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Alzheimer's stabilized for eight years?
Lane Simonian
Posted: Monday, August 14, 2017 2:30 PM
Joined: 12/12/2011
Posts: 4845


A Case of Alzheimer’s Disease Was Kept Relative Stable with Sequential Therapy for Eight Years

3. Discussion 

With carefully evaluation, she was diagnosed as mild dementia due to Alzheimer’s disease. The diagnosis was given by the following criteria, First, the patient was brought to our memory clinic for her insidious and progressive cognitive decline in half year without fluctuating characteristics. Second, she has more than two domains of cognitive impairment measured by global cognitive disorder with MMSE adjusted by education, [less than or equal to] 22 for primary school, and the cognitive impairment has interfered with her daily activities. Third, her brain MRI scan showed severe atrophy of the bilateral hippocampal volume, with an age-adjusted MTA-scale abnormal score 3 or more for 75 years and more. Overall, this is quite accord with AD diagnostic criteria. Other diseases that may cause cognitive impairment were excluded by the patient’s negative results of laboratory tests. 

After diagnosis of Alzheimer’s disease, she received the following medicines. First, donepezil hydrochloride for improve the level of cholinergic transmitter in her brain; Second, our herbal formula was prescribed for the purpose of effectively improvement of her neuron synaptic dysfunction induced by beta-amyloid accumulation. During the first stage of combinatory therapy, her cognitive function was obviously improved for about 10 months, and then retreated below the baseline at 21 months, which was already extended beyond the well-known parabola effect of donepezil. A surprising aspect of this patient is the dramatic drop in cognition after her quit from the treatment for about 40 months, a strong indication of the progressive Alzheimer’s disease. After that, the patient was re-prescribed with the similar combined medications. Interestingly, her MMSE score improved significantly from 16 to 21 as expected, and then fell back near the baseline after six months of treatment. Intriguingly, her cognitive condition was steady improved even after the wane of beneficial effect of donepezil, and reached a nearly normal cognitive status (MMSE 23). 

The cognitive outcomes of the patient after receiving eight year’s sequential therapy was significantly better than the expected changes. The use of donepezil in this case also showed similar pinnacle effects around three months followed by a retreat to the baseline. However, with the support from our herbal formula, the beneficial effects sustained for a longer time and her cognition was steadily improved significantly thereafter. Therefore, this phenomena cannot be explained solely by the effects of donepezil, indicating that our herbal formula might work additively and independently to the cholinesterase inhibitor donepezil. Our previous work using a similar herbal formula called GAPT can markedly enhance learning and memory of AD rat models induced by Aβ injection or transgenic mice of APPV717I and APPs we/PS1dE9, and also showed a significant improvement on cognitive function in patients with amnestic mild cognitive impairment, an early stage of AD (n = 101), consistently across different cognitive scales in a small sample of clinical trial. The good effects of multiple combined therapy in treating MCI (mild cognitive impairment) and SCI (subjective cognitive impairment) and AD, was published by Dale E. Bredesen et al. A therapeutic approach characterized by programmatic, personalization, as well as dubbed metabolic enhancement for neurodegeneration (MEND protocol) was used. Authors reported that those patients had unprecedented symptom improvement. However, the time of those patients treated with this MEND protocol only ranges from five to 24 months. Our case was treated and observed for much longer time than this study. Meanwhile, a two year polite [pilot] study to check effects of the sequential therapy was conducted in more than two hundred patients recently. Primary results favor the sequential therapy than pure conventional medicine, which will be published soon.

 

The specific herbal formula used in this study is not specified, but the components of the similar GAPT formula are as follows:

GAPT, also called as GEPT in our previous papers, is a combination of herbal extracts, including eight active components pro rata of Ginsenoside from ginseng 4.4 %, Cistanche 17.3 %, Radix Rehmanniae 17.3 %, Polygala tenuifolia 13 %, Acorus tatarinowii 13 %, Radix Curcumae 13 %, Poria cocos 13 %, Salvia officinalis 9 %


This is of course only one person (with a much larger data set potentially coming).  An open labelled study with Korean red ginseng showed individuals with Alzheimer's disease had improvements in cognition at 24 weeks that were stabilized for two years. The implication (not yet proven) is that certain herbal extracts can lead to initial improvements in cognition that can be sustained for years.


Mimi S.
Posted: Monday, August 14, 2017 4:22 PM
Joined: 11/29/2011
Posts: 7029


Yes, one case but interesting.

I do wish there would be a study of Mestinon, prescribed for Myasthenia Gravis.  I am on a very large dosage of 780 mg. per day.  Two different neurologists have given explanation of why this may be responsible for my long stay in Early Stage.  

At first thought, I would wish no one to be on this drug with its side effects.  But it doesn't take much thought to wish for more research to see if others could benefit.  Those actually diagnosed with both diseases are few.
Lane Simonian
Posted: Monday, August 14, 2017 10:02 PM
Joined: 12/12/2011
Posts: 4845


There may very well be a formula here: acetylcholinesterase inhibitors (donepezil/Aricept or Mestinon) plus antioxidants (Chinese herbs or Mediterranean diet) stabilizes Alzheimer's disease.
Lane Simonian
Posted: Tuesday, November 14, 2017 10:03 AM
Joined: 12/12/2011
Posts: 4845


This is the follow up to the above study (in the chart the red line is Chinese herbs plus Aricept/and or memantine, the blue line is Aricept and/or memantine, the black line is the standard decline):

Background

Conventional therapy (CT), such as donepezil and memantine are well-known short-term treatments for the symptoms of Alzheimer’s disease (AD). They, however, have little disease-modifying effects after 18 months. In a two-year study, combined CT with Chinese herbal medicines (CT+H) significantly ameliorated cognitive decline in patients with mild to moderate AD. 

Methods

A cohort of outpatients (n=344) meeting criteria for clinical diagnosis of AD were treated with either CT+H (n=243) or CT alone (n=101) for two years. All participants underwent standardized neuropsychological assessments. Coronary MRI scans were used to assess the age-adjusted medial temporal lobe atrophy. Cognitive function was assessed by the mini–mental state examination (MMSE) every 3 months.

Results

Most of the patients were initially diagnosed with mild (MMSE=21-26, n=177) and moderate (MMSE=10-20, n=137) dementia. At 18 months, CT+ H patients scored on average 1.76 (P=0.002) better than CT patients, and at 24 months, patients scored on average 2.52 (P<0.001) better (Figure 1). Patients with mild AD received the most robust benefit from CT+H therapy. The deterioration of the cognitive function was largely prevented at 24 months (ΔMMSE=-0.06), a significant improvement from CT alone (ΔMMSE=-2.66, P=0.005). Overall number of patients with improved (ΔMMSE≥0) or deteriorated (ΔMMSE≥-4) were showed over time (Table 1).

Conclusions

CT+H significantly benefited AD patients from CT alone. A disease-modifying effect of CT+H was more pronounced with time (≥ 18 months). These results imply that Chinese herbal medicines may provide an alternative and additive treatment for AD. Figure 1. MMSE change in groups with or without herbal therapy over 24 months. Patients with Alzheimer’s disease had a transient improvement in cognitive function with conventional therapy (CT), but declined to a level similar to no treatment after 18 months. CT supplemented with herbal medicine provided additional benefit. The effect from herbal medicines became more pronounced over time. Expected decline of MMSE were calculated by formula produced from previous data. CT+H denotes conventional therapy with herbal medicine; CT denotes conventional therapy alone; MMSE, mini-mental state examination. * P<0.05.

Large image of Figure.