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A Review of Nutrients and Botanicals in the Integrative Management of

Cognitive Dysfunction

Parris M. Kidd, PhD

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Abstract

Dementias and other severe cognitive dysfunction states pose a daunting

challenge to existing medical management strategies. An integrative, early

intervention approach seems warranted. Whereas, allopathic treatment options

are highly limited, nutritional and botanical therapies are available which

have proven degrees of efficacy and generally favorable benefit-to-risk

profiles. This review covers five such therapies: phosphatidylserine (PS),

acetyl-l-carnitine (ALC), vinpocetine, Ginkgo biloba extract (GbE), and

Bacopa monniera (Bacopa). PS is a phospholipid enriched in the brain,

validated through double-blind trials for improving memory, learning,

concentration, word recall, and mood in middle-aged and elderly subjects

with dementia or age-related cognitive decline. PS has an excellent

benefit-to-risk profile. ALC is an energizer and metabolic cofactor which

also benefits various cognitive functions in the middle-aged and elderly,

but with a slightly less favorable benefit-to-risk profile. Vinpocetine,

found in the lesser periwinkle Vinca minor, is an excellent vasodilator and

cerebral metabolic enhancer with proven benefits for vascular-based

cognitive dysfunction. Two meta-analyses of GbE demonstrate the best

preparations offer limited benefits for vascular insufficiencies and even

more limited benefits for Alzheimer's, while " commodity " GbE products offer

little benefit, if any at all. GbE (and probably also vinpocetine) is

incompatible with blood-thinning drugs. Bacopa is an Ayurvedic botanical

with apparent anti-anxiety, anti-fatigue, and memory-strengthening effects.

These five substances offer interesting contributions to a personalized

approach for restoring cognitive function, perhaps eventually in conjunction

with the judicious application of growth factors. (Altern Med Rev

1999;4(3):144-161)