Alzheimer's, ADHD, Parkinson’s and other Neurodegenerative disorders

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


A Long List of Pathological Problems May be Addressed with Complementary and Integrative Medicine, Both in Treatment and Prevention

  • Diet and Lifestyle - Stress Reduction
  • Antioxidant and Detoxifying Therapy with Herbs and Nutrient Medicine
  • Neuroprotective and Restorative Effects for the Brain
  • Neurohormonal and Immune Balancing and Modulation
  • Metabolic Restoration of Homeostasis
  • Chelation of Heavy Metal Toxicity
  • Prevention and treatment of low-grade microbial infections and endotoxins

As this lengthy article illustrates, there is abundant evidence for specific effects of of herbal and nutrient chemicals to effect studied and specific biological goals, and a combination of these effects needs to be devised and individualized in therapy. Acupuncture too is supported by much evidence of specific effects of neuromodulation and stimulation of key areas of the brain. While deep brain stimulation is being researched with some promise, these allopathic treatments affect only one or two areas of the brain, while a prescription of acupuncture and electroacupuncture is shown to affect many areas of the brain, and stimulate a homeostatic cascade of biochemical effects. The evidence to support this wide array of therapeutic benefits from TCM protocol is presented in the section of this article entitled Additional Information and Links to Scientific Study. What is left to do is to have Medical Doctors and patients fully utilize this wealth of knowledge and treatment protocols, finally supporting Complementary and Integrative Medicine and trusting in this evidence-based specialty of TCM.

Not only the TCM physician, but the patients themselves must work hard to overcome the progression of neurodegeneration, though, taking a proactive role and working with a team of integrated physicians. Of course, the best approach is preventive medicine and early intervention with safe and effective protocols. As emerging scientific proof of many common protocols in CIM/TCM effective in these regards grows in volume yearly, we clearly see that many patients receiving standard holistic treatment form a Licensed Acupuncturist and herbalist have obviously been getting effective treatments to prevent neurodegenerative diseases or effectively slow the pathology at early stages, without even being aware of these beneficial "side effects" of TCM therapy.

Lifestyle, Diet and therapeutic regimens may be a key to successful prevention and therapy for neurodegenerative disorders

Healthy diet and exercise routines are very important in the prevention of Alzheimer's and Parkinsonian neurodegeneration, and possibly for other neurodegenerative diseases as well. As we age, or acquire health problems that could lead to a more serious neurodegenerative condition, we should increase our focus on an effective and efficient daily exercise routine and improve our diet. A Harvard study showed that the most physically active men cut their risk of acquiring a Parkinson's syndrome by 50 percent. Women showed a more modest beneficial effect from a lifestyle that included daily exercise. A University of Pittsburg study showed how exercise prevented degeneration of nerve cells that are normally destroyed by disease. Researchers concluded that increased oxidative metabolism was probably responsible for the mitochondrial preservation within the nerve cells. A diet rich in antioxidants along with a routine of simple exercise is thus a key in neurodegenerative medicine.

A 2010 study by Columbia University in New York followed 2,148 older adults in Manhattan with an average age of 77 years, for four years. None of these subjects had dementia, or signs of neurodegeneration, at the beginning of the study, but 4 years later 253 had been diagnosed with Alzheimer's disease, which is an amazingly alarming percentage (over 10%). Of course, these people did not just suddenly acquire neurodegeneration, as this is a very slow process, and we can also assume that a much greater percentage of the subjects had a level of neurodegeneration that did not result in a full Alzheimer's diagnosis. The study followed the diets of this diverse cross section of the population. It found that those persons that ate a diet with sufficient dietary folates, essential fatty acid balance, and Vitamin E metabolites fared well, while those who ate more red meat, organ meat (lunch meats), and fatty dairy products fared poorly. The study concluded that a diet rich in dark, leafy green vegetables, oil and vinegar dressings on salads with hearty greens, fresh nuts, fish, poultry, and fresh fruit lowered the risk of Alzheimer's by over 30 percent.

A University of Toronto study of carbohydrates and cognitive function found a 37% increase in memory and cognitive function occurred in a group of subjects that ate a porridge of barley each morning. Simpler carbohydrates resulted in short lived memory and cognitive benefit. Complex carbohydrates may thus be very important to supplying your brain with the necessary chemicals for neuronal health. While barley may be difficult for many to incorporate into their breakfast diet, steel cut oats, amaranth and various whole grains can be made into delicious warm cereal porridge. Barley sprout powder can be used as a morning supplement, slowly pouring a tablespoon of the powder into warm liquid in a blender. Research concerning the effects of Ritalin on increased memory, cognition and control of hyperactivity in the brain showed that this drug increased glucose metabolism in the brain by 50%. It is suggested that an increased level of glucose bioavailability from a complex carbohydrate diet could achieve similar results.

Omega 3 fatty acids are also important to incorporate into the diet. Studies of Parkinson's patients found a consistent imbalance between Omega-6 and Omega-3 fatty acids in key areas of the brain. Deficiency of the Omega-3 DHA and EPA were common, and linked to various theories of metabolic dysfunction concerning inflammatory regulation and lipid peroxidation. DHA and EPA mutually support each other in the function of vascualar renewal, and deficiency could result in a poor vascularization that contributes to neural cell death or poor neural receptor function. DHA is essential to brain development and growth, and deficiencies have been linked to poor fetal development of brain function. These essential fatty acids are obtained from both foods and supplements. Various fatty ocean fish, as well as some fresh water fish are high in these EFAs, and this preformed DHA increases level more quickly than the foods and herbs rich in alpha-linolenic acid, but this latter class of foods is more commonly eaten and dietary changes incorporating these foods is recommended. The DHA levels rise more slowly from foods and herbs containing the Omega-3 alpha-linolenic acid, but the eventual change may be more dramatic.

Scientists long invested in treatment of populations with malnutrition of Omega-3 and Omega-6 fatty acids highly recommend using a combination of fatty fish with spirulina, blue-green algae and chlorella, which are rich and balanced with these nutrients. Salmon, mackeral and sardine are the fish highest in Omega-3 fatty acids. Trout, herring, anchovy, butterfish and tuna are also high in content. Various cooking, baking and salad oils are high in content, including pumpkin seed oil, and toasted walnut oil. Tempeh and dark, leafy green vegetables, such as collard greens, spinach, kale, chard, some endives, etc. are also rich in alpha-linolenic acid, the precursor to the DHA and EPA. Herbs such as digupi, and xuanshen that clear deficiency heat, and chaihu and cheqianzi, which benefit the liver and kidney, as well as duhuo, sangshen, gouqizi and nuzhenzi are all commonly used in TCM formulas and are rich in linolenic and linoleic acids. Nutritional benefits are one of the side effects of Chinese herbal formulas, a beneficial side effect.

