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Cognitive and learning disorders

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Related Terms
  • AAMI, AD, age-associated memory impairment, Alzheimer's disease, auditory perceptual deficit, brain diseases, brain disorders, brain injury, dyscalculia, dysgraphia, dyslexia, dyspraxia, cognition, cognitive deficits, cognitive enhancement, cognitive function, cognitive performance, delirium, dementia, intellectual disabilities, learning disabilities, mental retardation, multi-infarct disease, niacin deficiency, pellagry.

Background
  • Cognitive function, also called cognitive performance or cognition, refers to the ability of an individual to think, process, and store information in order to solve problems. Humans are the only organisms capable of cognition.
  • Cognitive disorders are characterized by delirium, dementia, and/or amnesia. Delirium is a term used to describe a confused mental state in which a patient has difficulty processing and interpreting information. Dementia is the loss of mental ability that is so severe that it interferes with daily functioning. Amnesia may cause difficulty remembering previously learned information. Patients with cognitive disorders may experience one or more of these symptoms.
  • Treatment for cognitive disorders depends on the underlying cause. Most disorders are incurable and some may have devastating effects. For instance, Alzheimer's disease eventually leads to complete cognitive impairment. Treatment may help delay progression of such disorders. Other disorders, such as age-associated memory impairment (AAMI) may only cause mild symptoms.
  • Cognitive learning disabilities occur when individuals have difficulty interpreting or processing what they see or hear. There is a gap between the patient's intelligence and his/her ability to perform. Patients may have difficulties with spoken and written language, self-control, coordination, and/or attention. As a result, patients may have a hard time with schoolwork or performing tasks at work.
  • Patients with cognitive learning disabilities are often able to live normal, healthy lives. There are many ways for patients to cope with their disabilities. Special education and adaptive skills training has been shown to improve patients' work and school performances. Patients who are diagnosed and treated promptly are often able to go to college and support themselves.

Signs and symptoms
  • General: The signs and symptoms of cognitive disorders and cognitive learning disabilities vary, depending on the type and severity of the condition. Some patients may live normal, healthy lives and are barely affected by the disorder. Other may have severe disabilities that limit their abilities to function independently.
  • Age-associated memory impairment (AAMI): Age-associated memory impairment (AAMI) causes mild forgetfulness in patients who are 50 years old or older.
  • Alzheimer's disease: Symptoms of Alzheimer's disease (AD) typically develop in patients who are 65 years old and older. However, a less common form of AD, known as early-onset AD, may develop in patients who are 30-40 years old. The youngest patient to be diagnosed with AD was 29 years old.
  • At first, symptoms may be mistaken for normal forgetfulness. However, overtime, the patient loses all cognitive functioning.
  • Mild symptoms may include memory impairment, confusion, difficulty learning and remembering new information, difficulty with daily tasks, mood swings, restlessness, and depression. In most cases, the patient is still able to do most activities, such as driving a car. However, the patient may get lost going to familiar places.
  • Moderate symptoms may include forgetting old facts, continually repeating stories, and/or asking the same questions repeatedly. The individual may make up stories to fill memory gaps. Patients have difficulty performing everyday tasks, such as keeping a checkbook, shopping for groceries, or following written notes. Patients may need help performing daily activities. Other symptoms may include agitation, restlessness, repetitive movement, paranoia, delusions, and hallucinations. Deficiencies in intellect and reasoning, along with a lack of concern for appearance, hygiene, and sleep, become more noticeable.
  • In the advanced stage of AD, damage to the brain's nerve cells is widespread. At this point, full-time care is typically required. The patient is generally bedridden. For friends, family, and caregivers, this can be the most difficult stage. Individuals with severe Alzheimer's disease may have difficulty walking, and they often suffer complications from other illnesses such as pneumonia. Signs of severe Alzheimer's disease may include groaning, screaming, mumbling, or speaking incoherently. They refuse to eat and may inappropriately cry out. Individuals with severe or advanced symptoms fail to recognize the faces of family members or caregivers. Apraxia (inability to perform physical tasks such as dressing or eating) and aphasia (loss of ability in comprehension of spoken or written language) are seen. They have great difficulty with all essential activities of daily life.
  • Multi-infarct disease: Memory impairment is often the first symptom to be noticed. An individual with dementia may be unable to remember ordinary information, such as his/her birth date, phone number, and address. Patients may be unable to recognize friends and family members. There is a progressive decline in cognitive function, including decision making, judgment, orientation in time and space, problem solving, and verbal communication. Behavioral changes may be seen in eating, dressing, and using the bathroom. Dementia patients may be unable to dress without help and may become incontinent or lose the ability to control urine flow. Normal interests, such as hobbies and social groups, are abandoned. They are unable to perform routine activities, such as driving, grocery shopping, and housecleaning. Individuals with dementia also experience changes in personality, such as inappropriate responses and lack of emotional control.
  • Trauma may cause prolonged or permanent changes in cognition, memory, emotions, or behavior.
  • Niacin deficiency-induced dementia: Patients with Niacin deficiency-induced dementia may suffer from the same symptoms as patients with multi-infarct disease.
  • In addition, niacin deficiency may cause symptoms that affect other parts of the body. Other symptoms, unrelated to dementia, may include skin lesions, inflammation of the tongue, reddening of the tongue, pain in the mouth, increased salivation, ulcerations in the mouth, burning in the throat, swelling in the abdomen, abdominal pain, constipation, diarrhea, nausea, and vomiting.
  • Learning disabilities: Cognitive learning disabilities vary from mild to severe. There are several different types of learning disabilities, including dyslexia, dysgraphia, dyscalculia, dyspraxia, and auditory perceptual deficit.
  • Dyslexia occurs when patients have difficulty translating written images into meaningful language. Patients may be unable to recognize written letters or words. Some may be reading at grade levels far below average.
  • Dysgraphia occurs when patients have difficulty writing letters within a defined space. Patients may take longer to write and have extremely poor handwriting that is almost illegible.
  • Dyscalculia occurs when patients have difficulty doing arithmetic and understanding mathematical concepts.
  • Patients with dyspraxia have poor motor control of large movements. Patients may have poor balance, poor posture, lack of rhythm when dancing, poor hand-eye coordination, and clumsy movement.
  • Visual perceptual deficit occurs when patients have difficulty processing visual information. Although nothing may be wrong with their eyesight, patients may have difficulty identifying an object from a background of other objects or they may not see things in the proper order.
  • Auditory perceptual deficit occurs when patients have difficulty processing auditory information. Although nothing may be wrong with their hearing, the brain does not interpret sounds properly. As a result, patients may have difficulty understanding and remembering things that are said. They may have difficulty distinguishing between similar sounds or hearing one sound over background noise.
  • Intellectual disability (mental retardation): Patients with mild intellectual disabilities have intelligence quotients (IQs) of 52-69. From birth to age six, patients are able to develop social and communication skills, but motor coordination is slightly impaired. By late adolescence, patients are able to learn until about a six-grade level. They are generally able to learn appropriate social skills. Adults are usually able to work and support themselves. Some patients may need help during times of social or financial stress.
  • Patients with moderate intellectual disabilities have IQs of 36-51. Children younger than six years old are able talk or communicate with others, but social awareness is generally poor. The patient's motor coordination is typically fair. Adolescents are able to learn some occupational and social skills. They may be able to learn how to travel alone in familiar places. Adults may be able to support themselves with a job. They usually require guidance and assistance during mild social or financial stress.
  • Patients with severe intellectual disabilities have IQs of 20-35. Young children can say a few words, but their speech is limited. Motor coordination is generally poor. Adolescents can usually talk or communicate with others. They are able to learn simple habits. Adults typically require lifelong assistance and guidance with daily activities.
  • Patients with profound intellectual disabilities have IQs of 19 or lower. Children younger than six years old have very little motor coordination and may require nursing care. Adolescents typically have limited motor and communication skills. Adults usually require lifelong nursing care.

Diagnosis
  • Age-associated memory impairment (AAMI): There are currently no tests to diagnose age-associated memory impairment (AAMI). However, if symptoms of forgetfulness worsen over time, patients should be tested for Alzheimer's disease (AD) or other cognitive disorders.
  • Alzheimer's disease: The earliest reported Alzheimer's disease diagnosis purportedly occurred in a 29-year-old patient. However, most patients are diagnosed with the condition when they are older than 65 years of age. There is no one test to diagnose Alzheimer's disease (AD). Typically, doctors start the diagnostic process by ruling out other diseases and conditions, such as brain injury or stroke, which may also cause memory loss.
