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Published in: BMC Complementary Medicine and Therapies 1/2017

Open Access 01-12-2017 | Research article

Adding Chinese herbal medicine to conventional therapy brings cognitive benefits to patients with Alzheimer’s disease: a retrospective analysis

Authors: Jing Shi, Jingnian Ni, Tao Lu, Xuekai Zhang, Mingqing Wei, Ting Li, Weiwei Liu, Yongyan Wang, Yuanyuan Shi, Jinzhou Tian

Published in: BMC Complementary Medicine and Therapies | Issue 1/2017

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Abstract

Background

Conventional therapy (CT) such as donepezil and memantine are well-known short-term treatments for the symptoms of Alzheimer’s disease (AD). The efficacy of them, however, drops below baseline level after 9 months. In China, herbal therapy as a complementary therapy is very popular. Should conventional therapy combined with herbal therapy (CT + H) make add-on benefit?

Methods

In this retrospective cohort study, 344 outpatients diagnosed as probable dementia due to AD were collected, with the treatment of either CT + H or CT alone in clinical settings. All the patients were examined with coronary MRI scan. Cognitive functions were obtained by mini–mental state examination (MMSE) every 3 months with the longest follow-up of 24 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. At 24 months, the patients with improved cognitive function (△MMSE ≥ 0) in CT + H was more than CT alone (33.33% vs 7.69%, P = 0.020). Interestingly, 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).

