Non-standard dementia treatments

Dementia is typically treated with medications to reduce symptoms.

Dementia is a general term for the impaired ability to remember, think, or make decisions, to the point that it interferes with everyday activities. Types of dementia include:

• Alzheimer’s: caused by the death of brain cells (Centers for Disease Control (CDC) 2023)
• Vascular dementia: caused by strokes, or other issues with blood flow to the brain with high blood pressure and cholesterol as risk factors (CDC 2023)
• Lewy Body dementia: caused by abnormal protein deposits in the brain (National Institute of Health (NIH) 2021)
• Fronto-temporal dementia: a brain disease in which the frontal and temporal lobes shrink (Mayo Clinic 2023)

Treatments for dementia include medications that reduce or control cognitive and behavioral symptoms, however these medications are primarily for Alzheimer’s disease (NIH 2023, Mayo Clinic 2024). People with dementia may also take medications like sleep aids or anti-anxiety drugs (Table 1, NIH 2023). Non-medication treatments include occupational therapy, reduce clutter and threats in their environment, and simplifying daily tasks (Mayo Clinic 2024).

B vitamins and anti-inflammatory drugs have unclear effects on dementia symptoms.

B vitamins. B vitamins have several roles including (Moretti & Penkhoger 2019):

• Protecting brain cells against damage and inflammation
• Repairing brain cells
• Helping with energy levels
• Helping with brain cell and neurotransmitter production
• Cell replication

A review found that when given vitamin B12 and folic acid (vitamin B9) people with dementia scored higher on mental state and cognitive assessment tests compared to a control group (Martínez et al. 2022). However, there were no significant differences in executive function, attention, or language before and after treatment.

One meta-analysis of trials for B vitamin supplementation found that B vitamin supplementation can slow cognitive decline 12 months after supplementation but cannot increase cognitive function from a baseline status (Wang et al. 2021). Folate (vitamin B9) intake is associated with a lower risk of dementia (Agnew-Blais et al. 2015, Wang et al. 2021, Zhou et al. 2022).

However, researchers have not made vitamin B recommendations because there is a lack of information on the relationship between vitamin B and dementia (Zhou et al. 2022).The World Health Organization strongly recommends that B vitamins should not be recommended to reduce the risk of cognitive decline or dementia due to the poor quality of available evidence (Chowdhary et al. 2022).

Anti-inflammatories. Studies have found differing results regarding the effects of anti-inflammatory medication on dementia. One study found that nonsteroidal anti-inflammatory medication was associated with a slight increase in the risk of all-cause dementia, but not for Alzheimer’s or Lew Body dementia (Dregan et al. 2015).

Another study found that nonsteroidal anti-inflammatory medication was not related to cognitive decline but that inhaled corticosteroids (a type of anti-inflammatory) increases the risk of cognitive decline (Ancelin et al. 2012). However, this study found no overall association between anti-inflammatory medication use and dementia.

There is a lack of comprehensive research on dementia treatments.

Available research on dementia is mainly focused on communities and countries that have adequate healthcare resources (Chowdhary et al. 2022). This makes it hard to generalize available data. One review showed that most studies fail to report the ethnicity of patients  (Brijnath et al. 2021). Of the studies that did report patient ethnicity, about 90% of patients were White.

Most studies do not focus on multiple factors that may affect cognitive decline, such as (Chowdhary et al. 2022):

• Long-term follow up of outcomes after treatment
• How age affects dementia treatments and interventions
• How changing modifiable risk factors like social isolation or depression affects cognitive decline
• Distinguishing between dementia types

Table 1. Dementia Treatments. Current treatments for dementia include medications and therapies. Medications are mostly used to treat Alzheimer’s. Data from NIH 2023 and Mayo Clinic 2024.

References

Agnew-Blais JC, Wassertheil-Smoller S, Kang JH, Hogan PE, Coker LH, et al. (2015). Folate, vitamin B6 and vitamin B12 intake and mild cognitive impairment and probable dementia in the women’s health initiative memory study. Journal of the Academy of Nutrition and Dietetics. 115(2): 231-241. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312724/?uid=ca87b3afb6.

Ancelin M, Carrière I, Helmer C, Rouaud O, Pasquier F, et al. (2012). Steroid and nonsteroidal anti-inflammatory drugs, cognitive decline, and dementia. Neurobiology of Aging. 33: 2082-2090. https://www.sciencedirect.com/science/article/abs/pii/S0197458011003927.

Brijnath B, Croy S, Sabates J, Thodis A, Ellis S, et al. (2021) Including ethnic minorities in dementia research: Recommendations from a scoping review. Translational Research & Clinical Interventions. 8. https://alz-journals.onlinelibrary.wiley.com/doi/pdfdirect/10.1002/trc2.12222.

Centers for Disease Control (2023) About Dementia. Accessed September 3, 2024. https://www.cdc.gov/aging/alzheimers-disease-dementia/about-dementia.html.

Chowdhary N, Barbui C, Anstey KJ, Kivipelto M, Barbera M, et al. (2022) Reducing the risk of cognitive decline and dementia: WHO recommendations. Frontiers in Neurology. 12. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.765584/full.

Dregan A, Chowienczyk P, Armstrong D. (2015). Patterns of anti-inflammatory drug use and risk of dementia: A matched case-control study. European Journal of Neurology. 22: 1421-1428. https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.12774.

Martínez VG, Salas AA, Ballestín SS (2022) Vitamin supplementation and dementia: a systematic review. Nutrients. 14: 1033. https://www.mdpi.com/2072-6643/14/5/1033.

Mayo Clinic (2023) Frontotemporal dementia. Accessed September 3, 2024. https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737.

Mayo Clinic (2024) Dementia. Accessed September 4, 2024. https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019.

Moretti R, Peinkhofer C (2019) B vitamins and fatty acids: What do they share with small vessel disease-related dementia? International Journal of Molecular Science. 20(22): 5797. https://www.mdpi.com/1422-0067/20/22/5797.

National Institute of Health (2021) What is Lewy Body Dementia? Causes, Symptoms, and Treatments. Accessed September 3, 2024. https://www.nia.nih.gov/health/lewy-body-dementia/what-lewy-body-dementia-causes-symptoms-and-treatments.

National Institute of Health (2023) How is Alzheimer’s Disease Treated? Accessed September 4, 2024. https://www.nia.nih.gov/health/alzheimers-treatment/how-alzheimers-disease-treated.

Wang Z, Zhu W, Xing Y, Jia J, Tang Y (2021) B vitamins and prevention of cognitive decline and incident dementia: a systematic review and meta-analysis. Nutrient Reviews. 80(4): 931-949. https://academic.oup.com/nutritionreviews/article/80/4/931/6357328.

Zhou J, Sun Y, Ji M, Li X, Wang Z (2022) Association of vitamin B status with risk of dementia in cohort studies: A systematic review and meta-analysis. Journal of the American Medical Directors Associations. 23(11): 1826.e21-1826.e35. https://www.sciencedirect.com/science/article/abs/pii/S1525861022004248.