Alzheimer’s disease is a condition characterized by the degeneration of neuronal cells in the brain resulting in dementia (loss of memory), altered thinking, and behavioral patterns. It is the most common cause of cognitive impairment in the elderly (The incidence and prevalence of the disease increases exponentially after 60 years of age, doubling in every 5 years). The pathogenesis and Ayurveda treatment of Alzheimer’s disease may be formulated regarding some of the disease models mentioned in the classical Ayurveda texts. The pathology of Alzheimer’s disease involves the degeneration of Kapala majja(brain) by vata resulting in the impairment of mental faculties like memory (smriti ), cognition (buddhi ), etc. Therefore, the treatment principles can be adopted from disorders of majjavaha srotas (like mada, murcha, sanyasa), unmada, and athathwabhinivesa.
The exact cause of this disease is still unknown. The pathological process consists of neuronal loss in response to the plaque and tangle formation in the brain.
The risk factors of Alzheimer’s disease include:
- Family history
- Genes like APOE and SORL1
- Decreased intake of fruits and vegetables
- Reduced mental and physical activity
- Head injury
- Risk factors associated with vascular diseases – Hypercholesterolemia, hypertension, smoking, obesity, diabetes
The initial symptom is the impaired ability in learning something new and remembering newly learned information. A memory of remote events is spared until late stages. Memory loss often goes unnoticed initially, but impairment in activities of daily living draws the attention of friends or family. Patients are usually frustrated and unaware of the deficit.
There will be a gradual decline in language functions. These include increased difficulty with names and understanding of what is being said, reduced vocabulary, circumlocution (the use of an unnecessarily large number of words to express an idea), etc.
Motor activities are impaired despite intact motor function.
Features like disorientation, poor judgment, and poor concentration become increasingly evident during the progression of the disease. There may also be behavioral problems, depression, and psychotic symptoms.
A gradual decline in activities of daily living leads to profound disability and dependence on others. Help may be needed with the simplest tasks, such as eating, dressing, and toilet function. In end-stage AD, patients become rigid, mute, incontinent, and bedridden.
- Lab tests are done to rule out other causes of dementia which may be treatable.
- These may include blood chemistry, a complete blood count, tests for syphilis, serum levels of Vit B12, and thyroid functions.
- Intracranial pathologies are excluded with the help of a CT head; while a high-resolution functional MRI of the brain may distinguish AD from normal aging.
- Thiamine deficiency
- Vitamin B12 deficiency
- Brain tumor
- Huntington’s disease
- Dementia with Lewy bodies
- Parkinson’s disease
- AD cannot be cured and hitherto no drug is proven to be highly effective in providing benefits or arresting progression.
- Cholinesterase inhibitors provide a modest improvement in symptoms and a reduction in the rate of cognitive decline. These drugs include donepizine, rivastigmine, and galantamine. Common side effects nausea, diarrhea, vomiting, and weight loss. However, these compounds are only modestly efficacious and offer little or no benefit in the late stages of AD.
- Depression, common in the early stages of AD, may respond to antidepressants or cholinesterase inhibitors.
- Control of agitation usually involves low doses of atypical antipsychotic medications. But these may increase the risk of cardiovascular complications in the elderly.
- Treatment of associated conditions like visual or hearing deficit, dental problems, and other common medical illness
- Memory aids like notebooks and posted daily reminders may help in the early stages.
- Kitchens, bathrooms, and bedrooms need evaluation for safety
- Caregiver burnout is common, so education of family, friends, and nurses is very important.
Ayurveda has a strong theoretical and philosophical foundation, based on which it puts forward a unique methodology for disease comprehension. Therefore, even a newly manifested illness can be understood effectively.
Ayurveda considers the body as an inverted tree (urdwamulam adhah sakham –roots on top, branching downwards) highlighting the importance of the head. Afflictions in the root can destroy the tree within no time; therefore those have to be treated immediately. According to Ayurveda, the siras (head) is one of the trimarmas (vital points of the body). It is also the seat of Prana, Manas, and Panchendriyas.
The treatment is according to the principles of yuktivyapasraya chikitsa (medicinal therapy) and satvavajaya chikitsa(metal upliftment).
The rasayana oushadhas and ghrta yogas can be used extensively with preventive as well as promotive benefits.
Medhya (that which promote intellect) rasayanas include the use of single drugs like Mandookaparni (Centella asiatica Linn.), Yashtimadhu (Glycyrrhiza glabra Linn.), Guduchi (Tinospora cordifolia Willd.), Shankhupushpi (Convolvulus pluricalis Linn.)
The main challenge in the way of drug administration in the CNS disorders is bypassing the blood-brain barrier. This is where ghee comes in handy. Ghrita by nature promotes intellect and memory capacity. By processing it with medhya drugs it can be used as a medium for the transfer of active principles across the blood-brain barrier, to bring about excellent results.
Another way of introducing therapeutic agents directly into the CNS is through the process of Nasya (intranasal instillation) with medicated sneha (fats). Among the snehas, ghrta itself is the medium of choice, due to the above-mentioned benefits.
Other internal medications may include
- Brahmi ghrita
- Kalyanaka ghrita
- Mahakalyanaka ghrita
- Panchagavya ghrita
- Saraswata ghrita
- Brahmi rasayana
- Chyavanaprasha rasayana
- Sankhapushpi churna
- Suvarna bhasma
- Manasamithra vataka
External therapies like snehana, swedana, shirodhara, thalam, kayasekam, etc may also be administered judiciously.
Yoga is another way of improving mental and physical well-being. It calms the nervous system by relieving tension, improves memory, attention, and concentration. Yoga is also found to reduce muscle tension.
Some of the Asanas which can be followed are
All these are to be practiced only under the supervision of a physician or a qualified yoga practitioner.
Ayurveda has deeply stressed the health benefits of vyayama(exercise). Regular exercise can prevent a variety of lifestyle disorders which are potential risk factors of AD.
Recently, it was found out by researchers that osteocalcin, a hormone produced in the bones plays a role in influencing the mood and boosting the memory. Exercise builds stronger bones and stronger bones produce more osteolacin. This very well explains the long-standing mystery of how regular exercise helps to keep Alzheimer’s disease at check.
Along with these the curative prospects of Ayurveda also needs a look-in. Those who have a familial history of Alzheimer’s disease may undergo rasayana therapies at an early or middle age. This helps to retain the vitality and prevent the ill effects of old age.
Alzheimer’s disease has no cure in modern medicine. The drugs used to treat the disease are limited in efficacy but have serious side effects. Ayurveda therapeutics have been used to treat neurodegenerative diseases for centuries. Plenty of dietary and pharmacological interventions are possible to counter such diseases. Modern laboratory techniques, for the early detection of the condition, coupled with Ayurvedic management can work wonders. This will improve the quality of life of the patient.