Ayurvedic approach to Alzheimer's Disease

Alzheimer’s disease (AD) is a complex neuro-degenerative disorder with  clinical hallmarks of memory loss, dementia, and cognitive impairment, comprising about 60-70% of dementias. According to the World Health Organisation (WHO), 5% of men and 6% of woman of above the age of 60 years are affected with Alzheimer's type dementia worldwide.

 The term “Alzheimer’s disease”, was first described by a German neurologist, named Alois Alzheimer. It’s a neurological disorder that affects the brain such that, the death of brain cells causes memory loss and cognitive decline. During the course of the disease, protein ‘plaques’ and ‘tangles’ develop in the structure of the brain, leading to the death of brain cells. Beta-amyloid protein is responsible for Plaques formation and twisting of  tau protein tail result in Tangle formation in the brain.People with Alzheimer’s disease have a shortage of some important chemicals in their brain. These chemicals are involved in the transmission of messages within the brain, ultimately resulting in non coordination of brain functioning. 

Stages of Alzheimer's Disease

Alzheimer’s disease typically progresses slowly in three general stages: early, middle and late (sometimes referred to as mild, moderate and severe in a medical context). Since Alzheimer’s affects people in different ways, each person may experience symptoms — or progress through the stages — differently.

Overview of disease progression

1 ) Early-stage Alzheimer's (mild) 

Symptoms may not be widely apparent at this stage, but family and close friends may take notice and a doctor would find 

• Difficulty in coming up with the right word or name.

• Difficulty in remembering names when introduced to new people.

• Having difficulty performing tasks in social or work settings.

• Forgetting material that was just read.

• Losing or misplacing a valuable object.

• Experiencing increased trouble with planning or organising.

2) Middle-stage Alzheimer's (moderate)

Middle-stage Alzheimer's is typically the longest stage and can last for many years. 

Symptoms, which vary from person to person, may include:

• Being forgetful of events or personal history.

• Feeling moody or withdrawn, especially in socially or mentally challenging situations.

• Being unable to recall information about themselves like their address or telephone number, and the  high school or college they attended.

• Experiencing confusion about where they are or what day it is.

• Requiring help choosing proper clothing for the season or the occasion.

• Having trouble controlling their bladder and bowels.

• Experiencing changes in sleep patterns, such as sleeping during the day and becoming restless at night.

• Showing an increased tendency to wander and become lost.

• Demonstrating personality and behavioural changes, including suspiciousness and delusions or compulsive, repetitive behaviour like hand-wringing or tissue shredding.

3) Late-stage Alzheimer's (severe)

In the final stage of the disease, dementia symptoms are severe. 

At this stage, individuals may:

• Require around-the-clock assistance with daily personal care.

• Lose awareness of recent experiences as well as of their surroundings.

• Experience changes in physical abilities, including walking, sitting and, eventually, swallowing

• Have difficulty communicating.

• Become vulnerable to infections, especially pneumonia.

Ayurvedic Perspective

Alzheimer’s disease are correlated as smrithi bhramsa in ayurveda and is developed due to imbalance of vatadosha. Heena satva, rajo predominant prakruthi and the person whose mind is weakened by all the stressful conditions are more prone to develop smruthibhramsa. Early detection of the condition and immediate treatment is required to prevent the progression of the disease. As the dementia involves neurodegeneration,  rasayana and panchakarma therapy play very important role in the management of dementia.

External therapy such as Abhyangam, Thalam, Siropichu, Sirovasthy, Dhoomapanam, Thala pothichil etc. are adviced as per the condition of the patient. The patient needs 3-4 weeks of inpatient treatment and follow up at regular intervals of 3months - 1 year. Meanwhile they can continue the medicines at home. 

Internally Formulations such as Panchagavya ghrita, Brahmi rasayana, and Triphala rasayana can be effectively utilized. Jivaniya as well as ojovardhaka drugs helps in slowing down of the degeneration of dhatus and promotes immunity. Many Ayurvedic herbs are used as tonics for nervous system. Eg;aswangandha, haridra, brahmi, guduchi, shankupushpi, gotukola, guggulu etc. The medicines are selected according to the prakriti and dosha imbalances.

1. Turmeric: (Curcuma longa, Zingiberaceae)

Growing body of evidence indicates that oxidative stress, free radicals, beta amyloid, cerebral deregulation caused by bio-metal toxicity and abnormal inflammatory reactions contribute to the key event in Alzheimer's disease pathology. Curcumin has powerful antioxidant and anti-inflammatory properties; according to the scientists, these properties believe help ease Alzheimer's symptoms caused by oxidation and inflammation.