Studies have also shown that excess alcohol consumption is proven to have a detrimental effect on the mitochondrial function of neurons. It is strongly advised that alcohol consumption be kept to a minimum in these disorders. Often, the habitual alcohol consumption increases with the neurodegenerative disorders, since depression and anxiety often result. The informed patient will find healthier means of calming anxiety and dealing with depression. Here, too, herbs, acupuncture, and nutrient medicine can help the patient deal with these problems and ease the elimination or reduction of alcohol consumption. This does not mean that all bits of alcohol must be eliminated, though. Many herbal chemicals need to be extracted into an alcohol medium, or tincture, to be effective, and small amounts of alcohol pose no risk of ill effects.

Studies in 2013 at the Centers for Neurodegenerative and Vascular Brain Disorders and Translantional Medicine at the University of Rochester, Rochester, New York, found that problems with copper accumulation in the brain capillaries and parenchyma (neurons and glial cells) of the brain resulted in greater accumulation of amyloid-beta protein tangles that are highly associated with Alzheimer's disease. Unfortunately, this was not due to a simple excess or deficiency of dietary copper, but rather due to a problem with copper homeostasis (see study link below). Essential mineral homeostasis is highly regulated in the body, and minerals that have a higher electrical potential, able to supply free charged electrical ions easily, such as iron, copper and calcium, are of course regulated in a number of ways, including the control of absorption, transport and storage. Copper is essential in the diet because it is a key constituent of the enzyme complex cytochrome C oxidase, and is found in higher concentration in the liver, bone and muscle. Copper is bound and transported with albumin in the blood to the liver, where it is bound to other specialized transporting molecules, such as ceruloplasmin. Excess copper is excreted via the bile. Copper also facilitates iron uptake and homeostasis, and is found in slightly higher concentration in the female. Copper deficiency is associated with anemia, neutropenia, bone abnormalities, osteoporosis, impaired growth, hyperthyroidism, abnormalities in glucose and cholesterol metabolism, and hyperpigmentation. Copper accumulation in the tissues is associated with Wilson's disease, a genetic abnormality, where symptoms include neurological, psychiatric and those associated with liver dysfunction.

Chronic copper toxicity does not normally occur in humans because of the tight regulation of absorption, transport and excretion. The link between copper accumulation in the brain and Alzheimer's disease thus may involve both genetic and metabolic components, liver function, quality of the protein transporting molecules albumin and ceruplasmin, and aspects of copper homeostasis, such as regulation of the release of minerals from bone storage. Albumin, a carrier protein in the blood, binds about 15 percent of the copper in the circulation, but less tightly than ceruloplasmin, a protein enzyme that binds about 70 percent of the circulating copper. Since ceruloplasmin is also associated with oxidation of iron into ferric iron, where it is tightly bound and transported with transferrin, problems with iron homeostasis and iron overload toxicity may also play a part potentially in problems with copper homeostasis. Elevated levels of ceruloplasmin may also be caused by hormone imbalance, oral contraceptive use, hormone replacement use, lymphoma, and chronic inflammatory disease. A 2008 study at the Oregon Health and Science University, in Portland, Oregon, found that the copper transporter ATP-ase, is essential in a number of aspects of copper homeostasis, as well as normal function and development of the central nervous system (CNS), and could be a key component in the link between copper accumulation and Alzheimer's disease.

The study of acupuncture as an adjunct therapy for Parkinson's disease

In recent years, the study of specific acupuncture stimulations in relation to the treatment of Alzheimer's and Parkinson's disease has increased due to improved means of testing brain function and specific effects on brain chemistry in various parts of the brain. This is largely due to the progress with use of fMRI studies combined with improved use of chemical analysis. Much of this research, of course, must be performed on laboratory animals (unfortunately), but has proven that acupuncture does exert specific beneficial effects that will benefit the patient with Parkinsonism and other neurodegenerative disorders. These studies will advance in the next few years to human clinical trials. For instance, in 2014, a large randomized controlled human clinical trial of acupuncture to treat mild cognitive impairment, the second stage of Alzheimer's disease, was begun at the Beijing Hospital of Traditional Chinese Medicine affiliated to the Capital Medical University, in Beijing, China (PMID: 25391431). So many studies of the effects of acupuncture and electroacupuncture on the brain have found significant, and often startling effects, that the outcome for this and other RCTs is expected to produce proof of clinical benefit. For instance, in 2010, at this Capital Medical University in Beijing, China, Key Laboratory for Neurodegenerative Disorders, researchers found that electroacupuncture stimulation at 100 Hz on specific points significantly improved motor coordination in Parkinsonism subjects by normalizing the GABA content in the midbrain nuclei responsible for the typical tremors and motor dysfunction. This stimulation was shown to have no effect on GABA content in neurons of other parts of the brain, such as the globus pallidus.

This type of electroacupuncture effect was shown to improve motor impairment by increasing GABAergic inhibition in the output nuclei of the basal ganglia (see study cited in Additional Information). In 2014, at this same University in Beijing, and at the General Hospital of the Chinese People's Armed Police Forces, experts showed in a controlled study of Alzheimer's patients and healthy control subjects, with fMRI study and simple acupuncture stimulation, that stimulation at LI4 and LV3 produced lasting increase in connectivity in a number of areas of the hippocampus related to Alzheimer's disease compared to measurements before stimulation in a resting state. The effects were significantly different than those in the healthy subjects, demonstrating that even this simple acupuncture stimulation can contribute to improvements with Alzheimer's disease (PMID: 24603951). This type of electroacupuncture stimulation has been used for some years in China, but these recent research studies now confirm its efficacy, and are finally unhindered by study design that was meant to make these studies nearly impossible to succeed, such as the need to blind the physicians to whether they were administering a real or fake acupuncture stimulation. Decades of such cynical manipulation of study design was finally deemed unacceptable in international research.

This study in Beijing had also previously found that specific electroacupuncture stimulation showed neuroprotective effects on dopaminergic neurons in the substantia nigra, and beneficial modulation of substance P and glutamate decarboxylase in the midbrain, which would explain the positive effects on improved motor function in Parkinsonism seen in studies. These findings showed that restoration of homeostatic mechanisms of dopaminergic transmission were achievable with electroacupuncture stimulation. The benefits to the Parkinsons patient with this therapy may be significant, and exert restorative rather than chemical blocking mechanisms. Combining this electroacupuncture with various other restorative protocols in Complementary Medicine shows great promise in the slowing of, or reversing of, neurodegeneration in Parkinson's Disease.

