Worldwide, 47 million people live with dementia, and by 2050, that number is projected to soar to 131 million. As this global health challenge grows, families and individuals search for ways to manage the symptoms and slow its progression. While modern Western medicine offers diagnostic tools and some pharmacological interventions, its efficacy remains limited, and the condition's progressive nature makes it daunting to treat. However, Chinese Medicine brings a different perspective—one that seeks to address the root cause and restore balance in the body.
How Dementia Arises
The pathophysiology of dementia varies depending on the subtype. Common types include Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, and others. For most types, dementia is linked to the accumulation of native proteins in the brain, leading to neurodegeneration. For example, Alzheimer’s is characterized by amyloid plaques and neurofibrillary tangles of hyperphosphorylated tau proteins, while Lewy body dementia results from the buildup of alpha-synuclein proteins. These protein deposits disrupt normal brain function, contributing to widespread cortical atrophy and progressive cognitive decline.
In the case of vascular dementia, ischemic injury to the brain, such as from a stroke, leads to permanent neuronal death. Huntington’s disease and prion-related dementias (like Creutzfeldt-Jakob disease) are caused by genetic mutations or misfolded proteins that spread in the brain, further exacerbating neurological damage.
Symptoms and Diagnosis
Symptoms of dementia often begin subtly, with patients experiencing memory loss, difficulty communicating, mood changes, social withdrawal, and a loss of independence. Over time, these symptoms worsen, leading to significant cognitive impairment, behavioral changes, and even aggressive tendencies. Diagnosing dementia requires a combination of medical history review, cognitive and neurological exams, lab tests, and brain imaging.
However, it’s important to note that a definitive diagnosis of dementia can only be confirmed at autopsy, meaning that treatment approaches must remain flexible and tailored to each individual. Chinese Medicine offers a holistic, personalized approach to this.
Chinese Medicine’s Holistic Approach to Dementia
In Traditional Chinese Medicine (TCM), dementia is seen not simply as a condition of the brain but as a disruption of the balance between the mind, body, and vital energy (Qi). Chinese medical theory identifies several potential root causes, such as kidney essence deficiency, blood stasis, phlegm accumulation, and Qi stagnation. These imbalances may manifest as cognitive decline and are treated using a combination of herbal medicine, acupuncture, dietary adjustments, and lifestyle changes.
For example, scientific research confirms that herbal formulas like Tian Ma Gou Teng Yin address the symptoms like tremors, dizziness, and mental confusion. Similarly, acupuncture points are selected to promote better circulation in the brain, ease emotional distress, and improve cognitive function.
Prevention Is Key
Being that dementia is difficult to diagnose and treat with modern medications, prevention and early intervention are critical. TCM emphasizes the importance of maintaining a healthy lifestyle to preserve cognitive function. This involves balancing Yin and Yang, nurturing the Kidney and Heart systems, promoting proper circulation of Qi and Blood, and ensuring the body’s overall vitality.
Preventive strategies in Chinese Medicine might include:
- Herbal support: Using tonifying herbs that strengthen the Kidney and nourish the brain.
- Regular acupuncture: Stimulating key points to improve blood flow, reduce stress, and enhance cognitive clarity.
- Mind-body practices: Tai Chi, Qi Gong, and meditation help harmonize the body’s energy and protect against mental decline.
- Dietary therapy: Eating foods rich in antioxidants, healthy fats, and minerals to nourish brain cells and prevent inflammation.
Current pharmacological treatments
Current pharmacological treatments for dementia include three cholinesterase inhibitors—donepezil, rivastigmine, galantamine—and the NMDA receptor antagonist, memantine. These medications are primarily symptomatic, providing limited effects on the underlying disease process of Alzheimer’s or other types of dementia. Studies supporting their efficacy led to their approval for use in treating Alzheimer’s disease (mild to moderate for cholinesterase inhibitors and moderate to severe for memantine) and other dementias like Parkinson’s disease dementia and dementia with Lewy bodies. However, they have shown little efficacy for frontotemporal and vascular dementia. Initiation of these drugs historically required specialist input, but with over a decade of experience, general practitioners may now handle prescribing and monitoring following an accurate diagnosis.
