com/article/1137207-treatment
(3) http://www.ncbi.nlm.nih.gov/pubmed/7936130
(4) http://www.ncbi.nlm.nih.gov/pubmed/22286794
(5) http://www.ncbi.nlm.nih.gov/pubmed/8229039
(6) http://www.ncbi.nlm.nih.gov/pubmed/19782872
(7) http://www.ncbi.nlm.nih.gov/pubmed/19960218

Dementia Treatments -In Herbal Medicine Perspective

3. Lavender
a. Spatial performance
Scientists at the Shaheed Beheshti University of Medical Sciences in the study to to evaluate the effects of aqueous extract of lavender (Lavandula angustifolia) on spatial performance of AD rats, found that in the first stage of experiment, the latency to locate the hidden platform in AD group was significantly higher than that in control group. However, in the second stage of experiment, control and AD rats that received distilled water (vehicle) showed similar performance, indicating that the maze navigation itself could improve the spatial learning of AD animals. Besides, in the second stage of experiment, control and AD rats that received lavender extract administration at different doses (50, 100, and 200 mg/ kg) spent less time locating the platform (except for the AD rats with 50 mg/kg extract treatment), as compared with their counterparts with vehicle treatment, respectively. In addition, lavender extract significantly improved the performance of control and AD rats in the probe test, only at the dose of 200 mg/kg, as compared with their counterparts with vehicle treatment(6).

b. Behavioural symptoms
Some researchers at the Aged Mental Health Research Unit, Monash University, suggested that the use of lavender oil is effective in reducing challenging behaviours in individuals with dementia, it will potentially provide a safer intervention rather than reliance on pharmacology alone. The study's findings will translate easily to other countries and cultures(7).

c. Cognitive function, emotion, and aggressive behavior
"A Lavender aromatherapy hand massage program is effective on emotions and aggressive behavior of elderly with dementia of the Alzheimer's type", Dr. Lee SY. at the Department of Nursing, Kongju National University suggested(8)

d. Etc.

4. Huperzine A, a chemical made from the plant Huperzia serrata have been studied for its effect on patient of dementia.
a. Dr. and the scientists at the suggested that Huperzine a, a potential therapeutic agent for Alzheimer's disease, inhibits acetylcholinesterase in primary cultures derived from forebrain, hippocampus, cortex and cerebellum of embryonic rat brain. Glutamate induces cell death in cultures from all these brain regions. and concluded that Huperzine A could be a potent neuroprotective agent not only where cholinergic neurons are impaired, but also under conditions in which glutamatergic functions are compromised(9).

b. Activation of Wnt/β-catenin signaling pathway
In the study to search for new mechanisms by which HupA could activate Wnt signaling and reduce amyloidosis in AD brain, researchers at the China Medical University, in the study of "Huperzine A activates Wnt/β-catenin signaling and enhances the nonamyloidogenic pathway in an Alzheimer transgenic mouse model", suggested that HupA inhibited GSK3α/β activity, and enhanced the β-catenin level in the transgenic mouse brain and in SH-SY5Y cells overexpressing Swedish mutation APP, suggesting that the neuroprotective effect of HupA is not related simply to its AChE inhibition and antioxidation, but also involves other mechanisms, including targeting of the Wnt/β-catenin signaling pathway in AD brain(10).

c. Mild to moderate vascular dementia (VaD)
In the investigation of the efficacy and safety of Huperzine A in treatment of mild to moderate vascular dementia (VaD), researchers at Third Military Medical University indicated that after 12 weeks of treatment, the MMSE, CDR, and ADL scores significantly improved in the Huperzine A group (P < 0.01 for all comparisons), whereas the placebo group did not show any such improvement (P > 0.05 for all comparisons). No serious adverse events were recorded during the treatment.
http://www.ncbi.nlm.nih.gov/pubmed/21833673

d. Etc.

