Dementia reversal

Dementia reversal represents attempts to treat the underlying cause of the so-called reversible dementias. Although only a few causes of dementia are to any... 

Since that time, we ve found that some causes of dementia can be treated. In addition, other treatable conditions as noted earlier cause cognitive impairment that resembles dementia (pseudodementia). Treatment aimed at dementia reversal depends on a careful assessment to identify those patients who have these potentially reversible conditions. 

Other than Ginkgo biloba, several herbal preparations or nutritional supplements are presently used by practitioners from diverse traditions to treat age-related memory loss or dementia. Exhibit 6 displays significant findings of controlled studies or clinical observation on selected natural products under investigation for cognitive-enhancing or dementia-reversing activities. 

Acetylcholine Precursors. Early efforts to treat dementia using cholinomimetics focused on choline [62-49-7] (12) supplement therapy (Fig. 3). This therapy, analogous to L-dopa [59-92-7] therapy for Parkinson s disease, is based on the hypothesis that increasing the levels of choline in the brain bolsters acetylcholine (ACh) synthesis and thereby reverses deficits in cholinergic function. In addition, because choline is a precursor of phosphatidylcholine as well as ACh, its supplementation may be neuroprotective in conditions of choline deficit (104). 

The anainoacridines, tacrine (19) and its 1-hydroxy metaboUte, velnacrine (20), are reversible inhibitors of AChE. Tacrine was synthesi2ed in the 1940s and has been used clinically for the treatment of myasthenia gravis and tardive dyskinesia (115). Placebo-controUed studies have indicated modest efficacy of tacrine to treat AD dementia (122,123) and in 1993 the dmg was recommended for approval by the PDA under the trade name Cognex. Tacrine (19) has been shown to interact with sites other than AChE, such as potassium channels (124) and muscarinic receptors. However, these interactions are comparatively weak and are not thought to contribute to the biological activity of the dmg at therapeutic levels (115). 

Delirium, e.g. post-narcotic delirium, somnolence or coma, is a common complication involving dementia, with fluctuating attention and consciousness and considerable morbidity. It is not always reversible and there is no specific treatment. Some of the accompanying central cholinergic syndromes can be reversed by ChEIs. 

True. Excessive alcohol use can lead to serious damage to mental health. Depression, anxiety, delusions and negative changes in personality can occur. Korsakoff s psychosis occurs in some excessive users of alcohol. This form of dementia results in disorientation, loss of memory and lowered intellectual abilities. It is reversible in some sufferers through the administration of thiamine (vitamin Bj. 

Is this dementia or something else that resembles dementia If this is dementia, is it a potentially reversible form ... 

Table 10.4 lists the various medications that can be stopped and medical illnesses that can be treated to reverse dementia. In some cases, such as hypothyroidism or dehydration, the reversal can be complete. More often, the dementia is only partially reversed or its further progression is halted. Examples of these partial improvements include normal pressure hydrocephalus and vitamin B12 deficiency. 

The majority of dementias including Alzheimer s disease and vascular dementia are not reversible. However, treatments to protect the brain can theoretically slow the deterioration of these illnesses. 

Although chelation is not helpful for Alzheimer s disease patients, it is the key to treating patients with dementia due to Wilson s disease. Wilson s disease is a genetically inherited disorder that usually strikes before age 30. The disease causes toxic levels of copper to accumulate in the liver, brain, eyes, and kidney. Untreated, Wilson s disease leads to tremors, cirrhosis, depression, psychosis, dementia, and ultimately death. Chelation with penicillamine (Cuprimine) can stop and even reverse the accumulation of copper. 

Tacrine (Cognex). Tacrine was hrst nsed in the 1940s to reverse the respiratory depressant effects of morphine. In the late 1980s, tacrine was first used to treat dementia. The results were promising. Nearly one-third of dementia patients in the early and middle stages of illness exhibit observable improvement with tacrine. 

Galantamine is a reversible inhibitor of acetylcholinesterase that also possesses nicotinic receptor agonist properties, and which is used in mild-to-moderate dementia in Alzheimer s disease. 

This class of antiretrovirals may be considered the most potent therapeutic agents for HIV to date. Protease inhibitors are used in combination regimens and combinations of reverse-transcriptase inhibitors and protease inhibitors have been proven most effective to decrease viral load and prolong survival. However, the protease inhibitors generally show poor penetration into the CNS and thus have no effect on aids dementia. The present Pis available for the treatment of HIV are indinavir, ritonavir, nel-finavir, saquinavir and (fos)amprenavir, atazanavir and lopinavir (in combination with ritonavir as ritonavir improves the bioavailability of lopinavir by inhibiting its metabolism in the liver by CYP3A). 

Naloxone is approved for use in neonates to reverse respiratory depression induced by maternal opioid use. In addition, naloxone has been used to improve circulation in patients in shock, an effect related to blockade of endogenous opioids. Other experimental and less well documented uses for naloxone include reversal of coma in alcohol overdose, appetite suppression, and alleviation of dementia from schizophrenia. Side effects of naloxone are minor. 

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