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Chinese alternative for dementia treatment

11-Jun-2003

A herb used for centuries in traditional Chinese medicine could treat some of the dementia resulting from stroke just as effectively as conventional drugs prescribed for the condition, suggests new research.

Treatment with a compound granule of Chinese gastrodine appears to improve impaired memory, orientation, language and other effects of stroke in patients with mild to moderate vascular dementia (VaD) after stroke, according to a study presented yesterday at the American Heart Association's Second Asia Pacific Scientific Forum.

Vascular dementia is one of the most common dementias after Alzheimer's disease, and is a growing problem in China, with a prevalence of about 1-3 per cent, similar to prevalence rates in the United States and Europe.

With much of the medication for the condition too expensive for most patients in China, researchers focused on finding treatments that would be effective and less costly. Chinese herbal medicines not only are less expensive and have fewer side effects than standard chemical medications, but they are also more accepted by the Chinese people, according to lead researcher Dr Jinzhou Tian, director of the Institute of Geriatrics at Beijing University of Chinese Medicine.

Researchers selected a gastrodine compound granule, extracted from tall gastrodia tuber plants and six other herbs, and the first new herbal drug for dementia to be tested in clinical trials. A 12-week, randomised, double-blind trial was carried out in Beijing Dongzhimen Hospital, between 1999 and 2002, on 120 stroke patients (75 male, 45 female) diagnosed with mild to moderate VaD lasting three months or more.

All patients were assessed for VaD at baseline and randomly divided into two treatment groups. One group (70 patients) was given one bag of the gastrodine compound granule (2.6 milligram gastrodine) three times a day for 12 weeks. The second group (50 patients) was given 40 mg of Duxilâ (almitrine + raubasine), a drug used to treat stroke patients in China, three times a day for 12 weeks. Both the gastrodine compound granule and the Duxilâ granule were dissolved in hot water and given orally.

In the gastrodine group, there were significant increases of the average MMSE (mini-mental state exam) score compared to baseline scores (20.83 vs.18.96). In the areas of memory, orientation, calculation, and language, the MMSE showed similar improvement in both groups, reported the researchers.

However, the gastrodine group showed a significant difference in the Blessed Behavioral Scale (BBS) score - including behaviour, activities of daily living, and personality - between endpoint (15.72) and baseline (18.76), as well as at endpoint (17.08) in the Duxilâ group. A score greater than or equal to 16 is abnormal and a score less than 16 is normal. The gastrodine group also suffered fewer side effects.

Researchers say combined results showed the gastrodine group improvement was 51.43 per cent, with 16 of the 70 cases showing much improvement, 20 cases with some improvement, and 34 cases with no change. The improvement rate for patients treated with Duxilâ was 52 per cent, with seven of the 50 cases showing much improvement, 19 cases with some improvement, and 24 cases with no change.

The study also found that the gastrodine treatment may increase regional cerebral blood flow in VaD patients, but Tian says further study is needed to determine other benefits. A study of six months or more is needed to further determine the clinical effectiveness of the gastrodine compound granule for treating mild to moderate VaD, added the team. Given the positive results in the areas of memory and behaviour, they say further research into herbal therapies for VaD may also be warranted.

"Chemical drugs, such as cholinesterase inhibitors, are effective in the treatment of cognitive and memory function in dementia, but these drugs are expensive and have side effects," said Tian. "This study might result in doctors considering the use of herbal medications, such as gastrodine compound granules to supplement the treatment of mild and moderate cognitive impairment in primary care for the elderly with cerebral ischemic damage."

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