5. Bacopa
a. Increases Cerebral Blood Flow
In the study to test Bacopa monnieri's chronic and acute effects on CBF compared with Ginkgo biloba and donepezil, Dr. Kamkaew N, and the research team at the Naresuan University, showed that G. biloba (60 mg/kg) also increased CBF (by 29% to 3019 ± 208 PU, p < 0.05, nine rats). No clear effect was obtained with donepezil (1 mg/kg). Chronic administration of the preparations had no effect on blood pressure. In contrast, intravenous acute infusion of these herbals (20-60 mg/kg) had marked dose-dependent hypotensive actions (diastolic ~31 mmHg lower with 40 mg/kg of either extract), which correspondingly reduced CBF by ~15%. Increased CBF with B. monnieri may account for its reported procognitive effect, and its further exploration as an alternative nootropic drug is worthwhile(11).

b. Ethnobotanical treatment
Scientists at the Jodrell Laboratory in the study of Ethnobotanical treatment strategies against Alzheimer's disease, suggested that Since two of the currently licensed drugs for AD are based on natural products (galantamine and rivastigmine), it is not surprising that many plants are now being investigated as a potential source of new therapies for AD. This review discusses those plants that have ethnobotanical uses suggestive of alleviation of AD pathology and associated symptoms, for cognitive and for behavioural and psychological symptoms of dementia (BPSD). An emphasis is placed on those plants that have shown some promising effects in clinical studies with dementia patients (e.g. Crocus sativus, Ginkgo biloba, Salvia species), but other plants and their phytochemicals showing relevant mechanistic effects for AD (e.g. Bacopa monnieri, Centella asiatica, Ptychopetalum olacoides) are also discussed(12).

c. Cognitive performance, anxiety, and depression
In the study to evaluate effects of Bacopa monnieri whole plant standardized dry extract on cognitive function and affect and its safety and tolerability in healthy elderly study participants, Dr. Calabrese C, and the research team at National College of Natural Medicine, indicated that Controlling for baseline cognitive deficit using the Blessed Orientation-Memory-Concentration test, Bacopa participants had enhanced AVLT delayed word recall memory scores relative to placebo. Stroop results were similarly significant, with the Bacopa group improving and the placebo group unchanged. CESD-10 depression scores, combined state plus trait anxiety scores, and heart rate decreased over time for the Bacopa group but increased for the placebo group. No effects were found on the DAT, WAIS digit task, mood, or blood pressure. The dose was well tolerated with few adverse events (Bacopa n = 9, placebo n = 10), primarily stomach upset(13).

d. Etc.

6. Other potential herbs
Dr. Howes MJ and Dr. Perry E. at the Jodrell Laboratory, Kew, Richmond, in the study to investigate The role of phytochemicals in the treatment and prevention of dementia suggested that Other phytochemicals discussed include cannabinoids (e.g. cannabidiol) from Cannabis sativa, which are emerging as potential therapeutic agents for BPSD, and resveratrol (occurs in various plants) and curcumin (from turmeric [Curcuma longa]), which have been investigated for their pharmacological activities relevant to dementia and their potential effects on delaying dementia progression. The review also discusses plant extracts, and their known constituents, that have shown relevant mechanistic effects for dementia and promising clinical data, but require more evidence for their clinical efficacy and safety. Such plants include Ginkgo biloba, which has been extensively studied in numerous clinical trials, with most outcomes showing positive effects on cognitive functions in dementia patients; however, more reliable and consistent clinical data are needed to confirm efficacy. Other plants and their extracts that have produced promising clinical data in dementia patients, with respect to cognition, include saffron (Crocus sativus), ginseng (Panax species), sage (Salvia species) and lemon balm (Melissa officinalis), although more extensive and reliable clinical data are required. Other plants that are used in traditional practices of medicine have been suggested to improve cognitive functions (e.g. Polygala tenuifolia) or have been associated with alleviation of BPSD (e.g. the traditional prescription yokukansan); such remedies are often prescribed as complex mixtures of different plants, which complicates interpretation of pharmacological and clinical data and introduces additional challenges for quality control(14).

Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/11140327
(2) http://www.ncbi.nlm.nih.gov/pubmed/11842916
(3) http://www.ncbi.nlm.nih.gov/pubmed/12519586
(4) http://www.ncbi.nlm.nih.gov/pubmed/22070157
(5) http://www.ncbi.nlm.nih.gov/pubmed/12888775
(6) http://www.ncbi.nlm.nih.gov/pubmed/21441971
(7) http://www.ncbi.nlm.nih.gov/pubmed/20649945
(8) http://www.ncbi.nlm.nih.gov/pubmed/15860944
(9) http://www.ncbi.nlm.nih.gov/pubmed/9141073
(10) http://www.ncbi.nlm.nih.gov/pubmed/21289607
(11) http://www.ncbi.nlm.nih.gov/pubmed/22447676
(12) http://www.ncbi.nlm.nih.gov/pubmed/22329652
(13) http://www.ncbi.nlm.nih.gov/pubmed/18611150
(14) http://www.ncbi.nlm.nih.gov/pubmed/21639405

Tuesday, May 15, 2012

Dementia Treatments of Multi-infarct dementia in Conventional Medicine Perspective

I. Dementia
A. About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability that is severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people. American typical diet contains high amount of saturated and trans fat, artificial ingredients with less fruits and vegetable which can lead to dementia and other kind of diseases.