  • A Mental Status Evaluation (MSE) screens memory, problem-solving abilities, attention spans, counting skills, and language skills. Questions such as "what day is it today?" or "who is the president of the United States?" may be asked. Recall tests are another example. Doctors may list familiar objects and then ask a person to repeat them immediately and again five minutes later. The Clock Drawing Test, the Mini-Mental State Examination (MMSE), and the Functional Assessment Staging (FAST) are commonly used mental status evaluation tools for determining if AD is present. On the tests, the final score helps confirm a diagnosis of AD
  • Brain scans may also be used to take pictures of the brain. Images of the brain are then analyzed for changes in function and structure of the brain that are associated with AD. Researchers have performed studies to determine if these brain scans may help predict a person's risk of developing the condition.
  • Multi-infarct dementia: The American Psychiatric Association has established two generally accepted criteria for the diagnosis of dementia: (1) a decline in recent and past memory and (2) impairment of one or more of the following functions: language (aphasia or the misuse of words or inability to remember and use words correctly); motor activity (apraxia or unable to perform motor activities even though physical ability remains intact); recognition (agnosia or unable to recognize objects, even though sensory function is intact); and executive function (unable to plan, organize, and think abstractly). Symptoms often develop gradually and show a progressive deterioration in function.
  • Once dementia is diagnosed, brain scans may be performed to detect possible abnormalities in the brain.
  • Niacin deficiency-induced dementia: If a patient meets the diagnostic criteria for dementia, additional tests are performed to determine the cause. A blood test is performed to determine if a niacin deficiency is the cause. Patients with dementia that is caused by niacin deficiency will have low levels of niacin in the blood. Healthy individuals typically have 2.4-6.1 milligrams of niacin per deciliter of blood.
  • Learning disabilities: Prompt diagnosis and early treatment of learning disabilities has been shown to improve a patient's long-term prognosis. In order to diagnose a learning disability, a specialist will administer several tests, which may involve writing, speaking, and listening. These tests are designed to measure the patient's strengths and weaknesses. In addition, the specialist will interview the patient and family members about medical history and problems that are being encountered.
  • Intellectual disability (mental retardation): Even though intellectual disability (mental retardation) is an irreversible condition, early diagnosis and prompt treatment has been shown to help improve patients' long-term prognoses.
  • Doctors diagnose intellectual disability after a medical history, physical examination, and intellectual quotient (IQ) test. If a patient does not show signs of adaptive behavior and scores well below average on the IQ test, then a positive diagnosis is made. To measure the patient's adaptive behavior professionals will compare what the patient can do to other children of his or her age. Many skills, including daily living skills (e.g. getting dressed, feeding oneself, and using the bathroom), communication skills (understanding what is being said and being able to respond), and social skills are important to adaptive behavior.
  • Patients with mild intellectual disabilities have intelligence quotients (IQs) of 52-69. Patients with moderate intellectual disabilities have IQs of 36-51. Patients with severe intellectual disabilities have IQs of 20-35. Patients with profound intellectual disabilities have IQs of 19 or lower.

Complications
  • Depression: Depression is common in patients with Alzheimer's disease (AD), especially during the earlier stages when they may be aware of losing mental functions. Depression may be treated with medications called antidepressants.
  • Falls and their complications: Individuals who suffer from dementia may become disoriented, increasing their risk of falls. Falls can lead to bone fractures that require hospitalization, medications, and surgery. Falls may also lead to an increase in the severity of AD symptoms, such as confusion and agitation. In addition, falls are a common cause of serious head injuries, such as brain hemorrhage (bleeding in the brain). Long-term immobilization after surgery and hospitalization may increase the risk of a pulmonary embolism (blood clot in the lungs), which can be life-threatening.
  • Infections: In severe and advanced dementia, individuals may lose all ability to care for themselves. This can make them more prone to additional health problems including pneumonia, which is an infection of the lungs and respiratory system. The individual may have difficulty swallowing food and liquids, which may cause them to inhale some of what they eat and drink into their airways and lungs, which may lead to pneumonia.
  • Urinary incontinence: Patients with severe or advanced dementia may develop urinary incontinence or the loss of bladder control that causes urine leakage. These patients may require the placement of a urinary catheter, which increases the risk of urinary tract infections (UTIs). UTIs can lead to more serious, life-threatening infections, such as pyelonephritis (bacterial infection of the kidney).

Treatment
  • Cholinesterase inhibitors: The U.S. Food and Drug Administration (FDA) has approved cholinesterase inhibitors for the treatment of Alzheimer's disease (AD). These drugs are also used to treat other types of permanent dementia, including multi-infarct dementia. Cholinesterase inhibitors increase the amount of a neurotransmitter, called acetylcholine, throughout the body. Acetylcholine is a chemical that carries messages between the nerves and muscles, and it appears to be involved in learning and memory. Patients with AD have low levels of acetylcholine. Commonly prescribed medications include donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®). About half of the people who take cholinesterase inhibitors experience a modest improvement in cognitive symptoms, such as memory.
  • Side effects are common and may include diarrhea, dizziness, drowsiness, fatigue, nausea, and vomiting. These side effects may cause some patients to discontinue medications. Individuals with liver disease, peptic ulcer disease, chronic obstructive pulmonary disease (COPD), and slow heart rate should not take these drugs.
  • Memantine: Memantine (Namenda®) is a drug approved by the FDA for treatment of moderate to severe Alzheimer's disease. Memantine is also used to treat other types of permanent dementia, including multi-infarct dementia. Memantine, an NMDA (N-methyl-D-aspartate) receptor antagonist, is the first AD drug of its kind that has been approved in the United States. It appears to work by regulating the activity of glutamate, which is one of the brain's specialized messenger chemicals involved in information processing, storage, and retrieval. Glutamate plays an essential role in learning and memory. Excess glutamate, on the other hand, may lead to disruption and death of brain cells. Memantine may protect cells against excess glutamate by partially blocking NMDA receptors. Side effects include headache, constipation, confusion, and dizziness.
  • Nicotinamide supplements: Patients who develop dementia as a result of niacin deficiency receive nicotinamide supplements (e.g. Advicor®, Niacor®, or Niaspan®). Since the supplement is made from niacin, it helps the patient return to normal niacin levels in the body. Nicotinamide supplements effectively cures dementia in these patients.
  • Long-term care: An individual with dementia may need monitoring and assistance at home or in an institution. Options include in-home care, boarding homes, adult daycare, and convalescent or long-term care facilities (nursing homes).
  • Visiting nurses, volunteer services, homemakers, adult protective services, and other community resources may help a family care for a patient with dementia. In some communities, support groups may be available. Family counseling may also help relatives of the patient cope with homecare and the debilitating effects of cognitive disorders.
  • The patient should be surrounded with familiar objects and people. Leaving the lights on at night may help reduce or prevent episodes of disorientation. Patients should follow simple schedules that are easy to remember.
  • Behavior modification may be beneficial in patients who exhibit unacceptable or dangerous behavior. This type of therapy involves rewarding appropriate behaviors and ignoring inappropriate ones (when it is safe to do so). Reality orientation is a technique in which caretakers take every opportunity to orientate the patient, such as reminding the patient where they are and what time of day it is. Reality orientation with repeated reinforcement of environmental and other cues may also help reduce disorientation.
  • Patients who are diagnosed with a progressive form of dementia, such as AD, should seek legal advice before they are unable to make decisions about medical care and end-of-life issues.

Integrative therapies
  • Strong scientific evidence:
  • Ginkgo: Ginkgo biloba has been used medicinally for thousands of years. The scientific literature overall does suggest that ginkgo may benefit people with dementia (multi-infarct and Alzheimer's type), and may be as helpful as acetylcholinesterase inhibitor drugs such as donepezil (Aricept®). Well-designed research comparing ginkgo to prescription drug therapies is needed.
  • Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Ginkgo should not be used in supplemental doses if pregnant or breastfeeding.
  • Sage: Sage has long been suggested as a possible therapy for memory and cognitive improvement. Several trials provide evidence for the use of sage for this indication. Additional study is needed to confirm these findings and determine the best dose.
  • Avoid if allergic or hypersensitive to sage species, their constituents, or to members of the Lamiaceae (mint) family. Use cautiously with hypertension (high blood pressure). Use sage essential oil or tincture cautiously in patients with epilepsy. Avoid if pregnant or breastfeeding.
