Clear up Confusion About Supplements for Dementia

Dementia affects about 50 million people worldwide. There are about 10 million new cases every year. There’s no cure for dementia. But a lot of products are promoted with misleading messages. Help patients understand which natural medicines might help, and which are probably a waste of money. Don’t let patients get sucked into marketing campaigns with no supportive evidence.

You might get questions about ginkgo. It’s been one of the top 25 selling herbs in the US for several years now. A huge number of ginkgo products are marketed for memory loss and dementia. Most evidence shows that taking 240 mg of ginkgo daily seems to improve dementia symptoms and help with activities of daily living. But there’s no evidence that it can prevent dementia or slow disease progression. If patients want to give it a try, there’s no reason to expect serious side effects. But explain that ginkgo supplements are commonly adulterated with other ingredients from cheaper sources. Advise patients to stick to products verified by a third party like USP. And emphasize that herbal combination products, particularly those manufactured overseas, are frequently tainted with drugs and heavy metals.

Although less well-known in the US, huperzine A is approved as a drug for Alzheimer disease in China. It’s a chemical with acetylcholinesterase inhibiting activity that is extracted from Chinese club moss or fir club moss plants. In the US, it is available in dietary supplements. Clinical research shows that taking huperzine A might improve memory, thinking skills, and behavior in people with Alzheimer disease. But it’s important to note that most clinical research on huperzine A has been conducted in China; only one clinical trial has been conducted in the US. If patients want to try huperzine A, explain that it can have similar side effects to conventional acetylcholinesterase inhibitor (AChEI) drugs, including nausea, diarrhea, vomiting, sweating, and blurred vision.

There’s also a lot of buzz around vitamin E. Taking vitamin E might slow the progression of Alzheimer disease – limited clinical evidence shows that taking 2000 IU vitamin E daily is similar to selegiline for slowing mental decline. There’s also evidence that taking vitamin E along with some anti-Alzheimer medicines might slow disease progression further. But taking vitamin E supplements doesn’t seem to prevent Alzheimer disease. While some research is promising, the World Health Organization (WHO) actually recommended against the use of vitamin E for dementia in their 2019 dementia guidelines. There are concerns that taking high doses might increase the risk for all-cause mortality in people with other chronic conditions. Until we know more, tell patients to stick to vitamins containing recommended daily allowances, or 22 IU for adults. This is almost 100 times less than doses studied for Alzheimer disease.

If your patients are worried about their dementia risk, explain that there’s no magic bullet. For now, their best bet is to stick to a well-balanced diet, such as the Mediterranean diet, remain physically active, maintain a healthy weight, and properly manage any existing conditions like high blood pressure or diabetes. Last, but not least, encourage patients to stay socially and mentally active.