CAM and Cognition: Does It Work?

Désirée A. Lie, MD, MSEd


April 23, 2013

In This Article

What Would You Do?

Mrs. Lee is a 50-year-old Asian woman with normal cognitive function and a family history of Alzheimer disease (AD). She wishes to delay cognitive decline and to prevent or delay dementia but wants to avoid medications and use "natural" therapies instead. How would you advise her?

Mr. Ortego is a 58-year-old Hispanic man with mild cognitive impairment (MCI). His wife would like to help improve his memory function and his ability to perform daily activities. How would you guide them on complementary and alternative medicine (CAM) or nonpharmacologic therapies for preserving or improving cognitive function?

Ms. Rosenthal is a 65-year-old white woman with early AD who currently resides in an assisted living facility. The facility staff is concerned that she has intermittent behavioral agitation while on a cholinesterase inhibitor. Her caregiver would like a nonpharmacologic intervention to reduce agitation. What would you suggest as a start?

Cognitive Impairment in Older Adults

Older persons account for an increasing proportion of the adult population and are expected to comprise 25% of the total US population within 20 years.[1] Worldwide, 35.6 million persons are living with dementia.[2] Increasing age is associated with a higher prevalence of cognitive decline. Cognitive symptoms are a concern in 3%-15% of older adults.[3]

Mild cognitive impairment (MCI) is cognitive impairment with sound functional capacity and isolated memory impairment without dementia,[4,5,6] although finer aspects of functional impairment have been described in this group. The most prevalent type of MCI is classified as amnestic, or related to memory. The prevalence of MCI in older adults is estimated at 3%, and 3% of those with MCI go on to develop AD; in comparison, only 0.5% of persons without MCI develop AD among the general population.[7,8]

Cognitive impairment is also associated with chronic and acute medical conditions and with such treatments as chemotherapy.[9] In these settings, impairment is often undetected or underrecognized. Even early cognitive impairment can adversely affect mortality and quality of life through heightened risk for comorbidities, such as falls and fractures.[10,11]

Although there is no known cure for AD, delaying disease onset by 6 months will reduce its incidence by 6%, and delaying it by 5 years will reduce its prevalence by 44%.[12] Hence, there is intense interest in therapies that may delay cognitive decline among both cognitively normal adults and those with MCI.