Key herbal and nutrient medicines in the treatment of neurodegenerative disorders

Unlike synthetic pharmaceutical medicines, herbs usually contain a long list of synergistic chemicals that help your condition in a variety of ways. In this section, key herbs will be explained, but many of the beneficial actions of the numerous chemicals in the herbs will not be explained due to the need for brevity. Of course, in this complicated subject, brevity is a relative term. If you want, you may do further research on the herbs and chemicals contained within the herbs yourself. Often, a small group of herbs and nutrients will be listed in the description of the herb or nutrient, so that you may see how to increase the potential of treatment with a small formula of substances. Of course, therapy guided by a knowledgable professional will achieve the best results, tailoring the treatment to the individual, and proceeding step-by-step in a logical manner to achieve medical goals. Despite the large number of products needed in neurodegenerative therapy, which is a drawback that discourages most patients, those patients that proceed with herbal and nutrient therapy patiently and persistently are thrilled with the results over time.

Is there evidence that herbal medicine really works in the treatment of Parkinson's and neurodegenerative diseases? A growing body of evidence is proving that herbal medicine can work in a variety of ways to reverse neurodegenertion. There are currently 158 scientific citations on the NIH website PubMed concerning herbal medicine and Alzheimer's disease. See some of this great body of evidence by clicking here: and here:

Chinese medical schools and research institutes have been studying the pharmacology and efficacy of Chinese herbal treatments. A review of the promising integrative therapies in 2007 from the Institute of Neurosciences at the Fourth Military Medical University in Xi'an, China stated: (click to link to the U.S. PubMed database PMID: 17691984) Each year the science of herbal pharmacology progesses exponentially, although economic interests in the United States continue to promote an idea that the science of herbal medicine is still undeveloped. Below is some explanation for the various strategies that have been found useful in the therapeutic protocol.

