Alternative and Integrative Therapies for AIDS Dementia Complex

Good Scientific Evidence :

Bacopa : Although bacopa is traditionally used in Ayurvedic medicine to enhance cognition, high–quality clinical trials are lacking. Two methodologically weak studies found some evidence that bacopa improves cognition. However, more high–quality and independent research is needed before bacopa can be recommended for enhancing brain function in adults or children.

Avoid if allergic or hypersensitive to Bacopa monnieri, its constituents or any member of the Srcophulariaceae (figwort) family. Use cautiously with drugs or herbs that are metabolized by cytochrome P450 enzymes, thyroid drugs, calcium blocking drugs, and sedatives. Avoid if pregnant or breastfeeding.

Ginseng : Several studies report that ginseng can modestly improve thinking or learning. Mental performance has been assessed using standardized measurements of reaction time, concentration, learning, math and logic. Benefits have been seen both in healthy young people and in older ill patients. Effects have also been reported for the combination use of ginseng with Ginkgo biloba. However, some negative results have also been reported. Therefore, although the sum total of available scientific evidence does suggest some effectiveness of short–term use of ginseng in this area, better research is necessary before a strong recommendation can be made.

Avoid ginseng if allergic to plants in the Araliaceae family. There has been a report of a serious life–threatening skin reaction, possibly caused by contaminants in the ginseng formulation.

Music therapy : In people with Alzheimer's dementia and other mental disorders in older adults, music therapy has been found to reduce aggressive or agitated behavior, improve mood, and improve cooperation with daily tasks such as bathing. Music therapy may also be beneficial for dementia–associated neuropsychiatric symptoms.

Unclear or Conflicting Scientific Evidence :

Acupuncture : There is insufficient available evidence to recommend either for or against the use of acupuncture in cognitive and communication disorders.

There is also insufficient evidence to recommend the use of acupuncture in the treatment of vascular dementia.

Astragalus : Based on one clinical trial, astragalus may improve the mental performance of children with low IQs. This trial, however, used astragalus as part of a combination therapy, and it is difficult to ascribe the effects to any one constituent. Further, well–designed clinical trials are required before recommendations can be made.

Ayurveda : The herb brahmi (Bacopa monnieri) is used in a number of Ayurvedic preparations for a variety of ailments. There is evidence from well–designed studies that it may improve memory and cognitive functioning in adults.

Another study suggests that the herbal preparation Maharishi Amrit Kalash (MAK–4) may enhance attention capacity or alertness, and thus reverse some of the detrimental cognitive effects of aging. Further research is needed to confirm these results.

Black tea : Several preliminary studies have examined the effects of caffeine, tea or coffee use on short and long–term memory. It remains unclear if tea is beneficial for this use.

Limited, low–quality research reports that the use of black tea may improve cognition and sense of alertness. Black tea contains caffeine, which is a stimulant.

Boron : Preliminary human studies report better performance on tasks of eye–hand coordination, attention, perception, short–term memory and long–term memory with boron supplementation. However, additional research is needed before a firm conclusion can be drawn.

Cranberry : Preliminary research suggests that cranberry juice may increase overall ability to remember. Further well–designed clinical trials are needed to confirm these results.

Green tea : Several preliminary studies have examined the effects of caffeine, tea or coffee use on short and long–term memory. It remains unclear if tea is beneficial for this use.

Limited, low–quality research reports that the use of green tea may improve cognition and sense of alertness. Green tea contains caffeine, which is a stimulant.

Guarana : In available studies, guarana has not been shown to alter cognitive function or arousal. Keuchel et al. found caffeine to decrease mental concentration in males while increasing mental concentration in females. Similar results were found with recall. A meta–analysis of 12 studies on theophylline and caffeine found that neither therapy has significant detrimental effects on cognition or behavior. However, elderly patients felt more alert when administered 250mg of caffeine as compared to 250mg of theophylline. Flat dose response relationship has been found for the psychoactive effects of caffeine. Caffeine may significantly improve simple reaction time, but may not improve immediate memory.

Guided imagery : Early research suggests that guided imagery of short duration may improve working memory performance. Further research is needed before a firm conclusion can be drawn.

Iodine : Iodine is required for the production of thyroid hormones, which are necessary for normal brain development and cognition. One study showed that oral iodized oil significantly improved performance on cognitive tests in 10–12 year–old school children. Further research is needed to confirm these results.

Khat : Two poorly documented trials evaluated khat in cognitive function. One study reported no difference in cognitive functioning between elderly men that used khat and those that did not. In the other study, cognitive functioning was negatively affected by khat use. Well–designed randomized controlled trials are needed before a firm conclusion can be made.

Kundalini yoga : Breathing exercises are an important part of Kundalini Yoga. There is some evidence from studies with healthy volunteers that use of certain breathing techniques (e.g., breathing solely through one nostril or the other) may improve different aspects of cognitive functioning. More studies are needed to determine if these techniques can reliably be used to improve cognitive performance and possibly aid in treating cognitive and nervous system disorders.

Lavender : Small studies of patients with severe dementia have found that lavender aromatherapy or pinning a cloth with the oil on it to the patient may help decrease agitated behavior. Further well–designed studies are needed in this area before a firm conclusion can be drawn.

Small trials investigating the effects of lavender aromatherapy on agitation and behavior in patients with Alzheimer's dementia report conflicting results. Further well–designed studies are needed before a conclusion can be drawn.

Lemon balm : Limited data are available supporting the use of lemon balm as a treatment of agitation in dementia patients. Additional studies are necessary before a conclusion can be drawn.

Clinical data suggest that the use of standardized lemon balm extract has some effect on particular self–reported measures of mood and cognition through cholinergic activities. More rigorous studies need to be conducted using patient–relevant outcomes to better assess the validity of these results as they apply to patient care.

Massage : Massage with or without essential oils has been used in patients with dementia in chronic care facilities to assess effects on behavior. There is compelling early evidence that aromatherapy with essential oils may reduce agitation in patients with dementia, although the effects of massage itself are not clear.

Omega–3 fatty acids : Well–designed clinical trials are needed before omega–3 fatty acids can be recommended for the prevention of cognitive impairment or dementia.

Polypodium leucotomos extract (anapsos) : Limited scientific information is available about the effectiveness of polypodium in the treatment of dementia.

Riboflavin (vitamin B12) : Adequate nutrient supplementation with riboflavin may be required for the maintenance of adequate cognitive function. Treatment with B–vitamins, including riboflavin, has been reported to improve scores of depression and cognitive function in patients taking tricyclic antidepressants. This may be related to tricyclic–caused depletion of riboflavin levels.

Soy : A recent study suggests that isoflavone supplementation in postmenopausal women may have favorable effects on cognitive function, particularly verbal memory. Further research is necessary before a firm conclusion can be drawn.

Traditional Chinese medicine (TCM) : TCM herbal combinations have been used for treatment of dementia and reportedly improve cognitive function and activities of daily living. More studies of better design are needed before recommendations can be made.

Yoga : There is limited human study of yoga to improve memory. Most research focuses on memory in children. Better studies are needed before a recommendation can be made.

Fair Negative Evidence :

Bitter orange ( Citrus aurantium ) : One randomized controlled trial demonstrated Citrus aurantium aromatherapy does not reduce combative, resistive behaviors in individuals who have dementia. Research with a larger sample in future studies may yield other results. Currently, however, there is no evidence supporting the use of bitter orange for dementia and behavioral challenges.

DHEA (dehydroepiandrosterone) : Studies of the effects of dehydroepiandrosterone (DHEA) on cognition have produced complex and inconsistent results. Additional study is warranted in this area.

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