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.
| Treatment | Contraindications | Paper links | Treatment details | Results | Strength of evidence (1-5) | Affected pathways | Dosage | Clinical trials |
| Modified Atkins diet | ApoE4 carriers should monitor their cholesterol on this diet | 1, 2 | Oils/fats, meat, eggs, dairy, vegetables. No sugars, grains, starchy vegetables/roots, processed foods, or most fruits | Improved cognitive function, quality of life for Alzheimer’s patients, prevention of Alzheimer’s | 5 | Optimizing insulin sensitivity, modulating cholesterol and lipid uptake | 6% 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 combined | Y |
| Ketogenic diet or ketones | ApoE4 carriers should monitor their cholesterol on this diet. This should not be necessary in the case of exogenous ketone use | 1, 2, 3, 4, 5, 6 | Fats/oils/MCT oils/ketone salts | Improved cognitive function, quality of life for Alzheimer’s patients, prevention of Alzheimer’s | 5 | Optimizing insulin sensitivity, modulating cholesterol and lipid uptake | Diet-induced nutritional ketosis (βhB > 0.5–5 mM) | Y |
| DHA/Omega 3 fatty acids | ApoE4 carriers may need higher DHA doses | 1, 2, 3, 4, 5 | Fatty fish | Brain DHA levels are lower in individuals with AD, greater consumption of fish and DHA is associated with lower rates of AD | 2, DHA serum levels are predictive of prevention, but trials of supplementation have not resulted in improvements in cognitive decline | DHA can inhibit NLRP3, tune microglia function, inhibit NFκB-MMP9 activity, anti-flammatory, prevents blood–brain barrier breakdown | 2 g/day may be considered a minimum dose | Y |
| Extra virgin olive oil polyphenols | 1, 2, 3 | Extra virgin, cold pressed olive oil | Improves cognitive function | 5 | Inhibits NFκB and MMP9 activity | Minimum 20 g of extra virgin olive oil/d | Y, Mediterranean diet and dose dependent affects of olive oil consumption | |
| Cruciferous vegetable sulphoraphane | 1, 2 | Cruciferous vegetables | Can improve cognitive function in pre-clinical trials (mice) | 3, only preclinical data | Reduces inflammation, reduces beta-amyloid and tau production, increases glutathione, decreases NFκB activity and MMP9 expression | Unknown | N, some in progress | |
| Quercetin from capers and red onions | 1 | Capers and red onion | Can improve cognitive function in pre-clinical trials (mice) | 3, only preclinical data | Anti-inflammatory, inhibits NFκB and MMP9, protects blood-brain barrier integrity, prevents the activation of DAM in ApoE4 carriers. | 1–2 g/day | N | |
| No alcohol | Light alcohol consumption may improve cognitive function in non-ApoE4 carriers, but no alcohol consumption is better from ApoE4 carriers | 1, 2 | Drinking no alcohol | Consumption of any amount of alcohol may increase the risk of AD for ApoE4 carriers | 3, good longitudinal data | Inflammatory | 0 units/month | N, not practical to do trials |