  • Essential nutrients for cognitive function and nervous system health: patients with neurodegenerative disorders should start with a period of replenishment of key nutrients that may be deficient and thus necessary to reverse the disease. You do not need to take these nutrients constantly or forever, but replenishing the body's store and metabolism may be essential to the success of therapy. Vitamin B6 has been found to be deficient in 50% of the U.S. population, and is essential for dopamine production. Choline is necessary for proper transmission of nerve impulses and is a key component of the cholinergic system, as well as fatty acid metabolism in the neural mitochondria. Phosphatidylcholine is an active metabolite of lecithin, and has been proven in human trials to decrease neurodegenerative disease. To utilize choline as as supplement, inositol, Vitamin B12 (sublingual high dose), folic acid, and Vitamin B complex are essential. Inositol hexacotinate is a Vitamin B3 (no flushing effect), and is the preferred type of inositol in this type of therapy. Choline as a food source is available in egg yolks (lecithin source as well), legumes, milk, soy and whole grains, and the taking of choline and inositol supplement with these foods is recommended. DMAE, or dimethylaminoethanol, is another supplement that stimulates production of choline by the brain cells, and also may be very useful. Lecithin, a B Vitamin, is also helpful to increase choline bioavailability, and to aid nerve transmission. The Glutamic acid metabolism is a necessary part of the central nervous system function and GABA regulation, and is best enhanced by taking a combination of L-Glutamate, niacinamide and Vitamin B6 with Choline and inositol (or the combination of P5P, L-glutamine, and inositol hexacotinate). A complete essential nutrient formula may include Choline (phosphatidylcholine), inositol (inositol hexactinate), Vitamin B6 (P5P), L-Glutamine, Vitamin B12 (sublingual or intramuscular injection), folic acid (5MTF is the active form), DMAE and lecithin (phosphatidylcholine). Foods that are dopaminergic include steel cut oats, fermented soy (tempeh), lentils, barley, rice, alfalfa, avocado and fenugreek. A quality dried barley sprout supplement is highly recommended for its array of beneficial chemicals, which include three types of anti-inflammatory biologics, chlorophyll, PD41 and mucopolysaccharides, as well as being a rich source of healthy proteins, enzymes and Vitamin A. Barleygrass sprouts also contain SOD, super-oxide dismutase, to help clear heavy metal toxicities and their oxidant free radicals.
  • Omega-3 Fatty acids, EPA and DHA: a 2007 study listed below confirms that these essential fatty acids are often deficient in the Parkinson's, Alzheimer's and ADD patients studied. A study published in the medical journal Neurology in 2012, headed by Dr. Nikolaos Scarmeas of Columbia University, showed that a broad population study confirmed that individuals with a dietary deficiency of omega-3 fatty acids had significantly higher levels of the problematic beta-amyloid proteins AB40 and AB42 in circulating blood plasma, despite differing levels of saturated and monounsaturated fats, omega-6 fatty acids, and other key nutrients. An excess of the Omega-6 essential fatty acids in our diet (usually due to a high intake of red meat) contributes to a dysfunction of the cells and inflammatory regulation in key areas of our brains, but the key point in this study is that the stripping of omega-3 fatty acids in commercial oils and transfats may be largely responsible for the increased problematic beta-amyloid proteins that comprise the core of brain plaques in Alzheimer's patients. The Omega-6 fatty acids should be balanced with Omega-3 for optimal health of the metabolism in neurodegenerative disorders, but the inclusion of fats and oils with omega-3 fatty acids, and a decrease in consumption of processed foods, fast foods and transfats is perhaps the most important factor related to problematic beta-amyloid proteins. A relative deficiency of Omega-3 fatty acids may impede membrane fluidity at the dopamine receptor sites by allowing stiff membranes to form. The best source of Omega-3 fatty acids, DHA and EPA, is krill oil, concentrated and possessing a natural preservative, unlike fish oils and flaxseed oil. EpaQ by Health Concerns is recommended. This oil is so concentrated in the right type of essential fatty acids that just one or two small capsules per day is needed, instead of the tablespoons of fish oil required. If you are a vegetarian, or vegan, you may have a deficiency of omega-6 fatty acids. The balance of omega 3 and 6 is essential to optimum health. A healthy source of omega-6 fatty acids are the algaes, spirulina, chlorella and blue-green algae (chlorella is also effective as a chelating agent to clear heavy metal accumulations).
  • Rhodiola rosea or Hong jin tian: imnproves dopamine optimization and serotonin bioavailability. Dopaminergic herbs include Muira puama, Murcuna pruriens, Salvia miltiorrhiziae (Dan shen), Alismatis orientalis (Ze xie), and Uncaria tomentosa (Gou teng or Cat's claw). Dapamine receptor sites will be enhanced through the nutrient Sam-E. Dopamine is a neurotransmitter that accounts for 90% of the catecholamines in the nervous system and is a precursor to norepinephrine and epinephrine, key adrenal neurohormones. Adrenal insufficiency could result in increased demand for dopamine as a precursor. Adrenal health can be enhanced by the use of a small formula called Adrenosen, from Health Concerns, that contains PKA, barley sprouts, wild mountain yam, schizandra berries and the hyacinth bean. In women, copper is in greater demand, and is sometimes deficient. The catecholamine oxidative metabolism of dopamine in the citric acid cycle of mitochondrial health, as well as oxidative conversion to norepinephrine, is dependant on a copper-containing enzyme, dopamine beta-monooxygenase. Copper in the diet is derived from organ meats, some seafood, dried beans, quality nuts and whole grains. Copper supplementation must include cofactors of zinc methionine (Opti-zinc) and folic acid to assimilate, but the 2.5 mg copper supplement (in the form copper amino acid chelate) should be taken about 2 hours after the zinc supplement to avoid competition in absorption. Rhodiola, muira puama, Cat's claw, SamE, Adrenosen formula, Essential Minerals, and zinc monomethionine (OpticZinc) would provide a course that is sure to improve dopamine optimization.
  • Uncaria Tomentosa or Cat's Claw: uncarine alkaloids (the Chinese herb Gou teng is analagous) have been studied and found to exert a beneficial effect on memory impairment induced by cholinergic dysfunction. Cat's claw is also dopaminergic and stimulating of the glutamate metabolism. Maca has been studied as a synergetic herb used in combination with Cat's claw to achieve enhanced effect (maca also contains uridine, an essential cofactor for mitochondrial neural glucose usage). Alpha-glyceryl-phosphoryl-choline, or Alpha-GPC, also aids the cholinergic system, acting as a precursor to acetylcholine, or ACh, and has been proven in studies to enhance memory and cognitive function. Inositol and Choline are often useful to enhance the treatment of cholinergic dysfunction, allowing for greater bioavailability of choline. To enhance assimilation of Choline, inositol, Vitamin B12 (sublingual large dose), folic acid, Vitamin C, and Vitamin B complex are helpful cofactors. Alpha-GPC is available in the Health Concerns product called Cogni-Spark.
  • Resveratrol, an active chemical found in the Chinese herb Polygonum cuspidatum, or Bushy knotweed, Hu zhang: this antioxidant is now well known and utilized, even by M.D.s, to protect dopamine neurons from degeneration. Patients report significant benefit soon after starting the herbal supplement. Perhaps due to this success there is now a plethora of misinformation about this chemical. Many doctors tell their patients that the chemical is extracted from red wine or grapes, when all studies show that the amount of this chemical in red wine is very small, and the companies marketing this herbal supplement obtain the chemical from the Chinese herb Polygonum cuspidatum. Newer studies cite the poor absorption of reservatrol from red wine and grapes to counter it's success. The truth is that a concentrated supplement from the herb prepared properly, or an extract in an alcohol tincture is effectively absorbed and utilized by the human body. The combination of resveratrol with another Chinese herbal chemical antioxidant, quercetin, is now available in standardized form, with Vitamin Research Products offering Resveratrol Plus.
  • Huperzine and Vinpurazine, from Clubmoss and Vinca Periwinkle: studies in Shanghai confirm that huperzine works better than tacrine or E2020 (the analogous drug used in the U.S. is Aricept), chemical anticholinesterases, to enhance memory and reverse neurodegeneration. The first group of drugs approved by the FDA to treat mild to moderate Alzheimer's are the acetylcholinesterase inhibitors, and huperzine is one of six herbal chemicals in Chinese herbs found to have significant anticholinesterase effects in scientific studies, and is also approved by the FDA now. The Health Concerns product Vinpurazine combines these two herbal chemicals with rosemary extract to form a potent combination, which also clears excesses of chronic inflammation in the CNS cells. A companion formula to aid function and maintenance of brain cells is called CogniSpark, consisting of L-alpha-glyceryl-phosphyl-choline (Alpha-GPC), which should be taken with L-carnitine and R-lipoic acid before 6 pm. The benefits of Huperzine A have been found to be broad, with significant acetylcholinesterase inhibition, antioxidant effect, modification of the amyloid beta pathway to decrease tangles, and enhancement of the beta-catenin pathway of neurovascular regrowth and cell adhesion.
  • Quercetin: the herbal and nutrient chemical is much studied and has passed initial tests on laboratory animals with induced neurodegenerative disease with flying colors in a number of University Medical Schools around the world. Quercetin acts as a potent antioxidant and phytohormonal agent, and standardized quercetin in now widely used in nutrient and herbal supplements to improve brain health and function. This chemical has shown potent ability to enhance the cell detoxification effects with superoxide dismutase and glutathione, and increase the activity of acetylcholinesterase, as well as activate the innate cellular detox and antioxidant pathway via Nrf2 expression (see study links below).
  • Trypterygium wilfordii or Lei gong teng, and Scutellaria baicalensis, or Huang qin: studies have confirmed that these herbs will protect dopaminergic neurons from inflammatory processes and inflammation mediated damage by inhibiting microglial activation of inflammatory mediators. Many citations of research published by the NIH on the PubMed research database show significant benefit from Trypterygium wilfordii. PMID 12504865 shows that the herb is found to benefit dopaminergic degenerative neurons. PMID 16989518 shows that there is some mild toxicity to the herb and should be used only with professional guidance, but that it contains alkaloids useful in chronic inflammatory states. PMID 16989518 shows that safety and efficacy has been confirmed in human clinical trials in the United States and abroad. PMID 17240858 shows that the herb inhibits key inflammatory cytokines that are linked to chronic inflammatory states. There are many beneficial chemical effects of Trypterygium, including immunomodulation and the inhibition of TNF-alpha, and IL-12, cytokines suspected in the cause of many cases of neurodegeneration. Clearly, this abundant research points to the fact that a variety of traditional herbal medicines that are used to treat deeply penetrating low-grade infections of an array of microbes and viruses show great potential in the prevention and treatment of neurodegenerative disease, especially Alzheimer's.
  • Alpha Lipoic Acid plus L-Carnitine: this combination will aid mitochondrial efficiency and clear buildup of sticky proteins that have been linked to Parkinson's and Alzheimer's pathologies. Sticky proteins are misshapen beta-amyloid extracellular plaque deposits, sometimes called tangles. Causes of the misshapen lipoproteins may be linked to toxic heavy metal accumulation, such as alumninum from cookware, along with accumulations of oxidant free radicals as the body tries to clear this accumulation. ALA helps to neutralize the effects of free radicals by enhancing the antioxidant benefits of Vitamins C, E, and glutathione. Carnitine is a B vitamin with a chemical structure similar to amino acids, whose main function is to help transport long-chain fatty acids, and also enhances the antioxidant effects of Vitamines C and E. Carnitine is produced in the body if sufficient amounts of B1, B6, lysine and methionine are available, and Vitamin B6 deficiency is common in the population. Vegetarians are more susceptible to deficiency, and a chief symptom of deficiency is confusion. The combination of these two nutrients helps antioxidant maintenance of neuron mitochondria as well as prevention of unwanted lipid proteins called sticky proteins, which are the subject of much research into the pathophysiology of Alzheimer's. Research has revealed that R-Lipoic Acid may be more effective, and Carnitine is included in the product Neuron Growth Factors (Vitamin Research).
