Complementary and alternative medicines in the treatment of dementia: an evidence-based review.

Alternative medicines may have potential beneficial results in treating certain forms of dementia and related symptoms, as well as slowing disease progression. Alternative medicines may ameliorate disturbances in cognition, mood, sleep and activities of daily living. Primary mechanisms of action include modifications in neurotransmitter synthesis, inhibition of neurotransmitter reuptake and enzyme-induced neurotransmitter breakdown, antioxidant and anti-platelet activity, enhanced blood flow and glucose metabolism. Adverse events can include cardiovascular, gastrointestinal, mood, autonomic and dermatologic effects. However, adverse events, when reported represent, a small percentage of treated groups and direct links between adverse events and alternative therapies are tenuous. Many studies of alternative medicines in dementia are inconclusive and characterised by methodological deficiencies such as small sample sizes and inadequate controls. If alternative medicines can be shown to be efficacious using more rigorous experimental designs, both consumers and clinicians could avail themselves of a wider range of pharmacological substances that may offer the advantage of being better tolerated and exhibiting safer therapeutic margins than some allopathic medicines. While a number of complementary interventions have shown both strengths and weaknesses, huperzine A, levacecarnine and EGB 761, based on the overall quality of the studies, identified mechanisms of activity and safety profiles merit further examination in controlled clinical outcome studies.

Telerehabilitation, cognition and user-accessibility.

Survivors of traumatic brain injury (TBI) often experience cognitive and physical impairments. The aims of this study were to: 1) build an internet-based, "Virtual Rehabilitation Center" (VRC) that provides rehabilitation, education and support services to individuals with TBI; and 2) to determine the relationships between the nature and severity of the participants' cognitive impairments and their ability to use the VRC. Eight individuals with brain injuries (Age: M=43, SD=15.4; Years of Education: M=13.8, SD=3.15) participated. The Neurobehavioral Cognitive Status Exam (NBCSE) was used to assess intellectual functioning. The VRC modules consisted of reaction time, functional modules, and communication capabilities. All participants learned how to use the VRC. However, those requiring more "trials to acquisition" showed greater cognitive impairment than those requiring fewer trials in: Construction (p=0.02), Reasoning-Similarities (p=0.01) and in calculation and language repetition.(i.e., a non-significant trend). Importantly, all participants learned how to use the system although learning rates varied. Moreover, one case-study demonstrated that learning on the VRC generalized to the community. Overall, impairments on the NBCSE in visual-constructional integration and executive-type functions, as well as language processing appeared to be related to how effectively participants learned how to use the VRC.