Alzheimer's is a common form of dementia (senility) affecting almost 5 million Americans. As our population ages, this is an area that drug companies believe may be quite profitable, so there is heavy advertising being done for the medication Aricept, which has very minimal to modest benefit.
The only definitive test for diagnosing Alzheimer's is a brain biopsy, which appropriately is not done. Because of this, and because most doctors do not have time to do a proper 30-60 minute evaluation for underlying causes (Medicare pays poorly for visits over ~ 5 minutes), many elderly folks get a label of Alzheimer's slapped on them and a prescription for Aricept at first sign of confusion, and perhaps a cursory look for other causes of confusion. In addition to the tragic personal costs, the financial cost of caring for someone with Alzheimer's averages from $70,000 to $174,000 (over a lifetime) with global costs for care being $248 billion yearly. It is insane to not aggressively look for and address simple reversible problems that can cause or aggravate dementia.
Let's look at a simple medical approach to evaluating and helping people with mild to severe loss of mental function. When doing this, you may find that the person never had Alzheimer's, and that even if they do, even modest improvements in mental function can dramatically improve the ability to function and remember names and people. We will also discuss a promising new medication for Alzheimer's that can stop it in its tracks (well, really an old natural compound that they will try to pass off as new).
Also, for those of you with day to day "brain fog" wondering if you may have Alzheimer's, here's a simple rule of thumb:
Alzheimer's is not when you keep forgetting where you left the keys—it's when you forget how to USE the keys.
This article will focus on Alzheimer's and dementia, as well as poor memory and mental function in general. It will also lay the foundation for next week's newsletter on "Brain Fog in CFS & FMS."
Are you ready to get your memory and mind back?
Where Do We Start?
Begin with the basics. These are:
- Nutritional support. Check a vitamin B12 level. If it is under 540, get a series of at least 15 B12 shots over several months (make sure the injections have 1,000-5,000 mcg of B12 per injection). If the B12 level is under 350, I would take the shots monthly forever, and add 1 teaspoon of cider vinegar to each meal (as convenient) as low B12 is usually associated with low stomach acid and the vinegar can help digestion. The B12 shots can take 3 months to fully kick in. In addition, supply overall nutritional support with a good multivitamin powder (one that also has a strong B complex vitamin, which can take care of the low B12 if your doctor won't give the injections). In addition, add fish oil: 3 to 4+ servings of tuna, herring, or salmon a week or a tablespoon of fish oil twice a week. The brain is made of the oil found in fish oil (DHA). This can also help address any hidden depression that may be present (see below). Also check a blood ferritin level (for iron) and supplement with iron if it is under 40.
- Address hormonal deficiencies—even if the blood tests are normal.
- I would recommend a trial of Armour Thyroid in most people with unexplained chronic confusion to see if it helps. If risk factors for heart disease are present, the doctor should start with a low dose and work up slowly. A recent study (see Thyroid Function and Alzheimer's) showed that even a low normal thyroid hormone (TSH over 2.1 vs. a TSH of 1-2—anything under 5.4 is consider "normal" by most doctors—even if it can kill you) in women was associated with more than a doubled risk of developing dementia!
- In men, if the total testosterone is under 400, I would give natural testosterone cream to bring the total testosterone level to ~ 600-800. Testosterone used in the natural form and safe dosing decreases heart disease and diabetes risk as well and does NOT increase prostate cancer risk (in fact , low testosterone is associated with a higher risk).
- Synthetic estrogen does not improve brain function—and can be dangerous. Bioidentical hormones do seem to have heart and cancer protective effects, where the synthetics worsen these. Though I have not seen studies on Bioidentical Estrogen and Progesterone in women and brain function, the other data suggests to me that it is worth a 6-month trial in women with cognitive/memory problems.
- Consider a trial of 1 aspirin a day. Much of what is called Alzheimer's is really the result of multiple small mini-strokes. This is especially so if the progression of mind problems seemed to occur in discrete small steps (worsening with each small silent stroke). An aspirin a day (or willow bark found in health food stores, 120 mg of salicin a day, if aspirin bothers your stomach) can decrease the risk of further strokes and often improve function as well.