Digital Tools for Dementia Diagnosis
Advancements in digital technology are transforming dementia care. AI-powered tools, smartphone apps, and wearable devices help in the early detection of cognitive changes indicative of dementia. For instance, the AI-powered analysis of neuroimaging data can predict Alzheimer's disease (AD) onset before symptoms arise. Apps like Sea Hero Quest assess spatial navigation skills, and wearables monitor physical activity and sleep patterns. Tools like BrainCheck, which features neurocognitive tests in game format, help gauge cognitive functions like memory and attention. These technologies facilitate early diagnosis, which is crucial for timely intervention.
Pharmacological Management of Dementia
With no official cure available, dementia treatment focuses on managing symptoms through both pharmacological and non-pharmacological approaches. Cholinesterase inhibitors, such as donepezil, rivastigmine, and galantamine, are primarily used for AD. These drugs work by increasing acetylcholine transmission in the brain, offering modest symptomatic relief, particularly in Alzheimer's and Lewy body dementia (LBD). Rivastigmine is FDA-approved for treating LBD, while other cholinesterase inhibitors are used off-label. Parkinson’s disease dementia and vascular dementia (VaD) can also be treated with these medications, though efficacy varies.
Memantine, an NMDA receptor antagonist, works differently by preventing excitotoxicity caused by excessive glutamate, offering neuroprotective benefits. It is commonly used alongside cholinesterase inhibitors, especially in more advanced stages of AD. Memantine has mixed efficacy in other dementias like Parkinson’s, vascular dementia, and frontotemporal dementia. Side effects, including hallucinations, have been noted in some patients.
New Pharmacological Treatments
Recent advancements include monoclonal antibodies like lecanemab and aducanumab, which target amyloid-beta plaques in Alzheimer’s disease. These drugs show potential in slowing cognitive decline. Lecanemab has been FDA-approved for mild cognitive impairment and early-stage AD, marking a significant step forward in dementia treatment. Studies have demonstrated its efficacy in reducing amyloid plaques, but careful management is required due to the risk of adverse effects.
Limits of Western Medical Research and Healthcare
While pharmacological interventions address symptoms, they neither alter the disease process nor improve mortality in dementia patients. Resource utilization such as hospital stays or GP visits resulting from interventions is rarely factored into models of healthcare costs.
Chinese Decoctions for the treatment of dementia
Chinese Medicine offers a promising alternative for treating dementia, with no side effects compared to conventional pharmaceuticals such as anti-Alzheimer, antimanic, and antipsychotic drugs. Traditional Chinese Medicine (TCM) focuses on balancing the liver, kidneys, and heart—organs commonly associated with dementia. Specific herbal formulas like Ling-Gui-Zhu-Gan-Tang, Ban-Xia-Bai-Zhu-Tian-Ma-Tang, and Bu-Zhong-Yi-Qi-Tang are effective in not only addressing early-stage symptoms, such as dizziness, vertigo, and fatigue, particularly in vascular dementia but treating the root cause. These formulas, rich in herbs like Poria cocos, can also alleviate stress, enhance memory, and improve sleep quality, providing a holistic approach to dementia care.
In later stages, formulas like Gui-Pi-Tang and Tian-Ma-Gou-Teng-Yin are commonly prescribed to manage agitation, delusions, and insomnia. TCM offers not only relief from cognitive decline but also addresses psychiatric symptoms, which often become more severe as dementia progresses. Additionally, TCM formulas have been found to reduce the side effects associated with benzodiazepines, a class of drugs commonly used in dementia treatment but linked to cognitive decline and an increased risk of falls.
The Impact of Benzodiazepines on Cognitive Function and Life Quality
Benzodiazepines are frequently prescribed to manage symptoms such as anxiety, insomnia, and agitation, particularly in patients with dementia. However, the long-term use of these medications often results in significant side effects. A recent study revealed that 70-80% of users report difficulties with daily tasks such as hobbies, work, friendships, self-care, and relationships with family and spouses. In contrast, only those who continued to take a full dose of benzodiazepines experienced fewer negative consequences in life, but not without side effects similar to the symptoms for which they started the medication, as well as other new ones.