  • SAMe, or S-adenosylmethionine, converts to methionine at D4 dopamine receptors sites, which becomes part of the healthy beta-amyloid protein structure at dopamine receptors. Dopamine receptor sites also need 5MeTHF, a folate and methyl donor for homocysteine, to methylate phospholipid membranes, and allow for healthier fluidity, or transport of molecules, across the membranes of dopamine receptors. 5MeTHF is deficient in the livers of patients with riboflavin, or Vitamin B2 deficiency, which is another common deficiency in the population, especially for patients who have used oral contraceptives, consumed excess alcohol, taken prolonged courses of antibiotics, or engaged in strenuous exercise. One of the signs of B2 deficiency is slowed mental response. 5MeTHF may also be deficient if the body has a folate deficiency, and dietary folic acid does not satisfy the demand for natural folate metabolism. A Vitamin B12 deficiency, also common in the elderly, contributes to this metabolic neurodegeneration. A combination of SAMe, Vitamin B2, B12 methylcobalamin, and 5MTHF folate is recommended to reduce sticky proteins and stiff membranes at dopamine receptor sites to insure healthier metabolism. To reduce beta-amyloid (Abeta) accumulation, or sticky protein plaques, the chemical S-allyl-L-cysteine from water extract aged garlic has also been proven effective. Astra Garlic is a formula from Health Concerns that is a synergistic blend of herbs for this effect. The Chinese herbs Yu jin and E zhu (curcuma zedoaria), which contain curcuma, have also been proven to break up and prevent beta-amyloid plaque accumulation. Regeneration is a formula from Health Concerns is a formula that contains curcuma and has a blend of herbs that could greatly benefit the Alzheimer's patient. Since the effects of curcuma are dose dependant, the herbalist sometimes prescribes a decoction of curcuma for a period of time, and this decoction has the added benefit of aiding digestion by increasing stomach and pancreatic secretions and bile flow, as well as being a proven anti-cancer agent. Short courses of these supplements and herbs may have a significant effect on neurodegeneration.
  • Bacopa Monnieri: Bacopa monnieri is a well-known and highly studied ayurvedic herb, called Brahmi, or water hyssop. Scientific studies show remarkable improvement in cognitive function with this herb. Many scientific studies in India have demonstrated that Bacopa has strong neuroprotective effects, antioxidant effects, and restoration of neural cell membrane enzymatic functions, including acetyl cholinesterase, decreased LPO (lipid peroxidation), and improvement in memory and cognitive function. Lipid peroxidation refers to oxidative degradation of lipids, where excess free radical reactive oxygen species take electrons from cell membrane lipids, resulting in neural cell damage. The decrease in LPO reflects an essential neuroprotective effect of the herb, aiding cell membrane function and health.
  • Mucuna pruriens: This herb contains a significant amount of L-Dopa (levodopa) and in double-blinded placebo controlled human trials compared to pharmaceutical L-Dopa, as the Universities of Southampton and Dusseldorf, and the Institute of Neurology in London (see study link below), this herbal extract in a powder worked better than pharmaceutical L-Dopa, and had a quicker response. Traditionally the herb, often in an alcohol glycerite tincture, was used to treat fatigue, impotence, lowered libido, and Parkinsonism.
  • Bioflavonoids, such as are found in Gingko biloba and many Chinese herbs: there are many bioflavonoid chemicals in the body, including quercetin, rutin, hesperidin, and eriodictyol, and bioflavonoids cannot be produced by the body, and are thus called essential nutrients. Depletion of our soil chemistry by modern farming methods has resulted in widespread deficiencies of bioflavonoids, which are linked to neurodegenerative disorders. These nutrient chemicals are important in microcurculation, antioxidant clearing, and cellular metabolism. A number of herbs are rich in bioflavanoids, which account for much of their success in therapy, the most well known being Gingko biloba. It is recommended that you ingest a variety of bioflavonoids to insure success. I recommend the herbal formula Flavonex, from Health Concerns, along with a tincture of fresh Gingko biloba leaf, and a diet that includes organic oranges, lemons, grapes, dried apricots, dried cherries, black currants, bell peppers, and dried buckwheat sprout powder. Vitamin C is an excellent cofactor to bioflavonoids, and the supplement formula Astra C, from Health Concerns, is highly recommended a part of the flavonoid regimen.
  • Antioxidants, especially CoQ10: Coenzyme Q10 is a vitaminlike substance that is also called ubiquinone, because it is needed by most cells in the body, hence ubiquitous. This chemical is essential to mitochondrial function and oxidative processes, and has long been an important part of standard medical therapy in Asia for treatment of Parkinson's, Alzheimer's and other neurodegenerative diseases. CoQ10 also aids circulation and microcirculation, stimulation of the immune system, prevention of cell aging or cell death, and tissue oxygenation. Deficiencies of CoQ10 are common, and are linked to such diseases as muscular dystrophy. Deficiencies may be caused by a number of common pharmaceutical medicines, including the cholesterol lowering statins, beta-adrenergic inhibitors prescribed for hypertension, tricyclic antidepressants, and anti-diabetic sulfonylurea drugs. More than 12 million patients are prescribed CoQ10 in Japan by their medical doctors. CoQ10 supplements vary considerably in quality and bioavailability, and enhanced forms, as well as sublingual powders are available. CoQ10-H2 is a form that is much better absorbed and significantly more active as a metabolite. CoQ10 is oil soluble and best taken with fatty or oily foods, especially sardines, mackerel and salmon, which contain the highest amounts of CoQ10 in foods. Peanuts, beef and spinach also contain CoQ10. Taking CoQ10 supplement with Krill oil, a potent source of essential fatty acids, especially EPA and DHA, or omega 3 and 6, is recommended as well.
  • Other antioxidants proven to protect dopamine neurons: epigallocatechin gallate in tea (camellia sinensis), especially quality green tea, is effective. Super oxide dismutase, or SOD, is a potent antioxidant the clear superoxides, which are a more harmful type of reactive oxygen species. A short course of copper/zinc SOD may be helpful, if you can find this supplement, but SOD is found in abundance in dried barleygrass powder, and this may be an easier supplement to find. Numerous large studies also point to the positive effects on memory from intake of barley, and properly prepared dried barleygrass contains an array of nutrients that make it a superfood. Gingko biloba standardized extract EGb761 was shown to be significantly neuroprotecive of dopamine depletion. Go to my article on antioxidants to learn more.
  • Glutathione metabolism and the nutrients needed to insure health: a deficiency of glutathione function is linked to many types of oxidative stress, and oxidative stress in the mitochondria of key nerve cells is a major part of the neurodegenerative process. To insure a strong glutathione metabolism it is recommended that liver function is optimal, and that a number of nutrients that are precursors to cellular glutathione metabolism are available in the body. These include, L-glutamate, N-acetyl-L-cysteine, and L-glycine. B12, active folate (5MTHF), and methylselenocysteine are also some of the essential aids to restoration of glutathione metabolism. Milk thistle and Schizandra berry are also beneficial to the glutathione metabolism of the liver. Studies of stroke patients revealed that those with deficient glutathione metabolism had a marked increase in oxidative damage in the hippocampus and corpus striatum. Excess glutamate metabolism may be responsible for some cellular damage in acute ischemic stroke, as the chemical floods the cells. In chronic pathology, it is believed that poor conversion of glutamate to glutathione may be responsible for excess glutamate metabolism. Simple taking of glutamate is a problem, and promoting of an improved glutamate metabolism is often needed, which is more complicated. Glutamates such as MSG, or monosodium glutamate, are now common in the food industry, and have resulted in the human organism acquiring specialized glutamate receptors in the brain and brainstem, often which interfere with normal brain function. To understand the key ways to restore glutathione function in your cells, and to understand how the glutamate metabolism may be made healthier and functional, you may refer to my articles entitle Glutatione Metabolism: restoration and function, as well as the article entitled Brain Health and Function. Unfortunately, helping your cells to detoxify and reverse excess oxidant stress is not a simple process, but it may be an essential task with neurodegenerative disorders.
  • L-Tyrosine: this amino acid is a precursor to dopamine and norepinephrine, which regulate mood and muscle firing, and are the key neurotransmitters deficient in function in Parkinson's and other neureodegenerative disorders. Tyrosine is used extensively by the thyroid gland and attaches to iodine to form thryroid hormones. Hypothyroid states, as well as deficient iodine states, could be related to deficient tyrosine, and this supplement could be a key part of therapy in both neurodegenerative disorders and hypothyroid dysfunction. Food sources include almonds, avocadoes, bananas, dairy, lima beans, pumpkin seed, and sesame seed. L-Tyrosine supplements should be taken with high carbohydrate meals, such as breakfast porridge, or with a small snack at bedtime so that the intake does not compete with other amino acids in the diet. Studies have demonstrated that increased tyrosine bioavailability can enhance dopamine synthesis in and release from nigrostriatal neurons if the firing rates of these neurons are accelerated, as in more advanced cases of Parkinson's degeneration, where the surviving cells are found to fire at increased rates to compensate. (Proc Natl Acad Sci USA 1980 Jul;77(7):4305-9 6254020 (PSGEB) E Melamed, F Hefti, R J Wurtman). As with all amino acids, concurrant use of active Vitamin B6, or P5P, will also enhance absorption and utilization.
  • R-Lipoic Acid: R-Lipoic Acid is rightly called the 'mitochondrial antioxidant', and many scientific studies (cited below) demonstrate its role in preventing or decreasing depletion of glutathione antioxidant compound (GSH). Lipoic acid is one of the most thoroughly investigated dietary supplements and most healthcare practitioners agree it is a preventive supplement of choice. R-Lipoic Acid is a more potent form – the more biologically active form – of alpha lipoic acid. As such, it offers more benefit with a lower dose. Lipoic acid serves to regenerate vitamins C and E, and helps maintain glutathione levels, a vital cellular antioxidant and liver protectant. It is a vascular and neuroprotective agent. The effects of R-Lipoic acid may occur after weeks of taking this supplement due to the positive indirect effects it produces.
  • 5HTP: there is some link between the serotonergic fibers in the striatal tissues of the basal ganglia and dopamine conversion and production in these 5HT (5-hydroxytryptophan) fibers in scientific study. Taking the 5HTP supplement (from Griffonia seed) may aid the dopamine metabolism. Study on animals found that the drug L-Dopa may be converted to dopamine within the 5HT fibers, and 5HTP possibly has some effect that may enhance the effectiveness for patients taking L-Dopa. 5HTP is also a precursor to melatonin, which is proven to be a potent neuroprotector for dopamine neurons. Both the amino acid L-Tryptophan, and 5-HTP, are precursors to serotonin and melatonin, and 5-HTP is able to pass the brain blood barrier to provide increased bioavailability of these important neurotransmitters. To enhance this metabolic bioavailability further, a blend of low dose 5-HTP, melatonin, P5P and St. Johnswort extract is recommended (re: Positrol from Vitamin Research).