  • Good scientific evidence:
  • Aromatherapy: Aromatherapy is the use of essential oils from plants for healing purposes. There is suggestive preliminary evidence that aromatherapy using essential oil of lemon balm (Melissa officinalis) may effectively reduce severe agitation in dementia when applied to the face and arms twice daily. Other research reports that steam inhalation of lavender aromatherapy may have similar effects. However, there is a conflicting study that reports no benefits of aromatherapy using lemon balm, Lavender officinalis, sweet orange (Citrus aurantium), or tea tree oil (Malaleuca alternifolia). Overall, the evidence does suggest potential benefits. It is not clear if this is because of anxiety-reducing qualities of these therapies. Additional study is necessary. There is also preliminary research suggesting that aromatherapy used with massage may help to calm people with dementias who are agitated. However, it is not clear if this approach is any better than massage used alone.
  • Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Bacopa: Bacopa monnieri leaf extract is called brahmi in Ayurvedic medicine (medicine practiced in India) and is widely used in India for enhancing memory, pain relief, and treating epilepsy. Although bacopa is traditionally used in Ayurvedic medicine to enhance cognition, high-quality clinical trials are lacking. Two methodologically weak studies found some evidence that bacopa improves cognition. However, more high-quality and independent research is needed before bacopa can be recommended for enhancing brain function in adults or children.
  • Bacopa may interact with medications such as calcium channel blockers (used for arrhythmias and high blood pressure), thyroid medications, phenytoin (Dilantin®), and drugs metabolized by the liver. Use cautiously with drugs or herbs that are metabolized by cytochrome P450 enzymes, thyroid drugs, calcium blocking drugs, and sedatives. Avoid if allergic/hypersensitive to Bacopa monnieri, its constituents or any member of the Srcophulariaceae (figwort) family. Avoid if pregnant or breastfeeding.
  • Ginkgo: Multiple clinical trials have evaluated ginkgo for a syndrome called cerebral insufficiency. This condition, more commonly diagnosed in Europe than the United States, may include poor concentration, confusion, absent-mindedness, decreased physical performance, fatigue, headache, dizziness, depression, and anxiety. It is believed that cerebral insufficiency is caused by decreased blood flow to the brain due to clogged blood vessels. Some studies report benefits of ginkgo in patients with these symptoms, but most have been poorly designed without reliable results. Better studies are needed before a conclusion can be made.
  • Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Ginkgo should not be used in supplemental doses if pregnant or breastfeeding.
  • Music therapy: Music is used to influence physical, emotional, cognitive and social well-being and improve quality of life for healthy people as well as those who are disabled or ill. It may involve either listening to or performing music, with or without the presence of a music therapist. In people with Alzheimer's dementia and other mental disorders in older adults, music therapy has been found to reduce aggressive or agitated behavior, improve mood, and improve cooperation with daily tasks such as bathing. Music therapy may also be beneficial for dementia-associated neuropsychiatric symptoms, such as depression and aggressive behavior. Additionally, music therapy may help maintain mental performance in elderly adults undergoing surgical procedures, reduce postoperative confusion and delirium, and increase energy levels. Music therapy is generally known to be safe.
  • Sage: Alzheimer's disease is characterized by memory loss that interferes with social and occupational functioning. Early evidence suggests that sage oil may be useful in the treatment of Alzheimer's disease.
  • Avoid if allergic or hypersensitive to sage species, their constituents, or to members of the Lamiaceae family. Use cautiously with hypertension (high blood pressure). Use the essential oil or tinctures cautiously in patients with epilepsy. Avoid with previous anaphylactic reactions to sage species, their constituents, or to members of the Lamiaceae family. Avoid if pregnant or breastfeeding.
  • Unclear or conflicting scientific evidence:
  • Acupressure, shiatsu: Acupressure may decrease verbal and physical agitated behavior in dementia patients. Further study is needed before a conclusion can be made.
  • With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious long-term complications have not been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
  • Acupuncture: Acupuncture has been reported to help improve memory and cognitive performance in the elderly. However, there is currently insufficient available evidence for the use of acupuncture in cognitive disorders and communication disorders. There is also insufficient evidence to recommend the use of acupuncture in the treatment of vascular dementia. More research is necessary.
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, and neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with a history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
  • Applied kinesiology: Applied Kinesiology (AK) is an assessment technique that uses muscle strength testing with the aim to identify nutritional deficiencies and health problems. It is based on the concept that weakness in certain muscles correspond to specific disease states or body imbalances. Applied Kinesiology, when used along with physical manipulation, massage, homeopathy, herbal remedies, and neuro-linguistic programming, showed some positive results in dyslexic children; however the effect of Applied Kinesiology alone for dyslexia cannot be isolated from the other therapies.
  • Applied kinesiology techniques in themselves are considered to be harmless. However, medical conditions should not be treated with AK alone, and should not delay appropriate medical treatment.
  • Arginine: There is not enough information available to make a strong recommendation about the use of the amino acid arginine in senile dementia.
  • Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Check blood potassium levels. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Art therapy: Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. The aesthetic aspect of the creation of art is thought to lift one's mood, boost self-awareness, and improve self-esteem. Art therapy also allows the opportunity to exercise the eyes and hands, improve eye-hand coordination, and stimulate neurological pathways from the brain to the hands. Art therapy may be an effective means of improving quality of life in the elderly. Art therapy has been used in only a few studies with Alzheimer's disease (AD) patients, with some suggestion of benefit in alleviating negative emotions and minimizing problematic behaviors. However, further studies are needed for definitive conclusions. There is evidence that the non-directed use of visual art (pictures) as a means of encouraging communication among elderly nursing home residents may increase well-being. It may also reduce blood pressure and improve medical health status with regard to reported dizziness, fatigue, pain, and use of laxatives.
  • Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.
  • Astragalus: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Based on human study, astragalus may help improve mental performance of children with low intelligence quotients (IQs). This study, however, used astragalus as part of a combination therapy, and it is difficult to ascribe the effects to any one constituent. Further, well-designed clinical trials are required before recommendations can be made.
  • Avoid if allergic to astragalus, peas, or any other related plants. Avoid with a history of Quillaja bark-induced asthma. Avoid if taking anticoagulants (e.g. warfarin or aspirin) or herbs or supplements with similar effects. Avoid with inflammation, fever, stroke, organ transplantation, or autoimmune diseases. Stop use two weeks before and immediately after surgery, dental, or diagnostic procedures that have bleeding risks. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously if taking blood-thinners, blood sugar drugs, diuretics, herbs or supplements with similar effects. Avoid if pregnant or breastfeeding.
  • Ayurveda: The herb Brahmi (Bacopa monnieri) is used in many Ayurvedic preparations for a variety of ailments. There is evidence from well-designed studies that it may improve memory and cognitive function in adults. Another study suggests that the herbal preparation Maharishi Amrit Kalash (MAK) -4 may enhance attention capacity or alertness, and thus reverse some of the detrimental cognitive effects of aging. Further research is needed to confirm these results.
  • Ayurvedic herbs should be used cautiously because they are potent and some constituents can be potentially toxic if taken in large amounts or for a long period of time. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs may interact with other herbs, foods, and drugs. A qualified healthcare professional should be consulted before use. Use guggul cautiously with peptic ulcer disease. Patients should avoid sour food, alcohol, and heavy exercise with use of this herb. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia chebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
  • Bacopa: Bacopa monnieri leaf extract is called brahmi in Ayurvedic medicine and is widely used in India for enhancing memory, pain relief, and treating epilepsy. However, additional study is needed before a firm conclusion can be drawn.
  • Bacopa may interact with medications such as calcium channel blockers (used for arrhythmias and high blood pressure), thyroid medications, phenytoin (Dilantin®), and drugs metabolized by the liver. Use cautiously with drugs or herbs that are metabolized by cytochrome P450 enzymes, thyroid drugs, calcium blocking drugs, and sedatives. Avoid if allergic/hypersensitive to Bacopa monnieri, its constituents, or any member of the Srcophulariaceae (figwort) family. Avoid if pregnant or breastfeeding.
  • Beta-carotene: Antioxidants such as beta-carotene may be helpful for increasing cognitive performance and memory. Long-term, but not short-term, beta-carotene supplementation appears to benefit cognition.
  • Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.
  • Black tea: Several preliminary studies have examined the effects of caffeine, tea, or coffee use on short and long-term memory enhancement. It remains unclear if tea is beneficial for this use. Limited, low-quality research also reports that the use of black tea may improve mental performance/alertness and cognition.
  • Black tea contains caffeine, which is a stimulant. Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes. Use caution if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances/insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. Tea consumption by infants has been linked to anemia, decreased iron metabolism, and irritability.
  • Boron: Preliminary human studies report better performance on tasks of eye-hand coordination, attention, perception, short-term memory, and long-term memory with the use of boron. Although boron has not been studied in AD, it may be beneficial in improving cognitive function.
