Advances in treatment of mild cognitive impairment (MCI) and dementia : a review of promising non-pharmaceutical modalities

Currently, available mainstream approaches used to treat mild cognitive impairment (MCI) and dementia are limited. In view of the high prevalence rate of Alzheimer's disease (AD) and other forms of dementia and the enormous social and financial burden associated with dementia on a global scale, developing more effective and more cost-effective ways to treat MCI and dementia is an urgent priority. This chapter reviews research findings on promising non-pharmaceutical approaches being investigated for their potential clinical applications in treating symptoms of cognitive impairment and behavioral dysregulation associated with dementia, reducing the risk of developing dementia, and slowing rate of progression of cognitive decline in individuals with Mild Cognitive Impairment (MCI) or dementia. Non-pharmaceutical treatment approaches covered include diet, exercise, single and compound herbal formulas used in Asian medicine, herbals used in Western countries, select other natural products including dehydroepiandrosterone, idebenone, acetyl-L-carnitine, alpha lipoic acid, phosphatidylserine and phosphatidic acid, select vitamins, nPUFAs and probiotics. Other non-pharmaceutical modalities reviewed include chelating agents; non-invasive brain stimulation techniques employing weak electrical current, sound and light; music therapy; cognitive training; electroencephalography (EEG) biofeedback; multi-modal interventions; Wander gardens; sensory stimulation interventions; massage, mindfulness, and energetic therapies (Healing Touch, Therapeutic Touch, taichi and qigong). Although select natural products are supported by compelling research evidence, most modalities reviewed in this chapter are supported by limited findings. Large prospective placebo-controlled studies are needed to further elucidate mechanisms of action, verify the efficacy of the various non-pharmaceutical modalities, and identify safe and appropriate treatment protocols for MCI and dementia.