  • St. John's Wort, Hypericum perforatum: this much maligned but effective dopaminergic and neuromodulating herb has been both proven safe for use and effective in the treatment of Alzheimer's and neurodegenerative disease. Prior reports that chemicals in St. John's Wort could alter levels of other pharmaceutical medications through competition in liver catabolism of the P450 enzyme pathway were shown to be overblown. Studies revealed that the effects of chemicals in St. John's Wort were modulatory of liver function, and that effects on the P450 enzyme pathway were modulated and normalized within two weeks of use to achieve a homeostatic effect despite catabolic competition from harsh pharmaceuticals. This was accomplished because a variety of chemicals in hypericum act to improve liver function. Of course, this also implies that the whole herb extract, and not pharmaceutical products with just the active ingredient enhanced, should be used. To see the current research on St. John's Wort, click here:
  • Topical progesterone and pregnenelone creams: studies show that progesterone modulates dopamine release in the corpus striatum and the pregnenelone could modulate the dopamine transmission in the corpus striatum by causing changes in the activity of tyrosine hydroxylase and/or in the pre- and post-synaptic dopaminergic terminals. This neurosteroid mechanism could be a new kind of neurotransmitter systems modulation affecting dopamine metabolism significantly. (Neurol Res 2007 Jan 16; 17535560 (PGSEB)). Since estrogens also are integral to neuron mitochondrial health, estriol cream may also be useful. Use of these simple bioidentical hormone therapies could have significant effect, especially if there is a progesterone and estradiol deficiency. Testing and administration should be overseen by a professional, as we want to utilize low doses of bio-identical hormone creams, and do so in a balance manner. These same hormones may have negative impact if too high of stimulation is suddenly introduced in a neurodegenerative patient. Studies reveal that hormonal deficiencies are the key to the beginning of the neurodegenerative process, so patients should try to maintain healthy hormonal homeostasis as they go through menopause and andropause. These simple herbal products could be the key to prevention. In 2012, a study sponsored by the NIH and overseen by Emory University in Atlanta, Georgia, showed that administration of progesterone immediately after brain trauma dramatically reduces mortality and neural damage. Patients with moderate traumatic brain injury experienced greater functional improvement when progesteron was administered. This study confirms findings reported in China. Decades ago, a researcher at Emory University, Donald Stein, noted neuroscientist and professor of emergency medicine, found that laboratory animals with high levels of progesterone performed better in tests of memory and cognitive function. Dr. Stein and his associates noted that progesterone stimulates a number of processes in the brain, providing antioxidant, neuroprotective and neural rebuilding effects, especially the promotion of myelin production in damaged cells.
  • Vitamin D3 cholecalciferol: recent studies of Parkinson's patients found a significantly increased incidence of Vitamin D3 hormone deficiency over the general population, which also shows a high rate of deficiency in this important hormonal chemical (85% in some studies). While these results are not highly significant at this stage of investigation, supplementation with cholecalciferol might help the neurodegenerative patient. Cholecalciferol Vitamin D3 is the prohormone, and is generated each day in our skin with exposure to midday sunlight for 5-10 minutes. Take the pills or liquid D3 in the morning with breakfast, and also go for a walk in the midday sunlight with the face and arms exposed each day. D3 supplements are still of relatively low dosage, and both supplements and sun exposure without sunscreen is recommended. Even these methods, though, may not be enough, as the endproduct hormone D3 is dependant on healthy kidney and adrenal function. A complete regimen, with both supplementation, sun exposure, and a combination of acupouncture and herbal medicine to insure improved kidney and adrenal function is recommended.
  • Herbal formula to enhance brain circulation: circulatory aids are helpful both for brain circulation, as well as peripheral circulation in Parkinson's. Circulatory aid is beneficial to improve cognitive function, repair of the nervous tissues, increased benefits from the other herbal and nutrient medicines, and peripheral circulation. I recommend Cir-Q from Health Concerns. A number of professional herbal formulas address the stimulation of increased circulation in the brain, as well as cognitive and mood benefits, though, and the Licensed Acupuncturist and herbalist is able to provide an individually tailored herbal formula for each patient.
  • Red Mold Rice extract: a number of polylipids from specific fermented grains have been proven to affect lipid metabolism in a healthy way and now show promise in the treatment of Alzheimer's. A combination of effects, including reduction of amyloid beta-peptide plaque, called neurofibrillary tangles, as well as various antioxidant and antiinflammatory mechanisms were found in this herbal supplement. I prescribe the Health Concerns supplement Polylipid, as well as Red Mold Rice extract. This common nutrient food and natural food color in China was the source for the statin drugs created to lower cholesterol. To review the research, click here:
  • Endocannabinoids: research around the world has confirmed that cannabinoids are not just chemicals found in marijuana, but actually are important chemicals used by the brain to regulate excessive activity of dopamine neurons in the corpus striatum. Studies at numerous universities found that patients that had used marijuana for some time in their life had a 30% decrease risk of acquiring Parkinson's. Stimulation of endocannabinoid cellular production, as well as the bioavailability of endocannabinoids from hemp seed in the diet, are being explored by scientists today. It could be that a topical cannabinoid cream that is oil based is the answer to immediate effect. Such a cream has been developed in England and is used to decrease neuralgia. Unfortunately, U.S. pharmaceutical lobbying has prompted the FDA to delay approval on the U.S. market of this benign topical medicine. There is no connection between the drug effects of THC in marijuana and this valuable herbal medicine.
  • Anticholinergic herbs: sometimes cholinergic dysfunction in Parkinson's can be calmed with anticholinergic chemicals, which have been used successfully at times by modern medicine. This treatment protocol runs counter to the anticholinesterase protocol, but in some cases has reduced acute symptoms related to cholinergic nerve stimulation. Some herbs have both anticholinergic chemicals and anti-cholinesterase chemicals, implying a modulatory effect on the cholinergic system. These effects will be milder than those produced by synthetic anticholinergic chemicals, but will have no side effect. The herbs that contain anticholinergic chemicals include the mulberry parts, leaf, bark, stem, and fruit, called Sang ye, Sang bai pi, and Sang shen, as well as Corydalis, or Yan hu suo, and Artemesia abrotanum, or Southernwood. Horse chestnut bark also contains an anticholinergic, and is beneficial for the health of the veins and veinous circulation. This herb is found in the Health Concerns formula, Formula V, along with butcher's broome and stoneroot. Some antichonlinergic herbs contain scopolamines, and are a little toxic, thus are rarely used, and monitored professionally. These include Jimsonweed and Anisodus tanguticus, or Zang qie. This type of therapy may be indicated for more advanced cases to control symptoms.
  • Immunomodulating herbs: recent research in neurodegenerative disease has led us to discover how the immune system is directly involved in a complex process leading to the persistence of degenerative failure of the process that protects our brain cells and glial support. While genetic research has failed to find specific genes that may be affected to reverse this disorder, the genetic research has delivered a lot of information important to therapy. For instance, the neurodegenerative condition called amyotrophic (muscle atrophy) lateral sclerosis (scarring of nerve tissue), or ALS, has revealed that mutations in the gene that produced cellular superoxide dismutase (SOD) results in a deficiency of this important antioxidant mechanism in about 20% of inherited cases of ALS. While no single genetic mutation has been found, 135 different mutations in the gene have been discovered that are associated with the ALS disease process. There is no single pharmaceutical agent that will correct this. The mutations discovered reveal that the SOD enzyme, which normally functions to clear free radical oxidants from the brain cells, now may be causing misshapen proteins in the cell nucleus of the neuron. The cause of the numerous genetic mutations is exceedingly complex, and the immune complement system has been heavily researched to find an imbalance in inflammatory mediators that could be driving these mutations. TNF-alpha is the immune mediator usually involved in driving excess mutations that lead to cancerous cells, and is the target of both much research, and now a novel approach to treatment of neurodegenerative conditions. Herbal research has also revealed how nature has created potent chemicals to modulate the activity of TNF-alpha, both by inhibiting its expression and by modulating the balance of immune chemicals that keep it in check. This highly evolved system of immunomodulation produces effective chemicals that are evolved to be free of the harsh side effects that the man-made chemicals create. A number of herbs are proven effective in this regard, and are now being tried and tested to determine the efficacy.
  • Carnosine and AGE block formula: Carnosine is an amino acid that is useful in the treatment for reduction of AGEs, or advanced glycation endproducts, which are implicated both in arterial plaques (atherosclerosis) and in neural plaques in neurodegenerative disease. Research in recent years has found the carnosine exerts potent inhibitory effects of excess glutamate and NMDA neurotoxicity (see link to the research below). NMDA glutamate receptor blockers or antagonists, as well as non-NMDA glutamate antagonists are now a widely used pharmaceutical for the treatment of various neurodegenerative conditions (re: Amantadine and other drugs). Carnosine and AGE block presents a safe and effective form or this treatment to use in the overall strategy.
  • Uridine: uridine is a nucleoside (RNA component) that is formed when uracil is attached to a ribose ring in health sugar metabolism. Uridine is an essential component for sugar utilization by neuron mitochondria, and has been touted as an effective aid in neurodegenerative states. Uridine is found in the Chinese Siberian ginseng, as well as the Peruvian herb Maca, and is now widely used as a supplement. Neuron Growth Factors (Vitamin Research) combines uridine with other essential aids to neuron health in a formula. Foods high in uridine content include natural brewer's yeast, sugar beets, unprocessed sugar cane or sugarcane extract, and organ meats (e.g. liver).
  • Green Perilla Leaf: research has revealed that various herbal and food chemicals activate the innate cellular detox and antioxidant pathway of Nrf2 expression. Green perilla leaf, a common vegetable used in Japanese cuisine, especially with types of sushi, is shown to be highly effective in this regard. Purple perilla leaf is a common herb used in Traditional Chinese Medicine, called Zi su ye. Studies have also revealed that the Chinese herb Ganoderma lucidum (Ling zhi, or Reishi mushroom) also achieves detox and antioxidant effects via the Nrf2 pathway activation. A 2006 review of herbal chemicals in potential drug-herb interactions, by the pharmaceutical giant Bristol-Meyers Squibb, in Princeton, New Jersey, U.S.A. concluded that "dietary phytochemicals can cause induction of drug metabolizing enzymes...including the nuclear factor erythroid-derived 2 (Nrf2) transcription factor." While the drug companies continue to try to find evidence of negative drug-herb interactions, the actual clinical evidence of harm is almost nonexistent. What this study reveals is that herbal and nutrient chemicals do exert significant induction of natural antioxidant and neuroprotective pathways, as confirmed by expert chemists at major pharmaceutical research facilities.