  • Avoid if allergic or sensitive to boron, boric acid, borax, citrate, aspartate, or glycinate. Avoid with a history of diabetes, seizure disorder, kidney disease, liver disease, depression, anxiety, high blood pressure, skin rash, anemia, asthma, or chronic obstructive pulmonary disease (COPD). Avoid with hormone-sensitive conditions like breast cancer or prostate cancer. Avoid if pregnant or breastfeeding.
  • Bupleurum: Bupleurum is an herb that is typically found in East Asia. Bupleurum has long thin leaves that look like fennel. An herbal combination formula containing bupleurum has been used as a treatment for minimal brain damage in children. Early study is inconclusive, and additional study is needed to make a firm conclusion.
  • Avoid if allergic or hypersensitive to bupleurum or any members of the Apiaceae or Umbelliferae (carrot) families. Use cautiously if driving or operating heavy machinery because bupleurum may cause drowsiness. Use cautiously with diabetes, high blood pressure, or edema. Use cautiously if taking drugs that increase the risk of bleeding (anticoagulants).
  • Choline: Choline is an amino alcohol that the body needs to make acetylcholine. The largest dietary source of choline is egg yolk. Early treatment with choline alphoscerate (CA), a substrate of phosphatydylocholine that is a carrier of choline, was shown to be safe. When taken as part of complex pharmacotherapy, choline has shown beneficial effects on patients with craniocerebral brain injuries. Additional study is needed to confirm these findings. There is also a lack of sufficient evidence to recommend the use of choline in coma patients. Available research is limited.
  • Avoid if allergic or hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney disorders, liver disorders, or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding, it seems generally safe to consume choline within the recommended adequate intake (AI) parameters. Supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
  • Chromium: Early research suggests that chromium picolinate may help improve cognitive function in the elderly. Further study is needed in this area.
  • Trivalent chromium appears to be safe because side effects are rare or uncommon. However, hexavalent chromium may be poisonous (toxic). Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke, and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
  • Coenzyme Q10: Coenzyme Q10, or CoQ10, is produced by the human body and is necessary for the basic functioning of cells. Promising preliminary evidence suggests that CoQ10 supplements may slow down, but not cure, dementia in people with Alzheimer's disease. Additional well-designed studies are needed to confirm these results before a firm conclusion can be made.
  • Allergy associated with coenzyme Q10 supplements has not been reported in the available literature, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin or warfarin), blood pressure, blood sugar, cholesterol, or thyroid drugs. Avoid if pregnant or breastfeeding.
  • Copper: Copper is a mineral that occurs naturally in many foods including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Conflicting study results report that copper intake may either increase or decrease the risk of developing Alzheimer's disease. Additional research about its effectiveness for Alzheimer's disease prevention is needed.
  • Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements during the early phase of recovery from diarrhea. Avoid with hypercupremia, occasionally observed in disease states including cutaneous leishmaniasis, sickle-cell disease, unipolar depression, breast cancer, epilepsy, measles, Down syndrome, and controlled fibrocalculous pancreatic diabetes (a unique form of secondary diabetes mellitus). Avoid with genetic disorders affecting copper metabolism such as Wilson's disease, Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than 6mg/L. Use cautiously with anemia, arthralgias, and myalgias. Use cautiously if taking oral contraceptives. Use cautiously if at risk for selenium deficiency. The United States Recommended Dietary Allowance (RDA) is 1,000?g for pregnant women. The United States Recommended Dietary Allowance (RDA) is 1,300?g for nursing women.
  • Cranberry: Preliminary study results show that cranberry juice may increase overall memory enhancement. Further well-designed clinical trials are needed to confirm these results.
  • It is best not to use sweetened cranberry juice or cranberry juice cocktail due to the high sugar content. The use of 100% cranberry juice products is recommended by healthcare providers. Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.
  • Creatine: Early studies show that creatine may improve memory in certain populations, such as vegetarians and the elderly. Further research is required before recommendations can be made.
  • Avoid if allergic to creatine or with diuretics (like hydrochlorothiazide, furosemide (Lasix®)). Use caution in asthma, diabetes, gout, kidney, liver or muscle problems, stroke or with a history of these conditions. Avoid dehydration. Avoid if pregnant or breastfeeding.
  • DHEA: Dehydroepiandrosterone (DHEA) is an endogenous hormone (made in the human body) and secreted by the adrenal gland. DHEA serves as precursor to male and female sex hormones (androgens and estrogens). DHEA levels in the body begin to decrease after age 30 and may need to be taken as supplements. Preliminary evidence, from a controlled trial and a case series, gives conflicting results as to whether DHEA offers benefit to individuals with dementia. Well designed clinical trials, with appropriate endpoints are required before recommendations can be made.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use with caution in adrenal or thyroid disorders or anticoagulants, or drugs, herbs or supplements for diabetes, heart disease, seizure or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Folate: Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food and folic acid is the synthetic form of this vitamin. Preliminary evidence indicates that low folate concentrations may be related to Alzheimer's disease. Well-designed clinical trials of folate supplementation are needed before a conclusion can be drawn.
  • Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents and with anemia and seizure disorders. It is recommended that pregnant women consume 400 micrograms of folate daily in order to reduce the risk of the fetus developing a defect. Folate is likely safe if breastfeeding.
  • Ginkgo: There is preliminary research showing small improvements in memory and other brain functions with use of ginkgo in patients with age-associated memory impairment (AAMI), although some studies disagree. Overall, there is currently not enough clear evidence to recommend for or against ginkgo for this condition. It remains unclear if ginkgo is effective for memory enhancement in healthy patients. Further well-designed research is needed as existing study results conflict.
  • Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy or oak or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (like aspirin or warfarin (Coumadin®)) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Ginkgo should not be used in supplemental doses if pregnant or breastfeeding.
  • Ginseng: Early small studies report that Fuyuan mixture, an herbal combination that contains ginseng, may improve symptoms of multi-infarct dementia. The effects of ginseng alone are not clear, and no firm conclusion can be drawn. In addition, the use of ginseng for mental performance has been assessed using standardized measurements of reaction time, concentration, learning, math, and logic. Benefits have been seen both in healthy young people and in older ill patients. Effects have also been reported for the combination use of ginseng with Ginkgo biloba. However, some negative results have also been reported. Therefore, although the sum total of available scientific evidence does suggest some effectiveness of short-term use of ginseng for mental performance, better research is necessary before a strong recommendation can be made.
  • Avoid ginseng with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in ginseng formulations.
  • Gotu kola: Ayurveda regards gotu kola (Centella asiatica) as an important rejuvenating herb for nerve and brain cells, believed to be capable of increasing intelligence, longevity, and memory. Asiaticoside derivatives, including asiatic acid and asiaticoside, were shown to reduce hydrogen peroxide-induced cell death, decrease free radical concentrations, and inhibit beta amyloid cell death in vitro, suggesting a possible role for gotu kola in the treatment and prevention of Alzheimer's disease and beta amyloid toxicity. Limited available clinical study investigated a combination product containing gotu kola on cognitive function in the elderly, but did not find any benefit. Additional study is needed to confirm these findings.
  • Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
  • Grapeseed: Grape seed oil is a popular (non scented) carrier oil used in aromatherapy. Although grape seed has been compared to lavender oil and thyme oil to reduce agitation in dementia patients, there is not enough scientific evidence to make a conclusion about its effectiveness.
  • Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously if taking blood thinners such as warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or anti-platelet agents. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with drugs processed using the liver's cytochrome P450 enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Avoid with disorders that increase the risk of bleeding or with active bleeding disorders (stomach ulcers, bleeding into the brain, etc.). Avoid if pregnant or breastfeeding.
  • Green tea: Several preliminary studies have examined the effects of caffeine, tea, or coffee use on short and long-term memory and cognition. It remains unclear if tea is beneficial for this use. Limited, low-quality research reports that the use of green tea may improve cognition and mental performance/alertness.
  • Green tea contains caffeine, which is a stimulant. Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease.
  • Guarana: Guarana is a native species of South America and has stimulating properties when taken by mouth. Guarana is also used to enhance athletic performance and to reduce fatigue. Guarana has not been shown to alter cognitive enhancement or arousal in preliminary studies. Caffeine found in guarana may improve simple reaction time, but may not improve immediate memory. Additional study is needed in this area.
  • Avoid if allergic/hypersensitivite to guarana (Paullinia cupana), caffeine, tannins, or species of the Sapindaceae family. Avoid with hypertension, psychological or psychiatric disorders, liver impairment, and arrhythmias. Avoid with other stimulatory agents, especially ephedra. Use cautiously with breast disease, impaired kidney function, diabetes, pre-existing mitral valve prolapse, iron deficiency, gastric or duodenal ulcers, bleeding disorders, glaucoma or if at risk for osteoporosis. Use cautiously if undergoing electroconvulsive therapy (ECT). Avoid if pregnant or breastfeeding.