Conclusions

Compared to CT alone, CT + H significantly benefited AD patients. A symptomatic effect of CT + H was more pronounced with time. Cognitive decline was substantially decelerated in patients with moderate severity, while the cognitive function was largely stabilized in patients with mild severity over two years. These results imply that Chinese herbal medicines may provide an alternative and additive treatment for AD.
Literature
1.
go back to reference Chan KY, Wang W, Wu JJ, Liu L, Theodoratou E, Car J, et al. Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990-2010: a systematic review and analysis. Lancet. 2013;381:2016–23.CrossRefPubMed Chan KY, Wang W, Wu JJ, Liu L, Theodoratou E, Car J, et al. Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990-2010: a systematic review and analysis. Lancet. 2013;381:2016–23.CrossRefPubMed
2.
go back to reference Farlow M, Anand R, Messina J Jr, Hartman R, Veach J. A 52-week study of the efficacy of rivastigmine in patients with mild to moderately severe Alzheimer's disease. Eur Neurol. 2000;44:236–41.CrossRefPubMed Farlow M, Anand R, Messina J Jr, Hartman R, Veach J. A 52-week study of the efficacy of rivastigmine in patients with mild to moderately severe Alzheimer's disease. Eur Neurol. 2000;44:236–41.CrossRefPubMed
3.
go back to reference Winblad B, Wimo A, Engedal K, Soininen H, Verhey F, Waldemar G, et al. 3-year study of donepezil therapy in Alzheimer's disease: effects of early and continuous therapy. Dement Geriatr Cogn Disord. 2006;21:353–63.CrossRefPubMed Winblad B, Wimo A, Engedal K, Soininen H, Verhey F, Waldemar G, et al. 3-year study of donepezil therapy in Alzheimer's disease: effects of early and continuous therapy. Dement Geriatr Cogn Disord. 2006;21:353–63.CrossRefPubMed
4.
go back to reference Tariot PN, Farlow MR, Grossberg GT, Graham SM, McDonald S, Gergel I, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA. 2004;291:317–24.CrossRefPubMed Tariot PN, Farlow MR, Grossberg GT, Graham SM, McDonald S, Gergel I, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA. 2004;291:317–24.CrossRefPubMed
5.
go back to reference Howard R, McShane R, Lindesay J, Ritchie C, Baldwin A, Barber R, et al. Donepezil and memantine for moderate-to-severe Alzheimer’s disease. N Engl J Med. 2012;366:893–903.CrossRefPubMed Howard R, McShane R, Lindesay J, Ritchie C, Baldwin A, Barber R, et al. Donepezil and memantine for moderate-to-severe Alzheimer’s disease. N Engl J Med. 2012;366:893–903.CrossRefPubMed
6.
go back to reference Liu J, Wang LN, Tian J. Recognition of dementia in ancient China. Neurobiol Aging. 2012;33:2948. e11-3PubMed Liu J, Wang LN, Tian J. Recognition of dementia in ancient China. Neurobiol Aging. 2012;33:2948. e11-3PubMed
8.
go back to reference American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994. p. 134–5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994. p. 134–5.
9.
go back to reference Tian J, Shi J, Wei MQ, Wang YY. Chinese version of clinical criteria for the diagnosis of Alzheimer’s disease. Chin J Front Med Sci (Electronic Version). 2012;4:1–6. Tian J, Shi J, Wei MQ, Wang YY. Chinese version of clinical criteria for the diagnosis of Alzheimer’s disease. Chin J Front Med Sci (Electronic Version). 2012;4:1–6.
10.
go back to reference Shi J, Wei MQ, Tian J, Snowden J, Zhang XK, Ni JN, et al. The Chinese version of story recall: a useful screening tool for mild cognitive impairment and Alzheimer's disease in the elderly. BMC Psychiatry. 2014;14:71.CrossRefPubMedPubMedCentral Shi J, Wei MQ, Tian J, Snowden J, Zhang XK, Ni JN, et al. The Chinese version of story recall: a useful screening tool for mild cognitive impairment and Alzheimer's disease in the elderly. BMC Psychiatry. 2014;14:71.CrossRefPubMedPubMedCentral
11.
go back to reference Tian J, Xie HG, Qin B, Shi J, Wang YY, Wang XP, et al. Chinese guideline on application of brief cognitive tests in the diagnosis of dementia. Natl Med J China. 2016;96:2945–59. Tian J, Xie HG, Qin B, Shi J, Wang YY, Wang XP, et al. Chinese guideline on application of brief cognitive tests in the diagnosis of dementia. Natl Med J China. 2016;96:2945–59.
12.
go back to reference Ni JN, Shi J, Wei MQ, Tian J, Jian WJ, Liu JP, et al. Screening mild cognitive impairment by delayed story recall and instrumental activities of daily living. Int J Geriatr Psychiatry. 2015;30:888–90.CrossRefPubMed Ni JN, Shi J, Wei MQ, Tian J, Jian WJ, Liu JP, et al. Screening mild cognitive impairment by delayed story recall and instrumental activities of daily living. Int J Geriatr Psychiatry. 2015;30:888–90.CrossRefPubMed
13.
go back to reference Korf ES, Wahlund LO, Visser PJ, Scheltens P. Medial temporal lobe atrophy on MRI predicts dementia in patients with mild cognitive impairment. Neurology. 2004;63:94–100.CrossRefPubMed Korf ES, Wahlund LO, Visser PJ, Scheltens P. Medial temporal lobe atrophy on MRI predicts dementia in patients with mild cognitive impairment. Neurology. 2004;63:94–100.CrossRefPubMed
14.
go back to reference Mendiondo MS, Ashford JW, Kryscio RJ, Schmitt FA. Modelling mini mental state examination changes in Alzheimer's disease. Stat Med. 2000;19:1607–16.CrossRefPubMed Mendiondo MS, Ashford JW, Kryscio RJ, Schmitt FA. Modelling mini mental state examination changes in Alzheimer's disease. Stat Med. 2000;19:1607–16.CrossRefPubMed
15.
go back to reference Zhang J. Jing Yue Quan Shu. Shanghai: Shanghai Scientifical & Technical Publishers; 1996. p. 576. Zhang J. Jing Yue Quan Shu. Shanghai: Shanghai Scientifical & Technical Publishers; 1996. p. 576.
16.
