complementary meds on sleep and dementia

gingko biloba for dementia

MOA:

- increase blood supply by vasodilatory effects by reducing blood viscosity

- affects neurotransmission and neuroplasticity

- protects amyloid beta toxicity

- modification of neurotransmitters

- Contains: flavonoids, terpenoids, organic acids

- Main active constituents: biflavone glycosides, ginkgolides A, B, C, J, M and the sesquiterpene lactone bilobalide.

Dose:

160-240 mg d in divided doses for 22-24 weeks

Evidence:

- Insufficient evidence

- EGb761 has modest improvements in symptoms of alzheimer, vascular or mixed dementia

Safety: well tolerated

AE:

- headache, nause, GI upset, diarrhoea, dizziness, allergic skin reactions

- increase bleeding risk

DDI:

-Alprazolam: low evidence, moderate interaction

- Anticoagulant/ anti platelet drugs: high evidence

omega-3 fatty acids for dementia

MOA:

-Role in brain neuron development/integrity, protective antioxidative effect, neurochemical mechanisms directly related to Alzheimer pathology

- > pt with dementia may have malnitrition towards this

Dose:

Evidence

Safety

AE

vitamin E for dementia

(watch this space)

Evidence:

- No evidence in some studies and moderate quality evidence on a study that it may slow functional decline in AD

Valerian for sleep

most common part of the plant used is roots and rhizomes

V.Officinialis constituent vary across species and part of the plant used (good agriculture & collection practices (GACP) factors influence composition )

- Valerienic acid constituent was thought to be the main component associated with benzodiazepine-like effects in modulating GABA receptors

MOA:

- potential anxiolytic and sedative effects

- Dose: 300-600mg d for up to 6 weeks. Some studies obserbed benefit after 4 weeks

Evidence: inconsistent

AE:

- excitability, vivid dreams, headache, gi upset

Taper dose - Abrupt cessation after long-term use -> tachycardia, anxiety, irritability, insomnia

Product quality varies

Educate on sleep hygiene

seven modifiable risk factors of dementia

diabetes

smoking

mid-life hypertension

physical activity

low education

depression

obesity

alcohol consumption

air pollution

traumatic brain injury

Diet and Lifestyle

Traditional Mediterranean diet or avoiding pro-inflammatory diet

27% lower risk of MCI

37% lower risk of AD

Up to 72% lower dementia risk