Dementia: A Homeopathic Perspective

As numbers of those diagnosed with dementia increase, more homeopaths are asked to help with this complex and challenging condition. While public awareness of the condition is becoming more widespread, the downside of this is that general help and information is becoming much less defined. This article is an attempt to tidy things up and to share a few thinking posts and pointers for practice in this area, which certainly has its challenges for us as practitioners too.

In September 2022 in the UK alone, there were 944,000 diagnosed cases of dementia according to Dementia UK statistics. This number is projected to increase due to the gradual nature of its progression, the mild early-stage symptoms and the (apparently) low diagnosis rate. It remains hard to ascertain an accurate number of people living with the condition and it is likely that this trend is reflected internationally.

Furthermore, Alzheimer’s and dementia are commonly confused, with the terms ‘Alzheimer’s disease’ and ‘dementia’ used interchangeably by many in both the healthcare sector and by the general public. However, there is an important difference between the two labels: Alzheimer’s is a disease, whilst dementia is a set of symptoms.

Although Alzheimer’s disease is the best known and most common form of dementia, not everyone with dementia has Alzheimer’s. Dementia itself is a brain disorder that impacts upon a person’s ability to communicate and to perform everyday activities; in other words, it is a general term for the behavioural changes and the loss of cognitive and mental acuity (including memory loss and difficulties with thinking and language) that this decline causes.  It is a progression that is frequently severe enough to severely disrupt daily life for the individual concerned as well as their significant others.

Even the types of dementia that have been identified and classified, mostly based on the location of the disruption to brain tissue and hence to specific related tasks, are not particularly helpful to those directly or indirectly affected by dealing with dementia: they are merely descriptions.

Symptoms will of course, vary from patient to patient but these categorisations and symptoms are worth addressing in the context of this article both for general reference and to illustrate the complexity of the dis-ease itself.

Also, some types of dementia fall into more than one category, as does Alzheimer’s disease, which is classed as belonging to both the progressive and cortical dementia types but Alzheimer’s warrants a separate consideration.

Tables 1 and 2 below demonstrate some of the most widely used groupings and their associated symptoms:

Table 1: Common classifications of dementia by type

TYPE OF DEMENTIA	PRESENTATIONS	SYMPTOMS
1) Lewy bodies (LBD)	Caused by protein deposits that develop in nerve cells in the areas of the brain involved in memory, movement and thinking.	Includes visual hallucinations, slowed movement, dizziness and confusion, memory loss, apathy and depression.
2) Cortical	A disease process primarily affecting the neurons of the brain’s outer layer or cortex.	Tends to cause general problems with memory, language, thinking and social behaviour.
3) Subcortical	Affects parts of the brain below the cortex.	Changes in emotions and movement, slowness of thinking, and difficulty starting activities.
4) Frontotemporal	When portions of the frontal and temporal lobes of the brain atrophy.	Apathy, lack of inhibition and judgement, loss of interpersonal skills, speech and language problems, muscle spasms and poor coordination, difficulty in swallowing.
5) Vascular	Caused by brain damage from impaired blood flow to the brain.	Difficulty with concentration, confusion, loss of memory, restlessness, and apathy.
6) Progressive	As the name implies, this type worsens over time and increasingly interferes with cognitive abilities such as thinking, remembering, and reasoning.
7) Primary	Does not result from any other disease and describes a number of dementia types including LBD frontotemporal and vascular.
8) Secondary	Occurring as the result of a disease or physical injury, such as head trauma and diseases such as Parkinson’s, Huntington’s or Creutzfeldt-Jakob.
9) Mixed	A combination of two or more types of dementia, the symptoms of which vary according to the types of changes to the brain and the area of the brain undergoing those changes. Examples include vascular dementia and Alzheimer’s disease, Lewy bodies and Parkinson’s disease.