B. Multi-infarct dementia
Also known asvascular dementia , is the second most common form of dementia after Alzheimer's disease in older adults. It is caused by different mechanisms all resulting in vascular lesions in the brain. Major depression, depressed mood/anhedonia, and subjective and neurovegetative symptoms of depression that were unaccompanied by depressed mood/anhedonia in patients with clinically-diagnosed Alzheimer's disease (AD) and multi-infarct dementia (MID), as separate entities in AD and MID(a).

II. Treatments of Multi-infarct dementia
There are no treatments which can reverse the damage to the brain caused by small strokes, but the goal of the treatment is to control the symptoms and reduce the risk factors to prevent future strokes. In order to make the blood thinner to reduce the risk blood clot causes of future stroke, your doctor may order
A. Medication
1. Plavix
Plavix tablets which is rescription-only medicine that helps keep blood platelets from sticking together and forming clots(2) with the main function to prevent blood clotted causes of future stroke.

b. Side effects are not limit to
According to the article of Plavix Side Effects (b), the author(s) wrote that Plavix has been studied thoroughly in clinical trials, with more than 17,500 people having been evaluated. In these studies, side effects are always documented and compared to those that occur in a similar group of people not taking the medicine always documented and compared to those that occur in a similar group of people not taking the medicine. The most common side effects of Plavix (occurring in more than 2 percent of people and more often in the group taking Plavix) include:
b.1. Major bleeding
b.2. Flu-like symptoms
b.3. Headache
b.4. Dizziness
b.5. Diarrhea
b.6. Upset stomach or indigestion
b.7. Bruising, Bloody nose
b.8. Unexplained rash
b.9. Itchy skin
b.10. Etc.

2. Antipsychotics (olanzapine, quetiapine)
a. Antipsychotic drugs effectively treat psychosis caused by a variety of conditions (Table 1, including dementia). Psychotic symptoms are classified as either positive or negative. Positive symptoms include hallucinations, delusions, thought disorders (manifested by marked incoherence, derailment, tangentiality), and bizarre or disorganized behavior. Negative symptoms include anhedonia, flattened affect, apathy, and social withdrawal(2).

b. Side effects are not limit to
B.1. Constipation,
b.2. Dry mouth and
b.3. Blurred vision
b.4. Sleepiness and slowness

b.5. Weight gain
b.6. Stiffness and shakines
b.7. Hormone change
b.8. Diabetes
b.9. Etc.

3. Serotonin-affecting drugs (trazodone, buspirone, or fluoxetine)
a. In the study to investigate of Ten patients with severe dementia due to Alzheimer's disease (AD) or multi-infarct dementia (MID) or both, were treated with the precursor amino acids of the neurotransmitters serotonin and dopamine, conducted by Dr. Meyer JS and the research team showed that analysis of the cerebrospinal fluid for HVA and 5-HIAA before and after the probenecid test indicated some improvement in the metabolic turnover of these acid metabolites of serotonin and dopamine after administration of their precursor amino acids(3).

b. Side effects are not limit to
b.1. Trembling
b.2. Blood-pressure changes
b.3. Confusion
b.4. Dizziness
b.5. Diarrhea and/or vomiting
b.6. Irregular heartbeat
b.7. Loss of coordination
b.8. Loss of bladder control
b.9. Etc.

4. Anti anticonvulsant
a. Scientists at the East Carolina University School of Medicine, reported that a patient with multi-infarct dementia and associated hypomanic features was treated effectively with clonazepam to control logorrhea, hyperactivity, agitation, intrusiveness, and impulsive violence and to promote cooperation and manageability(4).

b. Side effects are not limit to
b.1. Dizziness
b.2. Drowsiness
b.3. Unsteadiness
b.4. Nausea
b.5. Vomiting
b.6. Skin rashes
b.7. Etc.