A study conducted at UCLA found that Curcumin may help the macrophages to clear the amyloid plaques found in Alzheimer's disease. Curcumin has a potent anti-inflammatory effect. Curcuminoids decreases the low-density lipoprotein oxidation and the free radicals that cause the deterioration of neurons, not only in AD but also in other neuron degenerative disorders such as Huntington's and Parkinson's disease.

2.Brahmi :(Bacopa monnieri, fam. Plantaginaceae)

Studies have shown that the extract of Bacopa monnieri (EBm), Medhya rasayana promotes free radical scavenger mechanisms and protects cells in prefrontal cortex, hippocampus, and striatum against cytotoxicity and DNA damage implicated in AD. It also reduces lipoxygenase activity reducing lipid peroxidation, increases glutathione peroxidase and chelates iron. 

Therapeutically, EBm can be administered as BrahmiGhritam (clarified butter based oral supplement) or Churna (powder) or plain tablet form. In cases of AD, Brahmi capsule are given in doses of 250–500 mg once or twice a day and Brahmi Churna or Ghritam is given in doses of 1–2 g once or twice a day as per patient.

3. Ashwagandha(Withania somnifera, fam. Solanaceae), 

Ashwagandha or Indian Ginseng, is a common herb used in Ayurvedic medicine as an adaptogen or antistress agent. Ashwagandha root contains a large variety of compounds including 12 alkaloids, 40 withanolides, and several sitoindosides and flavonoids.

A study at National Brain Research showed that rather than altering brain chemistry directly, ashwagandha boosts a protein in the liver. This protein clears amyloid from . In high doses, the herb has shown to have a hypnotic effect, cause drowsiness and provoke intestinal problems. It’s also not recommended for people with hyperthyroidism or women who are pregnant.

4. Shankapushpa (Convolvulus pluricaulis, fam. Convolvulaceae)

Shankapushpa is a belongs to the family Convolvulaceae is a common plant seen in india. The whole plant of Shankapushpa is used in various formulae as a nervine tonic for improvement of memory and cognitive function .The paste of sankapushpa is used to boost the intelligence. 

5. Guggulu (Commiphora wightii, fam. Burseraceae)

Guggulu is an oleogum resin exuding from cracks and fissures or incisions in the bark of several plant species including Commiphora mukul, Commiphora wightii etc 

Guggulu contains ferulic acids, phenols, and other nonphenolic aromatic acids which are potent scavengers of superoxide radicals and can be important for the treatment of neurodegenerative diseases that are associated with oxidative stress .It is likely that beneficial effects of guggulu on AD is due to its cholesterol-lowering effects. Decreased neuronal cholesterol levels, in turn, inhibit the Aβ-forming amyloidogenic pathway, possibly by removing amyloid .

6. Mandukaparni  (Centella asiatica, fam. Apiaceae), 

Gotukola is known as Mandookaparni in Ayurvedic medicine.Gotu kola the rasayana or rejuvenating herb has the ability to enhance memory and nerve function, which gives it potential in treating Alzheimer Disease. This could also protect the brain cells from forming the plaque associated with Alzheimer’s Disease. 30 to 60 drops of liquid gotu kola extract 3 times per day is given as per each patient.

Diet

·       At least three servings of whole grains a day

·       Green leafy vegetables (such as salad) at least six times a week

·       Other vegetables at least once a day

·       Remeat less than thrice a week.

·       Incorporate Fruit daily 1 serving.

·       Berries at least twice a week.

·       Fish at least once a week.

·       Poultry at least twice a week.

·       Beans more than three times a week.

·       Nuts at least five times a week.

·       Mainly coconut oil and olive oil for cooking.

·       Incorporate wine ac to individual constitution.

·      Avoid – excess carbohydrate intake, white bread, white flour, white         sugar, pasta, processed food, Cheese, processed meat etc

Activities

• Regular exercise and other physical activities play an important role in reducing the risk of dementia and Alzheimer’s disease.
• Activities like working, volunteering, reading, playing games – mentally stimulating activities. 
• Yoga and meditation is most helpful in disorders related to nervous system.
• Clinical research has shown that practicing Kirtan Kriya for just 12 minutes a day can improve cognition and activate parts of the brain that are central to memory. In Sanskrit, a kirtan is a song, and kriya refers to a specific set of movements. The mantra that is repeated while practicing Kirtan Kriya is designed to be uplifting. The sounds come from the mantra ‘Sat Nam’, which means “my true essence’.
• From an Eastern perspective, it is believed that the placement of the tongue on the roof of the mouth while making these sounds stimulates 84 acupuncture points on the upper palate. This causes a beneficial bio-chemical transformation in the brain, thus help to bring the body, mind and emotions into balance to enable healing.