Table 2: Classifying Alzheimer’s Disease

STAGES OF AD	Overall symptoms are usually progressive over time and associated symptoms are often described in three stages or phases representing the ongoing and degenerative nature of the disease itself.
1) MILD	In addition to memory loss, early clinical symptoms probably include confusion over the location of usually familiar places, taking longer to accomplish normal daily tasks such as handling money and paying bills, poor judgment with resultant unhelpful decision-making, loss of spontaneity and sense of initiative along with changes in mood and personality, increased anxiety.
2) MODERATE	As the disease progresses, additional symptoms can include: increasing memory loss and confusion, shortened attention span, problems with recognising friends and family, language difficulty, numeracy and literacy problems, difficulty with organising thoughts and thinking logically, inability to learn new things or to cope with new or unexpected situations. Inappropriate outbursts of anger may occur, perceptual-motor problems (for example, trouble getting out of a chair or setting the table), repetitive statements or movements, occasional muscle twitches, hallucinations, delusions, suspiciousness or paranoia, irritability, loss of impulse control (eg undressing at inappropriate times or places or using vulgar language), exacerbation of behavioural symptoms such as restlessness, agitation, anxiety, tearfulness and wandering, particularly in the late afternoon or evening (‘sundowning’).
3) SEVERE	At this point, amyloid plaques and neurofibrillary tangles (the hallmarks of AD) can be clearly seen in the brain via MRI. This is the final stage of AD. Symptoms may include inability to recognise family and loved ones, loss of selfhood, inability to communicate in any way, loss of weight, bladder and bowel control, seizures, skin infections, increased sleeping, total dependence on others for care, and difficulty in swallowing.

From most of these summarisations, it is clear that many of the behavioural and mood related symptoms are likely to be reactions to the individual’s own changing state, especially as they are usually aware that they are clearly no longer as competent as they once were. Furthermore, the social, psychological, physical, economic and practical pressures upon all concerned are immense, as even Wikipedia acknowledges in its entry.

Pointers for practice

This leaves us with some major implications and questions to consider from the perspective of a practitioner: Whose reality and lived experiences are we treating in our patients with dementia? How much can we and are we able to rely on information from others as carers and is this subjective or objective?

How are remedies being administered, and / or are they being taken at all? What can we do about prevention and, indeed, about cure? More accurately perhaps, this should be framed as what can be the nature and extent of our help?

Some patients may be resident in a care home or in assisted living, others may be living alone at home, some may be cared for or helped by partners or relatives. All of these issues pose differing sets of legal, bureaucratic issues for the practitioner to bear in mind and negotiate when treating those living with dementia.

Examples might include whether a medical and financial Power of Attorney or equivalent exists or is appropriate; ethical considerations like the issue of informed consent and so on.

Given that in conventional, allopathic terms ‘there is no cure’ could we and do we make the treatment outcome more positive by what amounts to palliation and by encouraging the vital force to find its own way in its own time? I believe homeopathy has a defined role to play here.

Conventional and practical advice for symptom management

Brain games and exercise are often found to have positive effects for dementia sufferers. Researchers such as Adcock et al (2019) suggest that brain stimulating games and other activities might improve cognitive functioning and brain volume in older adults, as well as possibly reducing the risk of developing dementia.

But the exact role of brain games in dementia prevention and treatment is unknown and more research is needed to determine the extent of this helpfulness. While it has not been established whether solo or multi-person games benefit dementia the most, it is generally recognised that different types of games and leisure activities offer different cognitive benefits.

For example, crossword puzzles which are generally played alone can be helpful to encourage language and focus; board games can also enhance these skills and playing with others offer opportunities for socialisation and communication.

Other commonly recommended activities include reading books, poetry, magazines, newspapers, comics and other printed or online content; and watching television or listening to radio shows can also help to keep the brain engaged.

Any form of art expression such as painting, drawing, and playing musical instruments have been found to be beneficial in people with dementia and, if possible, learning new things, either via a class, videos and podcasts can be useful to reinforce cognitive skills in older age.

However, some people with severe dementia may struggle to do even simple tasks and, if some of these activities are too difficult to engage in, simpler activities such as chatting and reminiscing, looking through pictures and listening to music are also helpful.

The Guardian newspaper reported recently that an antibody therapy named Lecanemab which removes clumps of beta amyloid protein build-up in the brain has newly been developed, but it remains unclear how much these clumps do drive Alzheimer’s disease. In patients with inherited forms of the disease the drug appears to slow the steady destruction of brain tissue to some extent, but Lecanemab can only be given to those with early Alzheimer’s disease who do have the amyloid plaque build-up present in their tissues.

Consequently, it would not be useful for people with other types of dementia or who are in the later stages of Alzheimer’s disease. Furthermore, the cost of the drug is prohibitive (between £10,000 and £30,000 per patient per year) and so it is doubtful that medical regulators would deem it to be cost-effective and therefore widely available even if it was affordable.  Such are the ethics and politics of allopathic research and medicine of course.

Homeopathic treatment for Dementia

As with all conditions, the person in front of you needs to be the focus of your treatment. What is it that needs to be attended to at any given time? What issues and health priorities are uppermost for your patient?