How Complementary Medicine may even help caregivers in the treatment of advanced Alzheimer's disease

A January 1, 2011 article in the New York Times demonstrates the current effective approaches in the treatment of advanced Alzheimer's disease, and findings that providing a better environment for the patient is much more effective than giving them pharmaceutical drugs to control behavior, which have been proven ineffective to a large extent, and often even worsen the patient's condition. This article details how progressive and effective care facilities adapt to patients by increasing individualized activities and improved environments that create positive emotional experiences for the individual patient. Catering more to the individual needs and desires of the patient was found to be much more effective than a rigid one-size-fits-all routine and increased control of the patient. Giving patients more independence and providing stimulation of emotionally soothing activities and routines proved very beneficial to both patients and caregivers, who themselves experience much stress. Programs of providing training and counseling in this regard for family members that provide home care also was proven able to delay the time that the patient had to be transferred to a specialized care center. The article is available by clicking here:

Incorporating the care of Complementary Medicine physicians into the care of a relative with advancing Alzheimer's and Parkinson's diseases can be problematic. Combative and confused patients may be difficult to convince to go to a clinic to be treated. By learning how to handle these patients better at home, though, relatives may be able to more easily soothe apprehensions and convince the patient to attend treatments. Often, after the patient experiences the relaxation and calming effects of acupuncture, and even some physiotherapies, there is an emotional memory, though, that provides an incentive to go back to the clinic and be treated. This may not happen after the first few treatments, but an emotional memory and appreciation may develop. Patience and persistence may be the key. Addressing not only stress in treatment, but pain as well, may address some of the reasons why the patient is unhappy and responding with negative emotional outbursts and bad behavior. New research suggests that emotional memory and emotion-driven behavior persists after cognition deteriorates, and therapy that provides an emotional relief may stick with the patient even when cognitive memory fails.