go back to reference Shi J, Tian J, Zhang XK, Zeng CY, Wei MQ, Wang PW, Wang YY. A combination extract of Renshen (Panax Ginseng), Yinyanghuo (Herba Epimedii Brevicornus), Yuanzhi (radix Palygalae) and Jianghuang (Rhizoma Curcumae Longae) decreases glycogen synthase kinase 3beta expression in brain cortex of APPV7171 transgenic mice. J Tradit Chin Med. 2013;33:211–7.CrossRefPubMed Shi J, Tian J, Zhang XK, Zeng CY, Wei MQ, Wang PW, Wang YY. A combination extract of Renshen (Panax Ginseng), Yinyanghuo (Herba Epimedii Brevicornus), Yuanzhi (radix Palygalae) and Jianghuang (Rhizoma Curcumae Longae) decreases glycogen synthase kinase 3beta expression in brain cortex of APPV7171 transgenic mice. J Tradit Chin Med. 2013;33:211–7.CrossRefPubMed
17.
go back to reference Tian J, Shi J, Zhang L, Yin J, Hu Q, Xu Y, et al. GEPT extract reduces Aβ deposition by regulating the balance between production and degradation of Aβ in APPV717I transgenic mice. Curr Alzheimer Res. 2009;6:118–31.CrossRefPubMed Tian J, Shi J, Zhang L, Yin J, Hu Q, Xu Y, et al. GEPT extract reduces Aβ deposition by regulating the balance between production and degradation of Aβ in APPV717I transgenic mice. Curr Alzheimer Res. 2009;6:118–31.CrossRefPubMed
18.
go back to reference Shi J, Zhang X, Yin L, et al. Herbal formula GAPT prevents beta amyloid deposition induced Ca2+/Calmodulin-dependent protein kinase II and Ca2+/Calmodulin-dependent protein phosphatase 2B imbalance in APPV717I mice. BMC Complement Altern Med. 2016;16:159.CrossRefPubMedPubMedCentral Shi J, Zhang X, Yin L, et al. Herbal formula GAPT prevents beta amyloid deposition induced Ca2+/Calmodulin-dependent protein kinase II and Ca2+/Calmodulin-dependent protein phosphatase 2B imbalance in APPV717I mice. BMC Complement Altern Med. 2016;16:159.CrossRefPubMedPubMedCentral
19.
go back to reference Ni JN, Shi J, Zhang XK, et al. Effect of GAPT extract on expression of tau protein and its phosphorylation related enzymes in hippocampal neurons of APPV717I transgenic mice. Chin J Integr Med. 2017;23:605–10.CrossRefPubMed Ni JN, Shi J, Zhang XK, et al. Effect of GAPT extract on expression of tau protein and its phosphorylation related enzymes in hippocampal neurons of APPV717I transgenic mice. Chin J Integr Med. 2017;23:605–10.CrossRefPubMed
20.
go back to reference Tu Y, Bi X, Luo W. Quality control of traditional Chinese medicine formula granules. World Sci Technol. 2011;13:41–6. Tu Y, Bi X, Luo W. Quality control of traditional Chinese medicine formula granules. World Sci Technol. 2011;13:41–6.
21.
go back to reference Wilcock G, Howe I, Coles H, Lilienfeld S, Truyen L, Zhu Y, et al. A long-term comparison of galantamine and donepezil in the treatment of Alzheimer’s disease. Drugs Aging. 2003;20:777–89.CrossRefPubMed Wilcock G, Howe I, Coles H, Lilienfeld S, Truyen L, Zhu Y, et al. A long-term comparison of galantamine and donepezil in the treatment of Alzheimer’s disease. Drugs Aging. 2003;20:777–89.CrossRefPubMed
22.
go back to reference Wang SY, Liu JP, Ji WW, et al. Qifu-yin attenuates AGEs-induced Alzheimer-like pathophysiological changes through the RAGE/NF-κB pathway. Chin J Nat Med. 2014;12(12):920–8.PubMed Wang SY, Liu JP, Ji WW, et al. Qifu-yin attenuates AGEs-induced Alzheimer-like pathophysiological changes through the RAGE/NF-κB pathway. Chin J Nat Med. 2014;12(12):920–8.PubMed
23.
go back to reference Yang WT, Zheng XW, Chen S, et al. Chinese herbal medicine for Alzheimer's disease: clinical evidence and possible mechanism of neurogenesis. Biochem Pharmacol. 2017;141:143–55.CrossRefPubMed Yang WT, Zheng XW, Chen S, et al. Chinese herbal medicine for Alzheimer's disease: clinical evidence and possible mechanism of neurogenesis. Biochem Pharmacol. 2017;141:143–55.CrossRefPubMed
24.
go back to reference Schmitt B, Bernhardt T, Moeller HJ, et al. Combination therapy in Alzheimer's disease: a review of current evidence. CNS Drugs. 2004;18(13):827–44.CrossRefPubMed Schmitt B, Bernhardt T, Moeller HJ, et al. Combination therapy in Alzheimer's disease: a review of current evidence. CNS Drugs. 2004;18(13):827–44.CrossRefPubMed
25.
go back to reference Matsunaga S, Kishi T, Iwata N. Combination therapy with cholinesterase inhibitors and Memantine for Alzheimer’s disease: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2015;18(5):pyu115.CrossRefPubMedCentral Matsunaga S, Kishi T, Iwata N. Combination therapy with cholinesterase inhibitors and Memantine for Alzheimer’s disease: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2015;18(5):pyu115.CrossRefPubMedCentral
26.
go back to reference Canevelli M, Adali N, Kelaiditi E, et al. Effects of Gingko Biloba supplementation in Alzheimer's disease patients receiving cholinesterase inhibitors: data from the ICTUS study. Phytomedicine. 2014;21(6):888–92.CrossRefPubMed Canevelli M, Adali N, Kelaiditi E, et al. Effects of Gingko Biloba supplementation in Alzheimer's disease patients receiving cholinesterase inhibitors: data from the ICTUS study. Phytomedicine. 2014;21(6):888–92.CrossRefPubMed
27.
go back to reference Ihl R, Frölich L, Dierks T, et al. Differential validity of psychometric tests in dementia of the Alzheimer type. Psychiatry Res. 1992;44(2):93–106.CrossRefPubMed Ihl R, Frölich L, Dierks T, et al. Differential validity of psychometric tests in dementia of the Alzheimer type. Psychiatry Res. 1992;44(2):93–106.CrossRefPubMed
28.
go back to reference Ihl R, Ferris S, Robert P, et al. Detecting treatment effects with combinations of the ADAS-cog items in patients with mild and moderate Alzheimer’s disease. Int J Geriatr Psychiatry. 2012;27(1):15–21.CrossRefPubMed Ihl R, Ferris S, Robert P, et al. Detecting treatment effects with combinations of the ADAS-cog items in patients with mild and moderate Alzheimer’s disease. Int J Geriatr Psychiatry. 2012;27(1):15–21.CrossRefPubMed
Metadata
Title
Adding Chinese herbal medicine to conventional therapy brings cognitive benefits to patients with Alzheimer’s disease: a retrospective analysis
Authors
Jing Shi
Jingnian Ni
Tao Lu
Xuekai Zhang
Mingqing Wei
Ting Li
Weiwei Liu
Yongyan Wang
Yuanyuan Shi
Jinzhou Tian
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2017
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-017-2040-5

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