My starting point for treatment has usually been at the therapeutic and cellular level, using tissue salts such as the Narayani Brain tissue salts, Mix 5, combination (Davidson, 2005). This is simply because of its indication in a patient’s presenting picture, whether or not there has been a diagnosis or a label given to the set of symptoms that we are addressing.

Treatment focus is purely to address the nerves, muscles and blood vessels of the brain and to foster their optimum functioning: Calc fluor to provide elasticity; Kali mur is the basic salt found in the brain covering (fibrin) itself; Kali phos is to help address brain cell degeneration, brain fag, memory loss, mental and emotional disorder and Mag phos is to booster the function of the white nerve fibres and muscles of the brain. The potency of the Narayani mix is given at 200C, but I use X potencies since it is at that level that I wish support to start.

I accompany this with either a constitutional prescription or with an LM potency of a mental / emotionally centred remedy for gentleness and thoroughness of action. Again, this would be in accordance with issues that are uppermost for the individual concerned.

Careful thought needs to be given to practicalities around taking and / or administration of remedies themselves according to the lifestyle and circumstances of your patient and perhaps also to whether remedies are actually being taken.

Given that one of the two biggest risk factors for dementia is recognised as genetics (the other factor is age because the condition has longer to develop if it is going to) would indicate that a miasmatic nosode may also well be appropriate at some point. In this case the usual prescription criteria of choice applies, and I mention it here because the miasmatic role can frequently be overlooked where symptomatology takes the lead.

Some commonly used remedies for Dementia

Miranda Castro (1991, 2006) has listed some remedies that are commonly prescribed for older or elderly people and some of these may be useful pointers to consider in dementia cases although they clearly have more general applications. It is certainly not my intention to imply that because a patient is older in chronological terms, they are less able cognitively. This table is reproduced below:

 Table 3: Some suggested remedies to consider for dementia prescribing

REMEDY and MAIN KEYNOTES	EMOTIONAL SYMPTOMS	COMMON SYMPTOMS IN THE ELDERLY	GENERAL SYMPTOMS
Alumina: dry and slow	Confused and depressed, especially mornings. Mind slows down, forgetful and absentminded. Easily disoriented: very depressed if hurried.	Skin is dry and itches without eruption. Severe constipation even with soft stool. Weakness with trembling. Dry, hacking cough. Weak bladder, urination slow to start.	Aversion to / aggravation from potatoes. Generally < warmth.
Ambra grisea: erratic and embarrassed	Many losses and bereavements. Forgetful and confused. Easily embarrassed: shy and anxious in company, particularly with strangers. ‘Prattles’ and asks questions without waiting for answers. Prefers to be alone.	Constipation: with anxiety and ineffectual urging. Can’t pass stool or urine within hearing distance of others. Dry, nervous cough < talking and often followed by burping. Insomnia, hard to fall asleep before midnight. Vertigo with feeling of weakness in stomach. Numbness, twitching and / or trembling anywhere.	Generally < company (from conversation) and from music. Symptoms erratic and < lying down.
Arsenicum album: anxious, fussy and restless	Very scared of disease, cancer and death. Fears < when alone, to point of despair. Extremely tidy, unable to rest until everything is in its place.	Indigestion with burning pains and nausea. Loss of appetite and weight. Diarrhoea < mornings. Involuntary urination day and night. Insomnia with restlessness and anxiety. Skin eruptions, itching without eruptions, palpitations with anxiety.	Chilly. Burning pains > heat. Symptoms generally < from midnight to 3am. Thirsty for warm drinks; sips them frequently.
Baryta carbonica: childish and petty	Absent-minded, confused and forgetful. Revisits childhood in old age. Has great difficulty making decisions. Extremely anxious over unimportant things. Gets upset thinking others are talking about them.	Vertigo when getting up or bending down. Headache when bending, indigestion and weakness after eating. Constipation with straining and unfinished feeling. Weak bladder with involuntary urination; frequent urination at night with great urgency. Rattling cough with difficult production. Insomnia, restless sleep, frequent waking from getting overheated.	Much worse from cold and damp.
Carbo vegetabilis: sluggish and gassy	Great indifference and apathy. Sudden recurrent loss of memory and difficulty concentrating. Rude and irritable especially with relatives.	Indigestion, flatulence and diarrhoea. Severe and painful bloating with gas > burping. Rattling cough with breathlessness, > burping. Sluggish mentally and physically.	< eating rich foods and fats, < overeating. << for getting overheated. Wants to be fanned; wants fresh air and cool breezes.
Conium maculatum: withdrawn, slow and dizzy	Absent-minded, forgetful and confused. Difficulty understanding when reading. Tired of life, becomes withdrawn and averse to company. Superstitious.	Everything is slow: thinking, answering, moving, digestion, respiration, pulse and healing.	Vertigo < lying down, < rolling over in bed, < turning head; > closing the eyes. Dry ticklish cough < night. Weak bladder, frequent dribbly urination.
Ignatia amara: loss and grief	Very upset after a big loss or disappointment. Wants to be alone and doesn’t need comforting. Finds it hard to cry but eventually sobs uncontrollably. +++ sighing and feeling of lump in throat.	Headache, indigestion, diarrhoea, palpitations, insomnia and / or weakness from grief. Twitches and spasms, unexplained numbness anywhere.	Contradictory symptoms accompanying physical complaints (e.g. cough << coughing), cannot stand tobacco smoke.
Lycopodium: irritable, anxious and gassy	Depressed and anxious: worries about everything. Any changes or responsibilities are very stressful; lacks self-confidence. Absent-minded and forgetful. Snappy, irritable and critical. Sentimental, cries when thanked.	Thin and gassy, poor appetite. Feels full after a few mouthfuls. Everything turns to gas, indigestion with bloating. In men frequent urination, prostate problems. Rattling cough with much mucus.	Craves sweet things and chocolate. All symptoms worse 3-4pm and / or 4-8pm.
Phosphoric acid: weakness and apathy	Overwhelmed by loss especially bereavements. Ailments from grief and disappointment. Forgetful, mind too weak to even think.	Severe weakness. Painless diarrhoea, palpitations, headache and extreme weakness following grief.	Wants refreshing things to eat and drink, like fruit and juices. Feels better after a nap.
Rhus toxicodendron: restless, stiff and aching	Anxious and forgetful. Terrible restlessness, unable to rest in any position due to aching.	Joint and back pains (rheumatism and arthritis), < on first motion and stretching, > continued motion. Shingles.	Symptoms < night, < cold and damp in any form, > warmth.