  • Guided imagery: The term guided imagery may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Early research suggests that guided imagery of short duration may improve working memory. Further research is needed before a firm conclusion can be drawn.
  • Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. In patients feeling unusually anxious while practicing guided imagery, or in patients with a history of trauma or abuse, a qualified health care provider should be consulted before practicing guided imagery.
  • Hypnotherapy, hypnosis: It remains unclear whether hypnotherapy can enhance cognitive function and improve academic performance. Further research is warranted in this area.
  • Use cautiously with mental illnesses (e.g. psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
  • Iodine: Iodine is required for the production of thyroid hormones, which are necessary for normal brain development and cognitive function. One study showed that oral iodized oil significantly improved performance on cognitive tests in 10- to 12-year-old school children. Further study is needed to confirm these results.
  • There have been reports of severe and even fatal reactions to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Iron: Iron is an essential mineral. Iron is an important part of proteins that transport oxygen and are involved in metabolism. Taking iron by mouth seems to help with improving cognitive function related to iron deficiency in children and adolescents. Further research is needed to confirm the potential benefit of iron in this indication. Iron supplements are not recommended for improving cognitive performance in non-iron deficient people.
  • Iron is a trace mineral, and hypersensitivity is unlikely. Avoid if known allergy/hypersensitivity to products containing iron. Avoid excessive intake. The recommended dietary allowance (RDA) for males (19-50 years old) is eight milligrams per day; females (19-50 years old) 18 milligrams per day; adults (51 years and older) eight milligrams per day; pregnant women (all ages) 27 milligrams per day; breastfeeding women (19 years and older) nine milligrams per day. The RDA is 11 milligrams for babies 7-12 months old; seven milligrams for children 1-3 years old; 10 milligrams for children 4-8 years old; eight milligrams for children 9-13 years old; 11 milligrams for males 14-18 years old; 15 milligrams for females 14-18 years old; 27 milligrams for pregnant females 14-18 years old; and 10 milligrams for breastfeeding females 14-18 years old. For infants 0-6 months 0.27 milligrams is recommended as the adequate intake level (AI), which is used when RDA cannot be determined. Avoid iron supplements with blood disorders that require frequent blood transfusions. Use iron supplement cautiously with a history of kidney disease, intestinal disease, peptic ulcer disease, enteritis, colitis, pancreatitis, heart disease, hepatitis, alcoholism, or if older than 55 years of age. Use cautiously if trying to become pregnant. Pregnant or breastfeeding women should consult a healthcare professional before beginning iron supplementation.
  • Jasmine: Odors and memory improvement are considered to be somehow linked in the brain. Two clinical trials using weakly jasmine-scented rooms found that subjects did not have improved recall of a physical environment without the jasmine odor trigger but could remember a word list better when exposed to a jasmine trigger. More research is needed in this area.
  • Use cautiously during pregnancy, based on traditional use. Use cautiously in patients allergic to jasmine, jasmine oil, or other fragrances. Use cautiously during lactation as jasmine flowers applied to the breasts have been used as a lactofuge. Avoid oral consumption of essential oils, including jasmine essential oil, as they are extremely potent and can be poisonous.
  • Jojoba: Jojoba oil is traditionally used as a carrier or massage oil. There is currently not enough available evidence to recommend for or against the use of jojoba oil for dementia.
  • Avoid if allergic or hypersensitive to jojoba, its constituents, or members of the Simmondsiaceae family. Avoid oral consumption of jojoba products. Avoid if pregnant or breastfeeding.
  • Khat: Khat is a flowering evergreen plant that has been grown for use as a stimulant for centuries. Khat has been evaluated for its benefits for cognitive function; however, the results are mixed with some studies showing benefit and others showing negative effects. Additional study is needed to clarify these findings.
  • When taken by mouth, it is unknown whether khat is physically addictive. However, it is linked to psychological dependence and is illegal in the United States. Avoid if allergic to the Celastraceae family (staff vine family). Use cautiously if taking amoxicillin, ampicillin or stimulants. Use cautiously with a history of high blood pressure, fast heartbeat (tachycardia), depression, or motor tics (Tourette's syndrome). Avoid with glaucoma or mental illness. Avoid driving or operating heavy machinery after using khat. Avoid holding khat in the cheek for a long time. Avoid if pregnant or breastfeeding.
  • Kundalini yoga: Kundalini yoga is one of many traditions of yoga that share common roots in ancient Indian philosophy. It is comprehensive in that it combines physical poses with breath control exercises, chanting (mantras), meditations, prayer, visualizations, and guided relaxation. Breathing exercises are an important part of Kundalini yoga. There is some evidence from studies with healthy volunteers that use of certain breathing techniques (such as breathing solely through one nostril or the other) may improve different aspects of cognitive function. More studies are needed to determine if these techniques can reliably be used to improve cognitive function and possibly aid in treating cognitive and nervous system disorders.
  • Avoid exercises that involve stoppage of breath, with heart or lung problems, insomnia, poor memory, or concentration. Avoid certain inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Use cautiously with mental disorders as some techniques may cause an altered state of consciousness. Kundalini Yoga is considered safe and beneficial for use during pregnancy and lactation when practiced under the guidance of expert instruction. Lamaze techniques are based on yogic breathing. If started early in the pregnancy, it may be possible to master the ability of breathing to reduce stress and aid in labor. Teachers of yoga are generally not medically qualified and should not be regarded as sources of medical advice for management of clinical conditions.
  • Lavender: Small studies of patients with severe dementia in nursing homes have found that lavender aromatherapy or pinning a cloth to the patient with lavender oil on it may help to decrease agitated behavior. Although lavender is a sedative-type aroma, use during recess periods in a work environment after accumulation of fatigue seemed to prevent deterioration of cognitive performance in subsequent work sessions. Small trials investigating the effects of lavender aromatherapy on agitation and behavior in patients with Alzheimer's dementia report conflicting results. Further well-designed studies are needed before a conclusion can be drawn.
  • Avoid if allergic or hypersensitive to lavender. Avoid with history of seizures, bleeding disorders, eating disorders (anorexia, bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
  • L-Carnitine: Early evidence suggests the effectiveness of L-carnitine and/or acetyl-L-carnitine for Alzheimer's disease. However, the evidence is mixed. Most of the studies related to dementia suffer from various weaknesses. Although preliminary evidence is promising, there is insufficient available evidence to recommend for or against this use. There are also a limited number of studies relevant to the use of carnitine for memory. Carnitine does not appear to have any effect on memory. Additional study is needed before a conclusion can be made.
  • Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, hypertension (high blood pressure), alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.
  • Lemon balm: Limited data is available supporting the use of lemon balm as a treatment for agitation in dementia patients. Additional study is necessary before a conclusion can be drawn. Clinical data suggest that the use of standardized lemon balm (Melissa officinalis) extract has some effect on particular self-reported measures of mood and cognitive performance. More rigorous studies need to be conducted using patient-relevant outcomes to better assess the validity of these results as they apply to patient care.
  • Based on available research, lemon balm taken by mouth has been reported to be relatively well tolerated when taken for up to eight weeks. Evidence for topical administration of lemon balm cream suggested minimal side effects for up to 10 days of application. Avoid if allergic or hypersensitive to lemon balm. Avoid with Grave's disease or thyroid hormone replacement therapy. Use cautiously in glaucoma because lemon balm may increase eye pressure. Use caution when operating heavy machinery. Lemon balm preparations may contain trace amounts of lead. Avoid if pregnant or breastfeeding.
  • Macrobiotic diet: Macrobiotics is a predominantly vegetarian, whole-foods diet that emphasizes whole grains (especially brown rice), vegetables, fruits, legumes, and seaweeds. The evidence is mixed as to whether or not a macrobiotic diet helps, hinders, or has no effect on cognitive function in children.
  • There is a risk of nutrition deficiencies with use of an exclusive macrobiotic diet; however, this can be avoided with appropriate menu planning. Use cautiously with cancer or other medical conditions without expert planning or supplementation. Macrobiotic diets are not recommended in children or adolescents without professional guidance or appropriate supplementation, and are also not recommended in pregnant or lactating women due to potential deficiencies, unless properly supplemented.
  • Massage: Massage with or without essential oils has been used in patients with dementia in chronic care facilities to assess effects on behavior. There is compelling early evidence that aromatherapy with essential oils may reduce agitation in patients with dementia, although the effects of massage itself are not clear.
  • Sunflower therapy, which includes applied kinesiology, physical manipulation, massage, homeopathy, herbal remedies, and neuro-linguistic programming, has been studied for childhood dyslexia. Although initial research appears promising, additional studies are needed to make a firm recommendation.
  • Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
  • Meditation: Some forms of meditation may have positive effects on cognitive function. However, there is not enough clear evidence that any specific form of meditation can support or enhance cognitive function.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
  • Melatonin: Melatonin is a naturally occurring hormone that helps regulate sleep/wake cycles (circadian rhythm). There is limited study of melatonin for improving sleep disorders associated with Alzheimer's disease (including nighttime agitation or poor sleep quality in patients with dementia). It has been reported that natural melatonin levels are altered in people with Alzheimer's disease, although it remains unclear if supplementation with melatonin is beneficial. Further research is needed in this area before a firm conclusion can be reached.
  • Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. Melatonin should be avoided in patients using warfarin, and possibly in patients taking other blood-thinning medications or with clotting disorders. Melatonin may cause drops in blood pressure. Caution is advised in patients with high cholesterol levels, atherosclerosis, those at risk for cardiovascular disease, diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Mild gastrointestinal distress commonly occurs, including nausea, vomiting, or cramping. Patients with glaucoma taking melatonin should be monitored by a healthcare professional. Melatonin should be avoided in women who are pregnant or attempting to become pregnant; high levels of melatonin during pregnancy may increase the risk of developmental disorders. In men, decreased sperm motility and decreased sperm count are reported with use of melatonin.
  • Music therapy: Music therapy may reduce feelings of agitation and anxiety in patients with moderately severe and severe Alzheimer's disease. More research is needed to confirm these results. Music therapy is generally known to be safe.
  • Niacin: Dementia can be caused by severe niacin insufficiency, but it is unclear whether variation in intake of niacin in the usual diet is linked to Alzheimer's disease (AD) or cognitive decline. Further research is needed before a conclusion can be drawn.
  • Avoid niacin/vitamin B3 if allergic to niacin or niacinamide. Avoid with a history of liver disease or dysfunction, irregular heartbeats (arrhythmia), heart disease, blood clotting, bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout or diabetes. Avoid if pregnant or breastfeeding.
  • Omega-3 fatty acids, fish oil, alpha-linolenic acid: Well-designed clinical trials are needed before omega-3 fatty acids can be recommended for the prevention of cognitive impairment or dementia.
  • Avoid if allergic or hypersensitive to fish, omega-3 fatty acid products that come from fish, nuts, or linolenic acid or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements that treat any such conditions. Use cautiously before surgery. The Environmental Protection Agency (EPA) recommends that intake be limited in pregnant/nursing women to a single 6-ounce meal per week, and in young children to less than 2 ounces per week. For farm-raised, imported, or marine fish, the U.S. Food and Drug Administration recommends that pregnant/nursing women and young children avoid eating types with higher levels of methylmercury and less than 12 ounces per week of other fish types. Women who might become pregnant are advised to eat 7 ounces or less per week of fish with higher levels of methylmercury or up to 14 ounces per week of fish types with about 0.5 parts per million (such as marlin, orange roughy, red snapper, or fresh tuna).
  • Peppermint oil: Peppermint is a flowering plant that grows throughout Europe and North America. Peppermint is most often grown for its fragrant oil. There is currently a lack of sufficient evidence to recommend the use of peppermint oil for vigilance improvement in brain injury.
  • Avoid if allergic or hypersensitive to peppermint or menthol. Peppermint is generally considered safe in non-allergic adults when taken in small doses. Use cautiously with glucose-6-phosphate dehydrogenase (G6PD) deficiency or gallbladder disease. Menthol, which makes up part of peppermint oil, is generally considered safe in non-allergic adults. But, doses of menthol greater than one gram per kilogram of body weight may be deadly in humans. Avoid if pregnant or breastfeeding.
  • Pet therapy: In the institutionalized elderly, there is evidence that pet therapy may reduce depression and blood pressure, reduce irritability, reduce agitation, and increase social interaction. In Alzheimer's dementia, there is evidence that the presence of a companion animal may increase social behaviors such as smiles, laughs, looks, leans, touches, verbalizations, or name-calling.
  • Avoid if allergic to animal dander. Use only animals that have had veterinary screening, particularly in situations involving young children, frail elderly, or patients with immune disorders or medical conditions making them vulnerable to infection. Do not provide unsupervised use of animals with the severely mentally ill and very young children. Avoid with a fear of animals or traumatic history with animals.
  • Physical therapy: Patients with chronic traumatic brain injury often have gait (movement) disorders. Physical therapy techniques, such as treadmill training and weight-bearing gait training, have been used with mixed results. Better-designed studies are needed to make a stronger recommendation.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Policosanol: The effects of policosanol supplementation on reactivity and related brain activity have been examined. Although there is early compelling evidence, further research is necessary before a clear conclusion can be made.
  • Avoid if allergic or hypersensitive to policosanol. Use cautiously if taking aspirin or blood pressure medications. Use cautiously with high blood pressure. Use cautiously if pregnant or breastfeeding.
  • Polypodium leucotomos extract and anapsos: Extracts of the polypodium fern have been used for many health conditions. It is commonly found in South America and Europe. The South American species Polypodium leucotomos L. is also known as "calaguala." Extracts of this species are called "anapsos." Limited scientific information is available about the effectiveness of polypodium in the treatment of dementia and Alzheimer's disease.
  • Avoid if allergic or hypersensitive to ferns from the family Polypodiaceae. Use cautiously with heart disease or with use of blood pressure drugs. Avoid operating any heavy machinery when taking polypodium. Avoid if pregnant or breastfeeding.
  • Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behavior to help with problem solving. A type of psychotherapy, called child therapy, may improve language proficiency in children. Individual therapy may be more successful than group therapy. Further research is needed in this area.
  • Cognitive behavioral psychotherapy and cognitive remediation appear to lessen psychological distress and improve cognitive functioning among patients with traumatic brain injury. More study is warranted to confirm results of early study.
  • Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions (e.g. post-traumatic stress disorder or personality disorders) because some forms of psychotherapy may stir up strong emotional feelings and expression.
  • Reiki: Early research suggests that Reiki therapy may improve behavioral and memory problems in patients with mild cognitive disorders or mild Alzheimer's disease. However, additional studies are needed to confirm these findings.
  • Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.
  • Rhodiola: Early human study suggests that rhodiola may benefit learning, memory, and mental performance. Well-designed studies are needed before a recommendation may be made.
  • Avoid if allergic or sensitive to Rhodiola. Use cautiously in people with diabetes, cardiovascular disease, or neurological or psychiatric disorders. Rhodiola is not recommended for use during pregnancy or breastfeeding.
  • Rhubarb: Preliminary study has investigated rhubarb along with other herbs in the treatment of age-associated memory impairment (AAMI). Studies of rhubarb alone are needed to discern rhubarb's effect on aging and memory.
  • Avoid if allergic/hypersensitive to rhubarb, its constituents, or related plants from the Polygonaceae family. Avoid using rhubarb for more than two weeks because it may induce tolerance in the colon, melanosis coli, laxative dependence, pathological alterations to the colonic smooth muscles, and substantial loss of electrolytes. Avoid with atony, colitis, Crohn's disease, dehydration with electrolyte depletion, diarrhea, hemorrhoids, insufficient liver function, intestinal obstruction or ileus, irritable bowel syndrome, menstruation, pre-eclampsia, renal disorders, ulcerative colitis, and urinary problems. Avoid handling rhubarb leaves, as they may cause contact dermatitis. Avoid rhubarb in children under age 12 due to water depletion. Use cautiously with bleeding disorders, cardiac conditions, coagulation therapy, constipation, history of kidney stones, or thin or brittle bones. Use cautiously if taking anti-psychotic drugs or oral drugs, herbs or supplements (including calcium, iron, and zinc). Avoid if pregnant or breastfeeding.
  • Riboflavin: Adequate nutrient supplementation with riboflavin (vitamin B2) may be required for the maintenance of adequate cognitive function. Treatment with B-vitamins including riboflavin has been reported to improve scores of depression and cognitive function in patients taking tricyclic antidepressants. This may be related to tricyclic-caused depletion of riboflavin levels.
  • Avoid if allergic or hypersensitive to riboflavin. Since the amount of riboflavin a human can absorb is limited, riboflavin is generally considered safe. Riboflavin is generally regarded as safe during pregnancy and breastfeeding. The U.S. Recommended Daily Allowance (RDA) for riboflavin in pregnant women is higher than for non-pregnant women, and is 1.4 milligrams daily (1.6 milligrams for breastfeeding women).
  • Soy: It is unclear if soy isoflavone supplementation in postmenopausal women may improve cognitive function. Results from studies are mixed.
  • Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs like warfarin should check with a doctor and pharmacist before taking soy.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. TENS is often used to treat pain, as an alternative or addition to pain medications. Preliminary research suggests that TENS may be of benefit with some symptoms of Alzheimer's disease, including mood, memory, and cycles of daily rest and activity. Additional human study is necessary before a firm conclusion can be drawn.
  • Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Therapeutic touch: Studies suggest that therapeutic touch may reduce behavioral symptoms of dementia such as searching and wandering, tapping and banging, anxiety, agitation, and vocalization in people with Alzheimer's dementia. Well-designed studies are needed before a firm conclusion can be drawn.
  • Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
  • Thiamin: Because thiamin deficiency can result in a form of dementia (Wernicke-Korsakoff syndrome), its relationship to Alzheimer's disease and other forms of dementia has been investigated. Whether thiamin supplementation is of benefit in Alzheimer's disease remains controversial. Further evidence is necessary before a firm conclusion can be reached.
  • Thiamin is generally considered to be safe and relatively nontoxic. Avoid if allergic or hypersensitive to thiamin. Rare hypersensitivity/allergic reactions have occurred with thiamin supplementation. Skin irritation, burning, or itching may rarely occur at injection sites. Large doses may cause drowsiness or muscle relaxation. Use cautiously if pregnant or breastfeeding.
  • Traditional Chinese medicine: Traditional Chinese medicine (TCM) herbal combinations have been used for the treatment of dementia and reportedly improve cognitive function and activities of daily living. More studies of better design are needed before recommendations can be made.
  • Acupuncture is generally considered safe. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, and neurologic disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
  • Turmeric: Curcumin has been shown to have antioxidant and anti-inflammatory properties and to reduce beta-amyloid and plaque burden in lab studies. However, there is currently not enough evidence to suggest the use of curcumin for cognitive function.
  • Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding. Turmeric should be stopped prior to scheduled surgery.
  • Vitamin B12: Some patients diagnosed with Alzheimer's disease have been found to have abnormally low vitamin B12 (cyanocobalamin) levels in their blood. However, vitamin B12 deficiency itself often causes disorientation and confusion and thus mimics some of the prominent symptoms of Alzheimer's disease. Well-designed clinical trials are needed.
  • Avoid vitamin B12 supplements if allergic or hypersensitive to cobalamin, cobalt, or any other vitamin B12 product ingredients. Avoid with coronary stents (mesh tube that holds clogged arteries open) and Leber's disease. Use cautiously if undergoing angioplasty and with anemia. Vitamin B12 is generally considered safe when taken in amounts that are not higher than the Recommended Dietary Allowance (RDA). There is not enough scientific data available about the safety of larger amounts of vitamin B12 during pregnancy and/or breastfeeding.
  • Vitamin E: Vitamin E has been proposed and evaluated for the prevention or slowing of dementia (including Alzheimer's type), based on antioxidant properties and findings of low vitamin E levels in some individuals with dementia. There is some evidence that all-rac-alpha-tocopherol (synthetic vitamin E) is similar in effects to a commonly used drug for AD, selegiline (Eldepryl®), in slowing cognitive function decline in patients with moderately severe Alzheimer's disease. No additive effect was observed when used in combination with selegiline. Retrospective data suggests that long-term combination therapy with donepezil (Aricept®) may help slow cognitive decline in patients with Alzheimer's disease. Overall, the evidence remains inconclusive in this area. Other research suggests that vitamin E from dietary sources or supplements does not affect the risk of developing Alzheimer's disease or vascular dementia.
  • Vitamin E may cause bleeding, especially in sensitive individuals such as those taking medications for bleeding disorders (including warfarin or Coumadin®). Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid use above the recommended daily level in pregnant and breastfeeding women.
  • Yoga: There is limited human study of yoga for memory improvement. Better studies are needed before a recommendation can be made.
  • Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
  • Zinc: Early studies indicate that daily supplementation with zinc may be of limited usefulness for improving cognitive deficits in children exposed to lead. Further study may be warranted in this area.
  • Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
  • Fair negative scientific evidence:
  • Beta-carotene: Intake of dietary or supplemental beta-carotene has not been shown to have an effect on Alzheimer's disease risk.
  • Avoid if sensitive to beta-carotene, vitamin A or any other ingredients in beta-carotene products.
  • Bitter orange: Bitter orange has been used in aromatherapy, although it does not appear to reduce combative, resistive behaviors in individuals with dementia. Currently, evidence supporting the use of bitter orange for dementia and behavioral challenges is lacking.
  • Avoid if allergic or hypersensitive to bitter orange or any members of the Rutaceae family. Avoid with heart disease, narrow-angle glaucoma, intestinal colic, or a heart disease called long QT interval syndrome (LQTS). Avoid if taking anti-adrenergic agents, beta-blockers, QT-interval prolonging drugs, monoamine oxidase inhibitors (MAOIs), stimulants, or honey. Use cautiously with headache, hyperthyroidism (overactive thyroid), or if fair-skinned. Avoid if pregnant or breastfeeding.
  • Choline: Numerous studies have assessed the use of choline in cerebrovascular diseases, memory performance, dementia, and Alzheimer's disease without significant benefit.
  • Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding it seems generally safe to consume choline within the recommended adequate intake (AI) parameters. Supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
  • DHEA: Studies of the effects of dehydroepiandrosterone (DHEA) on memory have produced complex and inconsistent results. Additional study is warranted in this area.
  • Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants, drugs, herbs, or supplements that treat diabetes, heart disease, seizure, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
  • Ginkgo: The results of limited available study investigating the effect of Ginkgo biloba on post-prandial mental performance are unclear. Ginkgo may benefit some but not all endpoints. Further clinical trials are required before a conclusion can be made.
  • Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, sumac, poison ivy, oak, or cashews, then allergy to ginkgo is possible. Avoid with blood-thinners (e.g. aspirin or warfarin) due to an increased risk of bleeding. Ginkgo should be stopped two weeks before and immediately after surgical procedures. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding.
  • Psychotherapy: Based on limited available study, brief psychotherapeutic approaches may not help improve cognitive function and overall well-being in Alzheimer's disease patients. More studies are needed in this area.
  • Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.

Prevention
  • Mental fitness: Maintaining mental fitness may delay onset of dementia. Some researchers believe that lifelong mental exercises and learning may promote the growth of additional synapses, the connections between neurons, and delay the onset of dementia. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure dementia. Doing crossword puzzles, reading books, and increasing social activities are recommended by healthcare providers.
  • Lifestyle: Lifestyle habits that can reduce the risk for head injury include using seat belts, wearing a helmet when riding bicycles and motorcycles, and wearing protective headgear when playing contact sports. Avoiding substance abuse and addiction can reduce the risk for dementia resulting from disease, vitamin deficiency, seizure, and head injury. Safer sex practices can help prevent human immunodeficiency virus (HIV) and syphilis infection, reducing the risk for acquired immunodeficiency syndrome (AIDS) dementia complex and neurosyphilis dementia. The risk for dementia as a result of other metabolic or toxic conditions can be reduced by receiving prompt medical attention at the first sign of illness (such as fever, pain, swelling, heat, confusion, or other impairment of cognitive function).
  • Heart health: Some of the most recent research indicates that taking steps to improve cardiovascular (heart) health, such as losing weight, exercising, and controlling high blood pressure and high cholesterol, may also help prevent dementia and Alzheimer's disease. A clinical study found that individuals with mild to severe Alzheimer's disease placed on a simple exercise program (one hour, twice a week) had a significantly slower cognitive decline than those on routine medical care.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Several clinical studies have reported that the NSAIDs ibuprofen (Advil® or Motrin®), naproxen sodium (Aleve®), and indomethacin (Indocin®, a prescription drug) may reduce the risk of developing Alzheimer's disease. This may be because inflammation appears to play a role in Alzheimer's. Because NSAIDs can cause stomach and intestinal bleeding and kidney problems, clinical trials need to be completed before it is clear whether individuals should take NSAIDs solely to prevent Alzheimer's. Patients should not take NSAIDs regularly unless they consult their healthcare providers.
  • Statin drugs: Statin drugs are used to lower cholesterol levels. They include atorvastatin (Lipitor®) and simvastatin (Zocor®). Recent studies have reported that statin drugs may reduce the risk of Alzheimer's disease. More studies are being done to determine exactly what role, if any, statins may have in Alzheimer's prevention. Researchers believe that statins help improve blood flow to the brain by decreasing particles in the blood such as cholesterol and triglycerides.