5. Rivastigmine
In the study to determine the effects of rivastigmine on cognitive function, global daily living performance, and behavioral disorders in VaD patients versus an active control (nimodipine), stratifying patients according to the type of VaD, subcortical vascular dementia (sVAD), and multi-infarct dementia (MID) at the University of Trieste, indicated that hat long-term treatment with rivastigmine, at dosages approved for therapeutic use in Alzheimer's disease, produces significant improvement in all behavioral symptoms in 2 forms of VaD, MID and sVaD, except delusions. It also suggests that rivastigmine may enable a reduction in concomitant neuroleptics and benzodiazepines in VaD, especially in MID(5).

b. Side effects are not limit to
b.1. Nausea and vomiting
b.2. Loss of appetite
b.3. Weight loss
b.4. Diarrhea
b.4. Dizziness
b.5. Drowsiness
b.6. Trembling
b.7. Etc.

B. Surgery
In case of sensory problems, surgery can be helpful.

Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/22164676
(1) http://en.wikipedia.org/wiki/Clopidogrel
(2) http://www.aafp.org/afp/2003/0601/p2335.html
(3) http://www.ncbi.nlm.nih.gov/pubmed/301148
(4) http://www.ncbi.nlm.nih.gov/pubmed/3252876
(5) http://www.ncbi.nlm.nih.gov/pubmed/18184948

Dementia Treatments of Wernicke-Korsakoff Syndrome In conventional Medicine Perspective

Tuesday, May 8, 2012

Dementia Preventions - Phytochemicals Against Dementia

I. Dementia
About 5-8% of all people over the age of 65 have some form of dementia, and this number doubles every five years above that age. Dementia is the loss of mental ability that is severe enough to interfere with people's every life and Alzheimer's disease is the most common type of dementia in aging people.

II. Phytochemicals Against Dementia
A. Rosemarinol, is a phytochemical monophenols, found in essential oil of labiate herbs like Rosemary and also in variety of other plants.
1. Chemical stabilization of fish oil
In the study of fish oil undergoes multiple changes in its physical properties and its autoxidation occurred found that rosemary extract rich in carnosic acid to ternary blends of tocopherols, ascorbyl palmitate and lecithin or Citrem significantly retarded autoxidation, according to "Chemical stabilization of oils rich in long-chain polyunsaturated fatty acids during storage" by Pop F.

2. Anti-inflammatory effects
In the research of the extract of rosemary leaves from supercritical fluid extraction and its anti inflammatory effects found that the yield of 3.92% and total phenolics of 213.5 mg/g extract obtained from the most effective extraction conditions showed a high inhibitory effect on lipid peroxidation (IC(50) 33.4 μg/mL). Both the SC-CO(2) extract and CA markedly suppressed the LPS-induced production of nitric oxide (NO) and tumor necrosis factor-α (TNF-α), as well as the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), phosphorylated inhibitor-kappaB (P-IκB), and nuclear factor-kappaB (NF-κB)/p65 in a dose-dependent manner, according to the study of "Anti-inflammatory effects of supercritical carbon dioxide extract and its isolated carnosic acid from Rosmarinus officinalis leaves" by Kuo CF, Su JD, Chiu CH, Peng CC, Chang CH, Sung TY, Huang SH, Lee WC, Chyau CC.(1)

3. Supercritical fluid
In the investigation of rosemary extract could enhance antioxidant defenses and improve antioxidant status in aged rats found that rosemary extract produced a decrease in antioxidant enzyme activity, lipid peroxidation and ROS levels that was significant for catalase activity in heart and brain, NOS in heart, and LPO and ROS levels in different brain tissues. These observations suggest that the rosemary supplement improved the oxidative stress status in old rats, according to "Protective effect of supercritical fluid rosemary extract, Rosmarinus officinalis, on antioxidants of major organs of aged rats" by Posadas SJ, Caz V, Largo C, De la Gándara B, Matallanas B, Reglero G, De Miguel E.(2)

