It was in 1907 that Alois Alzheimer described a devastating progressive disease presenting with memory loss and accelerated ageing; but even 100 years later, we have no real remedy for Alzheimer’s disease which is becoming increasingly common in India too. Earlier it was thought that Alzheimer’s was “rare” in India; studies reported that multi-infarct dementia caused by reduced blood flow to the brain (very common in diabetics and hypertensives), infections of the brain like TB and cysticercosis, alcoholism and simple malnutrition were responsible for dementia in the elderly Indian rather than Alzheimer’s.
      But recent studies, particularly from Kerala, have shown that about three per cent of the elderly over 65 years of age have dementia; and what is more, the majority of them qualify by a process of exclusion, to be stricken with Alzheimer’s disease. Unfortunately, there is no simple test to diagnose Alzheimer’s disease. A PET scan can detect the illness but extremely high cost and non-availability make it a non.-option.

Detection by Exclusion
     However, a good rule of thumb would be to subject the elderly who present with memory problems to other tests that could detect a treatable problem. A simple vitamin B12 assessment could pick up many treatable, reversible cases; a high BP or elevated blood sugar could point to other treatable causes and so on. By a process of exclusion one zeros in on Alzheimer’s disease. What next?
     Pharmacotherpy for the associated behaviour problems such as delirium, anxiety, depression etc helps manage the patient better; but none of the drugs, including Donepezil, which is the one most widely used, are able to reverse the process.
     However, there is a lot of evidence building up that nutritional supplementation helps in slowing the progression of Alzheimer’s disease. Though purists who practise only evidence-based medicine may not agree, commonsense dictates that one try out nutritional supplementation when one’s near and dear ones are stricken with the disease. The Net is replete with reports from highly reputed medical journals about the benefits of nutritional supplements. From the food and beverage angle, it seems wise to give these patients green tea and fresh apple juice. These contain anti-oxidants and flavonoids which help stem the progression of Alzheimer’s. Adding a lot of turmeric into curries cooked can help as curcumin present in turmeric has shown benefit in some studies. Supplementing B6, B12 and folic acid is a good idea as these help reduce harmful homocysteine levels; high homocysteine levels have been implicated as one of the causes of Alzheimer’s disease. In many studies, improvement has occurred with omega3 fatty acids. Ginkgo tea or proprietary ginkgo biloba preparations have been found to be useful. Lipoic acid and co-enzymeQ are two dietary supplements which have also shown benefit. Reducing calorie intake has also been found to help.

No side-effects:
      The plus point is that these simple dietary changes and supplementation are safe; they do not have the side-effects of Schedule-H drugs. In private practice one does not have the where-with-all for pukka scientific studies. But the elders I have seen in my practice have done well with addition of these simple measures. The ones who have benefited most are those with Mild Cognitive Impairment (MCI) rather than advanced dementia.
      Keeping the patient mentally active is crucial. Encourage reading, doing crossword puzzles, reciting slokas, singing... Listening to music that they used to listen to in their youth and middle age can help too, as musical memories are among the strongest.