Alzheimer’s Disease is one of the irreversible, progressive, Neuro-degenerative disorder, which causes cognitive impairment with behavioural dysfunction, which gradually interferes with the social functioning with unknown aetiology. It usually affects older age people who are above 60 years. 

Dementia (Memory loss), being its most common symptom, affects the capability of thinking, behaving normal, and the ability to perform daily routine activities. It is caused due to the ATROPHY OF BRAIN – loss of neuronal cells, which causes the brain to shrink, and hence the brain losses the inter – cellular connections. Alzheimer’s is a long-term disease that has a long-running pre-clinical state. It takes almost nearly 15-20 years to be seen as a problem. Since dementia is one of the disease’s major symptoms, it is also called Alzheimer’s Dementia.  

PATHOPHYSIOLOGY.

Human Brain a complex organ. Neurons or the nerve cells are the functioning units of the Brain. It receives the information from the sensory nerves and sends the signal back into the motor system, which commands the muscles. Exchange of the signals is carried out by neuro-transmitters, e.g., this is what happens, when we touch a hot cup, and immediately we withdraw our hand. As age advances, these neurons slowly start to lose their function, and a person tends to forget things, there will be reduced social functions, etc. which we call “Aging” and happens in every cognitively intact person. There is a thin line between the normal aging process and the diseased destruction of the neuronal cells. This is the reason, where many old individuals get undiagnosed.    

In the human brain, we have a structure named the Cerebral cortex, which helps in thinking, decision-making, and “hippocampus” a brain structure, which holds the memory. In Alzheimer’s disease, tangles (Neuro-fibrillary tangles – NFT) and plaques (Senile Plaques -SP) are formed because of the destruction of the microtubules inside the neurons and tangled to each other, and plaques are formed at the microscopic levels. These changes or formation of the tangles and plaques occur in the cerebral cortex and hippocampus.

NOTE: NFT’s and SPs were discovered by Alois Alzheimer in 1907 hence the name.

Because of the above pathology, certain nerve cells lose their functions and connections and get destructed. These destructions cause a person to lose his memory, one can observe behavioural changes, personality changes, etc in a long run.

According to the research, there is a genetic involvement in this disease. It is an autosomal dominant genetic disorder that involves APP, APOE, PSEN1, and PSEN2 Genes. 

AYURVEDIC PERSPECTIVE

Alzheimer’s disease is considered as one of the Jarajanya Vyadhi (Old Age Disorder). Acharya Charaka, Vaghbhata and Acharya Sharangadhara (the Great Scholars of Indian System of Medicine) explains that naturally, Medha (Cognitive ability) will decline by the 4th decade of life, Drishti (Vision) will decline at 7th decade of life, and Manashakti (Strength), Buddhi (Intelligence) will decline by 9th decade of life and Karmendriya (Motor functions) will decline at the 10th decade of the life.

According to Ayurveda, our body consists of three basic constituents Vata, Pitta and Kapha, 5 Indriya (Sensory Organs), Pancha Mahabhuta, Agni (Digestive Fire), Mala (Excretory).  The balanced state of all these constituents maintains the proper health. In old age, these will end up in diseases because of the structural and functional changes of these. Vata, which is one of the major three constituents of the body is mainly responsible for these changes. The main function of Vata is to control the normal functioning of the central nervous system.

There are few disorders like Unmada, Atatwabhinivesha, Mada, Moorcha, and Sanyasa, whose features are related to the symptoms of Alzheimer’s Disease. In all these diseases, memory loss, cognitive dysfunctions, and behavioural changes are prominent. Understanding these clinical conditions and symptoms of the patient, helps us to reach proper diagnosis and plan a proper treatment protocol.