B. Gingerole
Gingerole, is also known as gingerol, a phytochemical of Flavonoids (polyphenols) found in fresh ginger. and in variety of other plants. The herb has been used to treat nausea and vomiting of pregnancy, motion sickness, rheumatoid arthritis, relieve migraine, etc.
1. Antioxidant and anti-inflammatory effects
In the investigation of the effectiveness of chemical constituents of Zingiber officinale Rosc. (Zingiberaceae)in treating oxidative stress found that compounds [6]-gingerol, [8]-gingerol, [10]-gingerol and [6]-shogaol of the herb scavenges of 1,1-diphenyl-2-picyrlhydrazyl (DPPH), superoxide and hydroxyl radicals, inhibitsof N-formyl-methionyl-leucyl-phenylalanine (f-MLP) induced reactive oxygen species (ROS) production in human polymorphonuclear neutrophils (PMN), lipopolysaccharide induced nitrite and prostaglandin E(2) production in RAW 264.7 cells, according to the study of "Comparative antioxidant and anti-inflammatory effects of [6]-gingerol, [8]-gingerol, [10]-gingerol and [6]-shogaol" by Dugasani S, Pichika MR, Nadarajah VD, Balijepalli MK, Tandra S, Korlakunta JN(3)

2. Dementia
In the study of Ginger effectiveness in treating dementia in South Asia with A 70% aqueous/methanolic extract of dried ginger (Zo.Cr) was used. Zo.Cr tested positive for the presence of terpenoids, flavonoids, secondary amines, phenols, alkaloids and saponins found that
specific inhibition of butyrylcholinesterase (BuChE) rather than acetylcholinesterase enzyme. Different pure compounds of ginger also showed spasmolytic activity in stomach fundus, with 6-gingerol being the most potent. 6-Gingerol also showed a specific anti-BuChE effect, according to "Muscarinic, Ca(++) antagonist and specific butyrylcholinesterase inhibitory activity of dried ginger extract might explain its use in dementia" by Ghayur MN, Gilani AH, Ahmed T, Khalid A, Nawaz SA, Agbedahunsi JM, Choudhary MI, Houghton PJ.(4)

C. Naringenin
Naringenin, a flavanone, belonging to the red, blue, purple pigments of Flavonoids (polyphenols) found predominantly in citrus fruits is considered as one of powerful antioxiant with many health benefits.
1. Antioxidant, radical scavenging and biomolecule activity
In the affirmation of the capacity of flavonoid naringenin and its glycoside naringin in the comparison of theirs antioxidant capacities, radical scavenging and biomolecule activities found that naringenin exhibited higher antioxidant capacity and hydroxyl and superoxide radical scavenger efficiency than naringin and both flavanones were equally effective in reducing DNA damage. However, they show no protective effect on oxidation of GSH, according to the study of "Antioxidant properties, radical scavenging activity and biomolecule protection capacity of flavonoid naringenin and its glycoside naringin: a comparative study" by Cavia-Saiz M, Busto MD, Pilar-Izquierdo MC, Ortega N, Perez-Mateos M, Muñiz P.(5)

2. Anti-inflammatory effects
In the evaluation of the mechanisms of action of the effective compounds. Flavone, the isoflavones daidzein and genistein, the flavonols isorhamnetin, kaempferol and quercetin, the flavanone naringenin, and the anthocyanin pelargonidin amd theirs anti-inflammatory effects found that they inhibited iNOS protein and mRNA expression and also NO production in a dose-dependent manner, according to "Anti-inflammatory effects of flavonoids: genistein, kaempferol, quercetin, and daidzein inhibit STAT-1 and NF-kappaB activations, whereas flavone, isorhamnetin, naringenin, and pelargonidin inhibit only NF-kappaB activation along with their inhibitory effect on iNOS expression and NO production in activated macrophages" by Hämäläinen M, Nieminen R, Vuorela P, Heinonen M, Moilanen E.(6)

3. Immunity
In the unvestigation of Naringenin, a flavonoid in grapefruits and citrus fruits and its effec in immune system found that naringenin potently suppressed picryl chloride (PCl)-induced contact hypersensitivity by inhibiting the proliferation and activation of T lymphocytes. In vitro, both of the activated hapten-specific T cells and the T cells stimulated with anti-CD3/anti-CD28 showed growth arrest after naringenin treatment, according to "A novel regulatory mechanism of naringenin through inhibition of T lymphocyte function in contact hypersensitivity suppression" by Fang F, Tang Y, Gao Z, Xu Q.(7)

D. Tangeritin
Tangeritin, one of the flavones, is found in tangerine and many citrus peels
1. Neuroprotective effects
In the evaluation of neuroprotective effects of a natural antioxidant tangeretin, a citrus flavonoid and its effect on Parkinson's disease found that tangeretin crosses the blood-brain barrier. The significant protection of striato-nigral integrity and functionality by tangeretin suggests its potential use as a neuroprotective agent, according to "Tissue distribution and neuroprotective effects of citrus flavonoid tangeretin in a rat model of Parkinson's disease" by Datla KP, Christidou M, Widmer WW, Rooprai HK, Dexter DT.(8)

