Traditional Chinese Medicine for Treatment of Dementia



Fig. 17.1
Change in NPI score. NPI significantly improved in the YGS group (n = 27, from 37.9 ± 16.1 to 19.5 ± 15.6, mean ± SD; p < 0.001) but did not change significantly in the control group (n = 25). In the NPI subscales, significant improvements were shown in hallucinations, agitation/aggression, irritability/lability, and aberrant motor activity. No treatment-emergent adverse event was seen in either group during the observation period



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Fig. 17.2
Barthel index. Barthel index scores significantly improved in the YGS group (from 56.4 ± 34.2 to 62.9 ± 35.2; p < 0.05) but did not change significantly in the control group


On the other hand, we published a case series of 15 patients with DLB and reported that hallucinations and other BPSDs were successfully improved with YKS treatment [7]. In a larger study, we found that YKS improved BPSD in DLB patients without worsening cognitive function and improved the burden score in caregivers [8]. Namely, in a study of 63 DLB patients, significant improvements were observed in the Neuropsychiatric Inventory (NPI) score (mean decrease of 12.5 points, p < 0.001; Figs. 17.3 and 17.4), Behave-AD insomnia subscale score (p = 0.011), and the Zarit’s Caregiver’s Burden score (J-ZBI; mean decrease of 3.5 points, p = 0.024; Fig. 17.5). The Mini-Mental State Examination also increased 1.1 points as mean, though the Disability Assessment for Dementia showed no significant change. Adverse events occurred in 11 (18 %) patients, and 3 (5 %) patients discontinued YKS due to adverse reactions, spasticity, BPSD deterioration, edema, and nausea. Four patients (6 %) showed hypokalemia (<3.5 mEq/L) at the study conclusion. Deterioration of extrapyramidal symptoms was not observed.

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Fig. 17.3
BPSD change with YKS treatment in DLB patients. ***p < 0.001. Abbreviation: NPI neuropsychiatric inventory


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Fig. 17.4
Change in each subscale. ***p < .001, **p < .01, *p < .05


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Fig. 17.5
Change in Zarit’s Caregiver’s burden score (J-ZBI) with YKS treatment in DLB patients. ***p < .001, **p < .01. Abbreviation: J-ZBI Zarit burden interview-Japanese edition



17.2.3 Pharmacological Mechanisms


In a 2009 report, Sekiguchi et al. demonstrated that YKS treatment ameliorated aggressive behavior in mice administered with beta-amyloid protein [9]. They also demonstrated that YKS did not suppress motor activity, nor did it induce catalepsy. Takeda et al. reported that YKS attenuated abnormal glutamate release in rats receiving a diet deficient in zinc [10], and in another study, they reported that YKS significantly suppressed the increase in extracellular glutamate and aspartate in the hippocampus of zinc-deficient rats after KCl stimulation [11]. In 2008, Egashira et al. reported that YKS inhibited the 2,5-dimethoxy-4-iodoamphetamine-induced head-twitch response and decreased expression of 5-hydroxytryptamine 2A receptors in the prefrontal cortex [12]. Terawaki et al. reported a partial agonistic effect of YKS on human recombinant serotonin 1A receptors expressed in the membranes of Chinese hamster ovary cells [13]. These reports collectively suggest the involvement of serotonergic and glutamatergic functions in the underlying mechanism of YKS. Tabuchi et al. reported that YKS ameliorated cognitive disturbances in APP transgenic mice, which are an animal model of Alzheimer’s disease [14]. Shimada et al. in 2001 reported that an aqueous extract of the hooks and stems of Uncaria sinensis (Oliv.) Havil., Uncariae uncus cum ramulus, a herb included in YKS, protected against glutamate-induced neuronal death in cultured cerebellar granule cells [15]. They suggested that oxindole alkaloids, such as isorhynchophylline, isocorynoxeine, and rhynchophylline, and indole alkaloids, such as hirsuteine and hirsutine, were the active components in Uncaria [16]. These compounds may cause the clinical effects of YKS. Similarly, in 2012, Nishi et al. reported that at least some of the effects of YKS may be due to an alkaloid found in the hooks of Uncaria known as geissoschizine methyl ether (GM), which acted as a partial agonist at the 5-HT1A receptor [17]. This assessment was supported by their concurrent finding that treatment with GM reduced aggression and increased social behavior in socially isolated mice, while treatment with YKS lacking Uncaria hooks did not.

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Dec 12, 2017 | Posted by in PSYCHIATRY | Comments Off on Traditional Chinese Medicine for Treatment of Dementia

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