This study is one of the first to extensively explore these adverse life consequences, with over 80% of respondents identifying more than five significant issues, many of which were linked to impaired cognitive functioning. A meta-analysis showed that long-term benzodiazepine users scored lower across all cognitive categories compared to controls, with particular deficits in processing speed and sustained attention. This finding aligns with other European studies, which reported that 20.7% of long-term users of benzodiazepines had cognitive impairments across multiple domains.
A growing concern is that patients being tapered off or abruptly taken off benzodiazepines may turn to other substances, such as alcohol, opioids, or even “designer benzodiazepines,” which can be purchased online and pose serious risks. While these designer substances are not typically prescribed by physicians, the presence of over two dozen distinct “designer benzodiazepines” in the market highlights the potential for misuse. Despite these concerns, 90.4% of survey respondents reported adhering to their prescribed benzodiazepine dosage.
Traditional Chinese Medicine as a Complementary Approach
As a Chinese doctor who frequently composes herbal decoctions to address cognitive decline and related symptoms, I have found that Traditional Chinese Medicine (TCM) offers powerful, holistic alternatives to alleviate symptoms in dementia patients without the adverse life consequences seen with benzodiazepines.
One such remedy is Bu-Zhong-Yi-Qi-Tang (BZYQT), also known as the Decoction for Reinforcing the Center and Replenishing Qi. This formula has been shown to elevate dopamine and noradrenaline levels, potentially improving memory and cognitive function, making it useful for addressing symptoms of dementia and chronic fatigue syndrome. While BZYQT is widely used for gastrointestinal diseases and allergic conditions in East Asia, its potential for improving cognitive health is promising. It’s important to note, however, that it should be avoided by individuals with certain contraindications, such as those with dry skin or internal inflammation.
Another effective TCM formula is Ban-Xia-Bai-Zhu-Tian-Ma-Tang, which can reduce symptoms like dizziness, nausea, and vomiting—common complaints among those with cognitive impairments. Still, further clinical trials are necessary to fully understand the scope of TCM's benefits for early-stage dementia.
In more severe cases, where psychiatric symptoms such as anxiety, depression, or obsessive-compulsive disorder arise, I often utilize Dang Tan Tang. This formula is traditionally used to treat conditions ranging from mania to hysteria. Additionally, for individuals suffering from insomnia, dizziness, and palpitations—symptoms that frequently co-occur with cognitive decline—Jiao Tai Wan (the Grand Communication Pill) provides effective relief. Liu Wei Di Huang Wan, known as Six-Flavor Rehmannia, is another valuable remedy that supports kidney and liver health and is frequently used to treat age-related conditions like cognitive decline.
While these herbal formulas provide supportive care for many, it is essential to work closely with a healthcare professional to tailor the treatment plan to each individual, ensuring the safe and effective integration of TCM with conventional medications such as benzodiazepines.
Other non-Pharmacological Treatments
Non-pharmacological approaches, such as lifestyle changes, play a critical role in dementia prevention and management. The Mediterranean and DASH diets, which emphasize plant-based foods, omega-3 fatty acids, and antioxidants, have been linked to cognitive health benefits. Regular physical activity, stress management, and sufficient sleep also contribute to reduced cognitive decline. Although no single dietary intervention can prevent dementia, these lifestyle factors can enhance overall brain health.
Integrating TCM with Modern Treatments
Chinese Medicine in my opinion can replace benzodiazepines used in dementia. TCM offers an alternative view that focuses on patient-centered care, addressing not just the symptoms but the whole person. Incorporating TCM into dementia care might not only slow the progression of the disease but also improve quality of life, reduce stress, and promote a sense of mental clarity and emotional balance avoiding the disastrous effects of the diazepines.
As dementia continues to affect millions worldwide, exploring integrative approaches that combine the wisdom of ancient healing with modern science may offer hope and support for those on this difficult journey.
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