2. Antioxidants
In the comparison of hand-pressed juice of polymethoxylated flavones (PMFs) and flavanone glycosides (FGs) and the peeled fruit of 'Sainampueng' tangerines ( Citrus reticulata Blanco cv. Sainampueng) antioxidant effects found that hand-pressed juice of C. reticulata Blanco cv. Sainampueng serves as a rich source of PMFs, FGs, carotenoids, and antioxidants: 4-5 tangerine fruits ( approximately 80 g of each fruit) giving one glass of 200 mL hand-pressed juice would provide more than 5 mg of nobiletin and tangeretin and 36 mg of hesperidin, narirutin, and didymin, as well as 30 mg of ascorbic acid, >1 mg of provitamin A active beta-cryptoxanthin, and 200 microg of alpha-tocopherol, according to "Polymethoxylated flavones, flavanone glycosides, carotenoids, and antioxidants in different cultivation types of tangerines ( Citrus reticulata Blanco cv. Sainampueng) from Northern Thailand" by Stuetz W, Prapamontol T, Hongsibsong S, Biesalski HK.(9)

E. Turmeric
Turmeric, principal curcuminoid of the popular Indian spice, a rhizomatous herbaceous perennial plant of the ginger family, Zingiberaceae, native to tropical South Asia, according to "Effects of different drying methods on the antioxidant properties of leaves and tea of ginger species" by E.W.C. Chan, Y.Y. Lim, S.K. Wong, K.K. Lim, S.P. Tan, F.S. Lianto and M.Y. Yong, posted in Science Direct. It has been used in traditional herbal medicine as an anti-inflammatory agent and to treat gastrointestinal symptoms associated with irritable bowel syndrome and other digestive disorders. Curcumin is a phytochemical found abundant in the plant. In acidic solutions (pH <7.4) it turns yellow, whereas in basic (pH > 8.6) solutions it turns bright red.
1. Alzheimer's disease and Anti-inflammatory agent
a. Alzheimer's disease
According to Aggarwal, the team determined that curcumin is more effective in inhibiting formation of the protein fragments than many other drugs being tested to treat Alzheimer's. The prevalence of the disease among older adults in India is 4.4 times less than in the U.S., suggesting that many Indians might be benefiting from having turmeric as a dietary staple.
In other study of `NSAID and antioxidant prevention of Alzheimer's disease: lessons from in vitro and animal models.`by Cole GM, Morihara T, Lim GP, Yang F, Begum A, Frautschy SA. (Source from Greater Los Angeles Healthcare System, Veterans Administration Medical Center, North Hills, CA 91343, USA. gmcole@ucla.edu) posted in US National Library of Medicine National Institutes of Health, reseachers found that the unconventional NSAID/antioxidant curcumin was effective, lowering oxidative damage, cognitive deficits, synaptic marker loss, and amyloid deposition. Curcumin proved to be immunomodulatory, simultaneously inhibiting cytokine and microglial activation indices related to neurotoxicity, but increasing an index of phagocytosis. Curcumin directly targeted Abeta and was also effective in other models, warranting further preclinical and clinical exploration.

b. Anti-inflammatory agent
According to the study of evaluation of anti-inflammatory property of curcumin (diferuloyl methane) in patients with postoperative inflammation. by Satoskar RR, Shah SJ, Shenoy SG., poated in US National Library of Medicine National Institutes of Health, researchers wrote that In this model of postoperative inflammation, the anti-inflammatory activity of curcumin (diferuloyl methane) was investigated in comparison with phenylbutazone and placebo. Phenylbutazone and curcumin produced a better anti-inflammatory response than placebo.