With the aging of the U.S. population, an explosive growth in the area of geriatric nursing care is presenting us with significant alarm concerning the way the elderly patients in nursing care facilities are treated. A New York Times article on May 10, 2011, reports that the U.S. Health and Human Services (HHS) has revealed in an audit that about 1 in 7 patients in nursing homes were routinely prescribed an anti-pychotic medication that was charged to Medicare. The actual number of prescriptions may be much higher, as Medicare supplement insurance policies also cover the prescription of drugs, and patients with a high expenditure on pharmaceuticals have been denied payment for drugs that fell within the "doughnut-hole" of drug expenditures. This audit revealed that about 50 percent of these anti-psychotic prescriptions charged to Medicare in 2007 did not meet FDA guidelines for usage, did not meet the standards set by Medicare for prescription and payment, and have been deemed erroneous claims. In fact, this HHS audit found that 83 percent of these prescriptions were for off-label uses, meaning for conditions not approved by the FDA, and that 88 percent of these antipsychotic medications were prescribed to patients with dementia, despited FDA warnings of a higher risk of death and serious side effects in this population, and perhaps a worsening of the neurodegenerative dementia with use of antipsychotic medications. The government has investigated drug companies for illegally marketing these drugs, resulting in many billions of dollars in settlements in lieu of fines, and fines for illegal kickbacks by pharmaceutical companies paid to nursing care companies have also occurred. For example, in 2009, a pharmacy chain tied to nursing homes, Omnicare Inc., paid a settlement of $98 million to avoid fines and settle accusations that major drug companies paid hundreds of millions of dollars in kickbacks to get Omnicare to overprescribe antipsychotic medications. Often medical doctors are paid very little to prescribe care at these facilities, spending only minutes with patients, and prescribing a large number of drugs. Senator Charles Grassley, head of a commerce committee oversight panel on abuses in the health care industry, called for this audit, and stated: "These results are alarming. Medicare officials need to pay attention." In 2013, yet another enormous settlement in lieu of a criminal penalty was paid to resolve charges of illegal marketing and kickbacks to doctors who prescribe anti-psychotics off-label to elderly patients in nursing homes, with Johnson and Johnson agreeing to a $2.2 billion settlement to avoid prosecution or official acknowledgement of criminal guilt. Patients and their families need to address the issue of proper care of the elderly with dementias, and to do more to prevent these diseases from progressing at early stages. The implications are that drugs routinely prescribed to sedate and control the elderly patients may be responsible for the advancement of their neurodegenerative conditions, such as Alzheimer's disease.