  • Selective estrogen receptor molecule (SERM): A drug called a selective estrogen receptor molecule (SERM, including raloxifene or Evista®) is used to protect against the bone loss associated with osteoporosis. It also appears to lower the risk of developing mild cognitive impairment, a memory disorder that often precedes Alzheimer's. The mechanism is unknown.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Alzheimer's Association. . Accessed May 17, 2009.
  2. American Psychiatric Association. . Accessed May 17, 2009.
  3. Cummings JL. Treatment of Alzheimer's disease: the role of symptomatic agents in an era of disease-modifying therapies. Rev Neurol Dis. 2007 Spring;4(2):57-62. .
  4. Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, et al. IANA Task Force on Nutrition and Cognitive Decline with Aging. J Nutr Health Aging. 2007;11(2):132-152. .
  5. Napryeyenko O, Borzenko I. GINDEM-NP Study Group. Ginkgo biloba special extract in dementia with neuropsychiatric features. A randomised, placebo-controlled, double-blind clinical trial. Arzneimittelforschung. 2007;57(1):4-11. .
  6. National Alliance on Mental Illnesses (NIMI). . Accessed May 17, 2009.
  7. National Institute of Mental Health (NIMH). . Accessed May 17, 2009.
  8. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 17, 2009.
  9. Rolland Y, Pillard F, Klapouszczak A, et al. Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial. J Am Geriatr Soc. 2007;55(2):158-65. .
  10. Stella F, Banzato CE, Gasparetto Se EV, et al. Risk factors for vascular dementia in elderly psychiatric outpatients with preserved cognitive functions. J Neurol Sci. 2007; [Epub ahead of print]. .

Common types of cognitive disorders and disabilities
  • Age-associated memory impairment (AAMI): Age-associated memory impairment (AAMI) refers to the normal decline in memory as patients age. AAMI causes mild forgetfulness in patients who are older than 50 years of age.
  • Alzheimer's disease: Alzheimer's disease (AD) is a progressive cognitive disorder that causes dementia. Dementia is the loss of mental ability that is so severe that it interferes with daily functioning.
  • Over many years, AD eventually leads to irreversible mental impairment. During the final stages of AD, patients are unable remember, reason, and learn new things.
  • AD typically develops in patients who are 65 years old or older. Although doctors know that AD causes healthy brain tissue to slowly degenerate over time, the exact origin of the disease remains unknown. Patients with AD develop abnormal clumps (called plaques) and irregular knots of brain cells (called tangles). Researchers believe that these clumps and tangles kill brain cells and may eventually lead to AD. It has been suggested that genetics may play a role in the development of plaques, which may lead to AD.
  • Inflammation of the brain has also been associated with AD. However, researchers have not discovered if there is a relationship between brain swelling and the development of AD.
  • There is currently no known cure for AD. Once diagnosed, patients typically survive eight to 10 years with the disease. Some have been known to live 25 years with the disease. In advanced Alzheimer's disease, people may lose all ability to care for themselves. This can make them more prone to additional health problems, such as pneumonia or malnutrition. They may have difficulty swallowing food and liquids, which may cause individuals with AD to inhale some of what they eat and drink into their airways and lungs, which may then lead to pneumonia.
  • Brain injury: Trauma to the head may damage brain cells and lead to cognitive dysfunction. Brain trauma can result from accidents (such as motor vehicle wrecks and falls), assaults (such as gunshot wounds or beatings), or from sports activities (such as boxing and football) without adequate protective gear. In some cases, injury may still result even if protective gear is worn.
  • Dementia caused as a result of trauma can be permanent or temporary, depending on the extent of the damage and the ability of the individual's brain to recover.
  • Infections of brain structures, such as meningitis (inflammation of the protective membranes in the brain) and encephalitis (inflammation of the brain), are primary causes of dementia. Other infections, such as human immunodeficiency virus (HIV) and syphilis (a bacterial sexually transmitted disease), can affect the brain in later stages. In all cases, inflammation in the brain damages cells. Damage to memory due to infection can be permanent or temporary, depending on the extent of the damage and the brain's ability to recover.
  • Niacin deficiency-induced dementia: Dementia can be caused by severe niacin insufficiency, a condition called pellagra. Niacin is a B-complex vitamin found in a many foods such as liver, poultry, fish, nuts, and dried beans.
  • Pellagra-induced dementia is uncommon in developed countries, such as the United States. It is most common in areas of the world where malnutrition is prevalent.
  • Multi-infarct disease: Multi-infarct disease is the second most common cause of irreversible dementia. The condition occurs when the blood flow to the brain is disrupted. If the brain does not receive enough blood, then it is starved of oxygen, and permanent brain damage may result.
  • In multi-infarct disease, multiple strokes lead to a progressive decline in cognition. Strokes cause neurological damage in the brain due to a lack of oxygen.
  • Multiple infarct dementia is more common in men who are older than 50 years of age. A person with this condition may also experience motor weakness, urinary incontinence, and ataxia (irregular muscle coordination). Patients may also develop high blood pressure, diabetes, or vascular disease.
  • Learning disabilities: Learning disabilities are disorders that occur when patients have difficulty interpreting or processing what they see or hear. There is a gap between the patient's intelligence and his/her performance in school, work, or other areas of life.
  • Patients may have difficulties with spoken and written language, self-control, coordination, and/or attention. As a result, patients may have a hard time with schoolwork or performing tasks at work.
  • Learning disabilities may be lifelong. In some cases, they may affect many areas of a person's life, including academics, work, social life, or daily routines. Some patients may have several different disabilities. Others may have only one problem that has little or no impact on their lives.
  • It is important to note that not all learning problems are learning disabilities or cognitive deficits. Some children are simply slower than others in developing new skills. In some cases, learning disabilities may be mistakenly suspected when a child is simply slower to mature.
  • Learning disabilities occur when certain areas of the brain do not function properly. Many factors, including genetics, may be involved in the development of learning disabilities.
  • Intellectual disability (mental retardation): Intellectual disability is a condition that causes significantly impaired cognitive functioning from birth or early infancy that ultimately limits the individual's ability to perform normal daily activities.
  • In the past, intellectual disability was commonly called mental retardation. However, the term, "mental retardation," has acquired a negative social stigma over the years. Therefore, doctors and other professionals have begun to replace the term with intellectual disability.
  • There is significant variation in the signs and symptoms of intellectual disabilities. Some patients may be able to live relatively normal lives with minimal assistance, while others may require 24-hour assistance with everyday tasks.
  • There are many potential causes of intellectual disabilities, including genetics, problems during pregnancy (e.g. infection or a mother who drinks or uses drugs during pregnancy), the baby not getting enough oxygen during delivery, and exposure to disease (e.g. whooping cough, measles, or meningitis). Doctors are only able to identify a cause of intellectual disability in about 30% of patients.

Improving work and school performance
  • General: Patients with cognitive learning disabilities are often able to live normal, healthy lives. There are many ways for patients to cope with their disabilities. Special education and adaptive skills training has been shown to improve patients' work and school performances. Patients who are diagnosed and treated promptly are often able to go to college and support themselves.
  • Education: Patients with learning disabilities or intellectual disabilities must have the option of receiving education that is tailored to their specific strengths and weaknesses. According to the Individuals with Disabilities Education Act, all children with disabilities must receive free and appropriate education. According to the law, members of the patient's school should consult with the patient's parents or caregivers to design and write an individualized education plan. Once all parties agree with the plan, the educational program should be started. The school faculty should document the child's progress in order to ensure that the child's needs are being met.
  • Educational programs vary among patients. In general, most experts believe that children with disabilities should be educated alongside their non-disabled peers. The idea is that non-disabled students will help the patient learn appropriate behavioral, social, and language skills. Therefore, some patients are educated in mainstream classrooms. Other patients attend public schools but take special education classes. If the disability is severe or profound, then patients may benefit from specialized schools that are designed to teach children with disabilities.
  • Adaptive skills training: Many patients with intellectual disabilities (mental retardation) need help improving their adaptive skills, which are needed to live, work, and function in the community. Teachers, parents, and caregivers can help patients work on their daily living skills, communication skills, and social skills.

Tips for caregivers, friends, and family members
  • Caregivers, friends, and family members of patients who have cognitive disorders or learning disabilities should educate themselves about the condition. The more a caregiver or loved one knows about the condition, the better they can help the patient. Being educated on the disorder or disability may also help the caregiver learn how to communicate better with the patient.
  • Caregivers may find support from other families who are caring for patients with cognitive disorders. Many communities have local support groups for parents, family members, and caregivers of patients with cognitive disorders.
  • Parents of children with learning disabilities or intellectual disabilities should stay in close contact with their children's teachers. This helps ensure that the child is receiving appropriate education that is tailored to his/her specific needs. Parents are also encouraged to find out how they can support their children's learning needs at home.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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