2. Antioxidants
In a study of `Protective Role of Curcumin Against Oxidative Stress,Immunosuppressive and Cytotoxic Effects of Lead Exposure` by Mahmoud El-sherbiny, Azza Araffa, Mona Mantawy and Hany M. Hassan (Therapeutic Chemistry Department, National Research Centre - Dokki, Giza, Egypt. Immunology Department, Animal Reproduction Research Institute (ARRI), Giza, Egypt), posted in World Applied Sciences Journal 12 (10): 1832-1838, 2011, researchers found that
ground, curcumin's benefits on tumorigenesis are thought to be mediated by its antiinflammatory activity; however, these effects have not been well characterized in a mouse model of colon cancer. Briefly, curcumin is efficacious for chronic nonbacterial prostatitis in rats and the action mechanism may be associated with its decreasing effect on the proinflammatory cytokines IL-8 and TNF-alpha in the blood and tissues. Curcumin has protective effect on DNA of pulmonary cells. There was direct evidence for an involvement of curcumin in reducing arsenic and lead induced oxidative stress in Swiss albino mice by virtue of its antioxidant potential and trapping of free radicals. The current investigation concluded that curcumin has protective role against cytotoxic, immunosuppressive , oxidative and immunosuppressive profile that perform due to lead acetate exposure.

F. Gallic acid
Gallic acid is a phytochemical in the class of Phenolic acids, found abundantly in tea, mango, strawberries, rhubarb, soy, etc.
1. Cytotoxic and antioxidative activities
In the investigation of the bioactivity guided isolation and characterization of phytoconstituents, indicated the extract showed strong radical scavenging effects against DPPH, nitric oxide (NO) and superoxide (SO) radicals comparable to that of known antioxidants 3-t-butyl-4-hydroxyanisole, ascorbic acid (vitamin C), and quercetin in addition to its cytotoxic activities against HEP-2 (human larynx epidermoid carcinoma) and RD (human rhabdomyosarcoma) cell lines based on MTT assay for growth inhibition. The gallic acid equivalent total phenolic content of the plant was found to be 79.94mg/g dry extract. Phenylethanoid glycosides, verbascoside and calceorioside A were isolated from the most active fraction and both compounds showed strong radical scavenging activity against tested radicals and cytotoxicity against HEP-2, RD and MCF-7 (human breast adenocarcinoma) cell line, according to "Cytotoxic and antioxidative activities of Plantago lagopus L. and characterization of its bioactive compounds" by Sebnem Harput U, Genc Y, Saracoglu I.(10)

2. Antioxidants
In the evaluation of the antioxidant, anti-inflammatory, and antiproliferative activities of organic fractions from Cystoseira sedoides (Desfontaines) C. Agardh, indicated that the F-CHCl(3) and F-AcOEt fractions showed significant total phenolic content at 55.09 and 61.30 mg gallic-acid equivalent/g dried sample, respectively. Using the DPPH method, the F-CHCl(3) and the F-AcOEt fractions exhibited the strongest radical scavenging activity, with IC(50) 120 µg/mL for F-CHCl(3) and 121 µg/mL for F-AcOEt, which approaches the activity of the powerful antioxidant standard, Trolox (IC(50) = 90 µg/mL), according to "Antioxidant, anti-inflammatory, and antiproliferative activities of organic fractions from the Mediterranean brown seaweed Cystoseira sedoides" by Mhadhebi L, Laroche-Clary A, Robert J, Bouraoui A.(11)

G. Cinnamic acid
Cinnamic acid is a phytochemical in the class of Hydroxycinnamic acids, found abundantly in cinnamon, aloe. etc.
1. Antioxidant effects
found that TPP-OH protected cells against H(2)O(2) and linoleic acid hydroperoxide-induced oxidative stress. As mitochondrial oxidative damage is associated with a number of clinical disorders, TPP-OH may be a useful lead that could be added to the family of mitochondria-targeted antioxidants that can decrease mitochondrial oxidative damage, according to "Rational discovery and development of a mitochondria-targeted antioxidant based on cinnamic acid scaffold" by Teixeira J, Soares P, Benfeito S, Gaspar A, Garrido J, Murphy MP, Borges F.(12)

2, Anti-platelet aggregation
A series of novel ligustrazinyloxy-cinnamic acid derivatives were synthesized and evaluated for their inhibitory effect on adenosine diphosphate (ADP)-induced platelet aggregation in vitro,
found that compound 2e displayed the highest protective effect on the proliferation of the damaged ECV-304 cells (EC(50) = 0.020 mM), and compound 2f was the most active anti-platelet aggregation agent (EC(50) = 0.054 mM). Structure-activity relationships were briefly discussed, according to "Ligustrazine derivatives. Part 5: design, synthesis and biological evaluation of novel ligustrazinyloxy-cinnamic acid derivatives as potent cardiovascular agents" by Chen H, Li G, Zhan P, Liu X.(13)

