Dementia therapies

In the course of researching brain tumor therapy I frequently read research on the same therapies with dementia. In some cases this was because drugs that are neuroprotective help in a wide variety of neurological diseases, but upon further exploration I discovered that dementia is also, like cancer, a disease that features very disregulated metabolism. Because of this many metabolic therapies may help treat or prevent dementia.

In the case of cancer, tumors are voracious consumers of glucose in particular, but also amino acids and lipids. With Alzheimer’s there is a different type of disregulation. Brain cells in Alzheimer’s disease have a reduced ability to consume glucose, which they usually need to function. They also have disregulated lipid metabolism and utilization, resulting in the formation of beta-amyloid plaques. Below is some research on adjunct therapies to reduce dementia risk and progression that I discovered in the literature.

TreatmentContraindicationsPaper linksTreatment detailsResultsStrength of evidence (1-5)Affected pathwaysDosageClinical trials
Modified Atkins dietApoE4 carriers should monitor their cholesterol on this diet1, 2Oils/fats, meat, eggs, dairy, vegetables. No sugars, grains, starchy vegetables/roots, processed foods, or most fruitsImproved cognitive function, quality of life for Alzheimer’s patients, prevention of Alzheimer’s5Optimizing insulin sensitivity, modulating cholesterol and lipid uptake6% calories from carbohydrates (no more than 20 g/d), up to 30% from protein, 64% from fat, approximately 1 gram of fat per grams of protein and carbohydrates combinedY
Ketogenic diet or ketonesApoE4 carriers should monitor their cholesterol on this diet. This should not be necessary in the case of exogenous ketone use1, 2, 3, 4, 5, 6Fats/oils/MCT oils/ketone saltsImproved cognitive function, quality of life for Alzheimer’s patients, prevention of Alzheimer’s5Optimizing insulin sensitivity, modulating cholesterol and lipid uptakeDiet-induced nutritional ketosis (βhB > 0.5–5 mM)Y
DHA/Omega 3 fatty acidsApoE4 carriers may need higher DHA doses1, 2, 3, 4, 5Fatty fishBrain DHA levels are lower in individuals with AD, greater consumption of fish and DHA is associated with lower rates of AD2, DHA serum levels are predictive of prevention, but trials of supplementation have not resulted in improvements in cognitive declineDHA can inhibit NLRP3, tune microglia function, inhibit NFκB-MMP9 activity, anti-flammatory, prevents blood–brain barrier breakdown2 g/day may be considered a minimum doseY
Extra virgin olive oil polyphenols1, 2, 3Extra virgin, cold pressed olive oilImproves cognitive function5Inhibits NFκB and MMP9 activityMinimum 20 g of extra virgin olive oil/dY, Mediterranean diet and dose dependent affects of olive oil consumption
Cruciferous vegetable sulphoraphane1, 2Cruciferous vegetablesCan improve cognitive function in pre-clinical trials (mice)3, only preclinical dataReduces inflammation, reduces beta-amyloid and tau production, increases glutathione, decreases NFκB activity and MMP9 expressionUnknownN, some in progress
Quercetin from capers and red onions1Capers and red onionCan improve cognitive function in pre-clinical trials (mice)3, only preclinical dataAnti-inflammatory, inhibits NFκB and MMP9, protects blood-brain barrier integrity, prevents the activation of DAM in ApoE4 carriers.1–2 g/dayN
No alcoholLight alcohol consumption may improve cognitive function in non-ApoE4 carriers, but no alcohol consumption is better from ApoE4 carriers1, 2Drinking no alcoholConsumption of any amount of alcohol may increase the risk of AD for ApoE4 carriers3, good longitudinal dataInflammatory0 units/monthN, not practical to do trials