- Get your 8 hours of sleep a day. Begin with Melatonin 3-5 mg (I usually recommend ½ mg, but use the higher dose in this setting) at bedtime. If needed, add an herbal supplement that promotes healthy sleep at bedtime (see Addressing Insomnia).
- Make sure there is no depression (which can mimic Alzheimer's).
- Look for and address diabetes, liver disease, anemia, heart disease, and other medical conditions.
- Look for and eliminate any chronic infections (e.g., silent bladder infections; yeast overgrowth reflecting as increased gas or clearing one's throat a lot).
- Look for medications (or excess alcohol) that could contribute to confusion, and see if the doctor will work with you to leave each medication off for 2-3 days (if able) to see if the mind clears.
- I would add a trial of Gingko Biloba 40-80 mg 3x day. Give it 6 weeks to work. Though a long shot, the natural supplement PhosChol 1-3 caps a day could also raise acetylcholine levels (the brain chemical raised by Alzheimer medicines), but I have not seen studies using it in Alzheimer's and it is expensive.
How About Alzheimer Medications?
A new therapy called "Rember" is twice as effective as Aricept. While the Aricept slightly slowed Alzheimer's progression over 12 months, Rember stopped the progression entirely—even when followed over 18 months! Interestingly, Rember is simply Methylene Blue, an old-time natural compound. I remember back in Junior High I was very much the scrawny geek. If a bully came after me, there was no good way to defend myself. I was able to get my revenge though (being a science geek). A little methylene blue slipped into their colas had them peeing a pretty shade of blue—and having a great panicked look! For the really nasty ones, I could get them peeing red as well…
Methylene blue will have an interesting time getting a patent (it is older than I am), but the drug company will probably patent the delivery system. It is worth keeping an eye out for, for use with those with Alzheimer's. Although it will be 4-5 years before the FDA process is completed, so it can be approved for Alzheimer's and available in pharmacies, the optimal dose is 60 mg 3 x day (more is not better) and it can be prescribed by Holistic Physicians and made by compounding pharmacies. For more info on Rember, see Rember for Alzheimer's: Methylene Blue's Comeback. It may cause blue urine, which is normal (it is a blue dye that gets excreted in the urine).
The benefit of Aricept and other medications that raise the brain transmitter acetylcholine (cholinesterase inhibitors) is minimal, but still reasonable to use. The effect of these drugs was not very large when measured in 13 studies. In one measure of how well the drugs worked, for instance, patients across the studies improved by an average of less than three points on a 70-point scale that tracks mental functioning.
"There is nothing to suggest the effects are less for patients with severe dementia, although there is very little evidence for other than mild to moderate dementia," according to Cochrane review author Jacqueline Birks of the University of Oxford.
Side effects caused about 29 percent of the patients taking the Aricept family drugs to leave the studies, compared with 18 percent dropout among the patients taking a placebo. The most common side effects were nausea, vomiting, and diarrhea. Although minimally effective compared to the other options we discuss in this article, I would add in 5 mg a day of Aricept (not 10 mg, which simply adds costs and side effects with minimal benefit) if you have prescription insurance. I suspect the rest of the options discussed above are MUCH more effective, but I'd add the Aricept for now for the additional tiny benefit it adds. For severe Alzheimer's, especially if the person also has chronic pain, a trial of the medication Namenda may have modest benefits (but may also help pain).
That your doctor is not thinking in the terms we discuss in this article simply reflects that almost all the information doctors get comes from the drug companies (e.g., "give Aricept"). I invite you to give this article to your physician. If they are open minded and willing to try these approaches, great! Once they see people get better, they can help many more folks. If your doctor won't do what you ask and gets hostile or dismissive with you for bringing up these options, don't argue with them (it's a waste of time trying to force open a physician's closed mind). Instead find a Board Certified Holistic Physician to help you or your loved ones.
You can restore or at least improve mental function in most people. Now you know how!