H. Tyrosol
Tyrosol is a phytochemical compound, a derivative of phenethyl alcohol, belongings to the group of tyrosol esters, including found mostly in olive oil. It is best known for its antioxidants in protecting the forming of free radicals and lipid oxidation causes of heart disease. According to the study of " Tyrosol and hydroxytyrosol are absorbed from moderate and sustained doses of virgin olive oil in humans" vy E Miró-Casas, M-I Covas, M Fitó, M Farré-Albadalejo, J Marrugat and R de la Torre, posted in European Journal of Clinical Nutrition (European Journal of Clinical Nutrition (2003) 57, 186–190. doi:10.1038/sj.ejcn.1601532), researchers indicated that tyrosol and hydroxytyrosol are absorbed from realistic doses of virgin olive oil. With regard to the dose–effect relationship, 24 h urinary tyrosol seems to be a better biomarker of sustained and moderate doses of virgin olive oil consumption than hydroxytyrosol.
1. Antioxidant
In study of " Tyrosol, the major olive oil biophenol, protects against oxidized-LDL-induced injury in Caco-2 cells." by Giovannini C, Straface E, Modesti D, Coni E, Cantafora A, De Vincenzi M, Malorni W, Masella R. (Source from Department of Metabolism and Pathological Biochemistry, Department of Food and Department of Ultrastructures, Istituto Superiore di Sanita, 00161 Rome, Italy.), posted in PubMed, researchers found that Caco-2 cell treatment (24 and/or 48 h) with oxidized LDL (0.2 g/L) resulted in cytostatic and cytotoxic effects characterized by a series of morphological and functional alterations: membrane damage, modifications of cytoskeleton network, microtubular disorganization, loss of cell-cell and cell-substrate contacts, cell detachment and cell death. The oxidized LDL-induced alterations in Caco-2 cells were almost completely prevented by tyrosol which was added 2 h before and present during the treatments.

2. Alzheimer Disease
In a study of " Tyrosol and Hydroxytyrosol, Two Main Components of Olive Oil, Protect N2a Cells against Amyloid-β-Induced Toxicity. Involvement of the NF-κB Signaling." by St-Laurent-Thibault C, Arseneault M, Longpré F, Ramassamy C. (Source from INRS-Institut Armand Frappier, 531, boul. des Prairies, Laval, Québec, H7V 1B7, Canada. Charles.Ramassamy@iaf.inrs.ca.), posted in PubMed, researchers found that the increase in the nuclear translocation of the NF-κB subunits after Aβ exposure was attenuated in the presence of Tyr or OH-Tyr. These results identified two individual food components of the MeDi as neuroprotective agent against Aβ and their potential involvement in the beneficial effect of the MeDi for the prevention of AD.

I. Silymarin
Silymarin is a phytochemical in the class of Lignans (phytoestrogens), found abundantly in artichokes, milk thistle, etc.
1. Antioxidants
In the testing the effects ofEthyl acetate (100mg/kg bw) and ethanol seed extracts for S. marianum (100mg/kg bw) against the injection (i.p.) by carbon tetrachloride (2 ml/kg bw) the inducer of liver damage, found that ethanolic extract showed the most significantly decrease in the liver enzymes. For the oxidative experiments, ethyl acetate showed the most increase for glutathione level and the risk factor HDL/LDL significantly. Hepaticum was the most powerful group for the significant decreasing for malondialdehyde and fucosidase activity, according to "Silymarin, the antioxidant component and Silybum marianum extracts prevent liver damage" by Shaker E, Mahmoud H, Mnaa S.(14)

2. Neuroprotective effect
In numerous studies reported impaired cognitive and neurochemical function in diabetic patients and streptozotocin induced diabetic rodents, found that HO-1 is differently expressed in various brain regions in db/db mice when compared to lean animals. Furthermore, silibinin provides DNA protection and reduces oxidative stress in a brain specific area, in part via the activation of the HO system. Silibinin may provide a valid tool to counteract oxidative stress in the diabetic status in the central nervous system under diabetic condition, according to "Neuroprotective effect of silibinin in diabetic mice" by

Marrazzo G, Bosco P, La Delia F, Scapagnini G, Di Giacomo C, Malaguarnera M, Galvano F, Nicolosi A, Li Volti G.(15)

J. Etc.