(Castro, 2006]

Under the entries for Alzheimer’s disease, Robin Murphy’s Clinical Repertory (2005) lists 13 remedies in italics, 33 in single type and 1 in bold capitals (grade 3). The bold is Hyoscyamus niger. Under the ‘Dementia in the Mind, Delusions’ section of Murphy there is a separate heading for senile dementia which is cross-referred as Alzheimer’s disease. Senile dementia under this classification has Baryta carbonica in bold, underlined type (grade 4) with Anacardium, Conium and Hyoscyamus as grade 3 remedies, 9 others grade 2 and 29 grade 1.

Principally, these entries illustrate to me complexities in the perception of dementia and AD symptoms for prescribers and act to highlight the need for precision in case-taking as well as in the differentiation of remedy choices that would accurately reflect the experiences of those who live with these conditions.

In conclusion, the attention that homeopathy gives to everyone’s health uniqueness as well as to the need for optimal lifestyle measures and nutritional awareness can only enhance its contribution to the treatment of dementia and of those affected by it. It is able to present a positive and valuable donation to the field.

References

Adcock et al (2019) Effects of an In-home Multicomponent Exergame Training on Physical Functions, Cognition, and Brain Volume of Older Adults: A Randomized Controlled Trial ncbi.nim.nih.gov/pmc/articles/pmc6997483/

Castro M (1991) The Complete Homeopathy Handbook. Macmillan

Castro M (2006) ‘Top 10 remedies for the elderly’. Picture of Health, issue 13

Murphy R (2005) Homeopathic Clinical Repertory, 3rd edn. Lotus Health Institute

Narayani M (2005) Mataji Narayani’s Materia Medica of Combination Remedies, 2nd end. Robert Davidson Publications

alzheimers.org.uk/about-dementia/risk-factors-and-prevention/what-can-increase-persons-risk-of-dementia

dementiastatistics.org/statistics-about-dementia/

healthline.com/health/alzheimers-disease/difference-dementia-alzheimers

theguardian.com/society/2022/nov/30/drug-slows-cognitive-decline-in-alzheimers-patients-study-reveals?utm_term=6386e35418bffb217639ae1ea9

wikipedia.org/wiki/alzheimer’s_disease

This article was originally published in the Winter 2023 edition of Homeopathy in Practice (the journal of the Alliance of Registered Homeopaths) as ‘A homeopathic Perspective on Dementia’ .