CAUSES OF ALZHEIMER’S DISEASE: 

  • Old Age > 60 Years
  • Genetic predisposition – Presence of APP, APOE, PSEN1, and PSEN2 Genes.
  • Neuro-degenerative Disorders like Parkinson’s Disease, ALS – Amyotrophic Lateral Sclerosis.
  • Drugs that cause Oxidative stress to the brain. 
  • High intercellular Calcium- which causes the Neuronal injury
  • Auto-immunity
  • Inflammation or Infection of the brain
  • Trauma to the Brain 

RISK FACTORS 

  • Men > Women
  • Post-menopausal – Estragon loss might be a triggering factor.
  •  Obesity
  •  Vascular Disorders
  • Insulin Resistance/ DM
  • Dyslipidaemia
  • Hypertension
  • Mental instability / Mental Disorders

SYMPTOMS OF ALZHEIMER’S DISEASE.

  • Dementia – Forgetfulness/Memory Loss – both short term and long term
  • Lack of Judgment
  • Inability to take simpler decision making 
  • The problem in Reasoning, Problem-solving
  • Disorientation to Time, Place, Person
  • Lack of Abstract thinking
  • Difficulty in language/Symbols
  • Change in Behaviours
  • Change in Mood, mostly depressive 
  • Confusion
  • Poor sense of Direction
  • Less Impulsive
  • Visual Problems in a later stage. 

 STAGES OF THE DISEASE

  1. Pre – Clinical 
  2. Clinical – Mild
  3. Clinical – Moderate
  4. Clinical – Severe

DIAGNOSIS

Diagnosis is done based on the symptoms, Physical and Neurological examination, Mental status examination, Blood investigation, MRI, Ct, Amyloid PET imaging.

TREATMENT

There is no such permanent cure for the disease. It is irreversible. Few of the oral medicines and therapies can help in controlling the symptoms and improving the quality of life. Which includes

  • Oral medicines, which help to improve cognition
  • Cognitive Behavioural therapy
  • Music therapy
  • Yoga
  • Mindful Meditation
  • MSRT: Mind Sound Resonance techniques
  • Lifestyle changes like carrying home address, pphone numbers of the family doctors, Family members, etc, avoid keeping harmful things outside, etc.

AYURVEDIC THERAPIES:

  • Shiro Dhara
  • Shiro Pichu
  • Shiro Abhyanga – Head massage
  • Shiro Basti
  • Sarvanga Abhyanga – Full body massage
  • Sarvanga Patra Pinda Sweda
  • Nasya – Nasal instillation
  • Basti Karma – Enema
  • Vestana
  • Akshi/Netra Tarpana

AYURVEDIC SINGLE DRUGS WHICH HAS SHOWN PROMISING RESULTS 

  • Ashwagandha – Withania somnifera
  • Shankapushpi – Convolvulus prostratus
  • Guduchi – Tinospora cordifolia 
  • Brahmi – Bacopa monnieri
  • Yastimadhu – Glycyrrhiza glabra
  • Mandukaparni – Centella asiatica
  • Haridra – Curcuma longa

RASAYANA:

  • Medhya Rasayana
  • Guduchi Rasayana
  • Brahmi Rasayana
  • Triphala Rasayana

INTERNAL MEDICATIONS:

  • Saraswatharista
  • Brahmivati
  • Brahmi ghrita
  • Manasa mitra vati

Note: All the medications and therapies to be taken or conducted under Ayurvedic Physician’s Direction only. Improper administration might end up in serious medical emergencies in old age.

REFERANCES

  1. Anthony S, Joseph B Martin et al. Harrison’s principles of Internal Medicine. 19th ed. Vol 2.P2598
  2. Anthony S, Joseph B Martin et al. Harrison’s principles of Internal Medicine. 19th ed. Vol 2.P2599
  3. Agnivesha. Charaka Samhita.Yadavji Trikamji Acharya editor. 2014. Sutra Sthana.09thChapter.
  4. Agnivesha. Charaka Samhita.Yadavji Trikamji Acharya editor. 2014. Shareera Sthana.07thChapter.
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506936/
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