Dementia

Posted by: Cleo Libonati, RN, BSN in A LISTING OF ALL HEALTH CONDITIONS, Brain Disorders, Cerebrum (Neurologic) Disorders, Complications, Copper, Folic Acid, Iron, Malabsorption Disorders, Omega-3 Fatty Acids, Omega-6 Fatty Acids, System - Nervous, Vitamin B1 (Thiamin), Vitamin B12, Vitamin B3 (Niacin) 0 3,734 Views

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DementiaWhat Is Dementia?

Dementia is the term used to describe a group of symptoms that show significant deterioration of an individual’s intellectual and social abilities.

The deterioration in intellectual function is progressive and is characterized by memory and cognitive impairment involving deficits in reasoning, judgment, abstract thought, comprehension, learning, use of language, and task execution.

Some types of dementia can be reversed,  while most types of dementia are degenerative or nonreversible.

Q: What causes dementia?

A: There are  many differing causes of dementia.  Here are some causes according to nonreversible and reversible:

  • Nonreversible dementia may not be turned back due to these conditions:
  • Alzheimer’s disease is the most common type of degenerative dementia caused by abnormal protein structures in certain areas of the brain. 
  • Lewy body disease is a leading cause of dementia in elderly adults.
  • Vascular dementia due to many small strokes.
  • Medical conditions: Huntington’s disease, multiple sclerosis, infections that can affect the brain, such as HIV/AIDS and Lyme disease, Parkinson’s disease, Pick’s disease, and progressive supranuclear palsy.
  • Reversible dementia may be stopped or reversed if these conditions are found soon enough:
  • Brain injury.
  • Brain tumors.
  • Chronic alcohol abuse.
  • Changes in blood sugar, sodium, and calcium levels.
  • Changes that can occur with celiac disease, diabetes, thyroid disease, and other metabolic disorders.
  • Nutritional deficiencies.
  • Use of certain medications, including cimetadine and some cholesterol-lowering medications.1

What Is Dementia In Celiac Disease and/or Gluten Sensitivity?

  • Relationship between dementia and celiac disease. Dementia in celiac disease is a neurologic complication that can be a non-gastrointestinal presentation of gluten sensitive enteropathy.2
  • Relationship between dementia and nutritional deficiency. A study investigating neurologic patient types and the cause of symptoms in patients with either (1) celiac disease or (2) no celiac disease, but gliadin antibody positivity found that only patients with celiac disease had dementia and did not have Tg6-IgA/IgG (transglutaminase 6 antibody). In celiac disease, nutritional deficiency and coexisting autoimmunity may cause neurologic dysfunction.3
  • Relationship between dementia and brain cell involvement. The results of neuropsychological testing in study patients suggested a trend of a frontosubcortical (front part of brain involved with cognition) pattern of impairment. A detailed histological analysis (biopsy) revealed nonspecific gliosis. Some patients were shown to  improve or stabilize on a gluten free diet.4 Gliosis is a proliferation of astrocytes (brain cells) which contribute to the protective blood-brain barrier system.
  • Relationship between dementia and gluten-free diet. A longitudinal pilot study investigating relationships between cognitive function and mucosal healing in people with newly diagnosed celiac disease at start of a gluten-free diet found that cognitive performance improves with adherence to the gluten-free diet in parallel to mucosal healing.5
  • Relationship between dementia and dysbiosis due to high fat/sugar gluten-free diet. The consumption of a diet high in fat and sugar can lead to the development cognitive decline. In the human gut, the trillions of harmless microorganisms harboured in the host’s gastrointestinal tract are called the ‘gut microbiota’. Consumption of a diet high in fat and sugar changes the healthy microbiota composition which leads to an imbalanced microbial population in the gut, a phenomenon known as gut dysbiosis.6

How Prevalent Is Dementia In Celiac Disease and/or Gluten Sensitivity?

Prevalence of dementia in 42 study neurologic patients with celiac disease is reported to be 1.9%. In this same study, no prevalence was found in neurologic patients with non-celiac gluten sensitivity.3

What Are The Symptoms Of Dementia?

Dementia that occurs with metabolic disorders may cause confusion and changes in thinking or reasoning. These changes may be short-term or lasting. Dementia symptoms can be different for everyone. They depend on the health condition causing the dementia.

Early dementia.  Includes these symptoms:

  • Difficulty performing tasks that used to come easily, such as balancing a checkbook, playing games (such as bridge).
  • Learning new information or routines.
  • Getting lost on familiar routes.
  • Language problems, such as trouble finding the name of familiar objects.
  • Losing interest in things previously enjoyed.
  • Flat mood.
  • Misplacing items frequently.
  • Personality changes such as irritability or silliness.
  • Loss of social skills or appropriateness.

Worsening dementia. Symptoms are more obvious and interfere with the ability to take care of self. These include:

  • Changing sleep patterns, often waking up at night.
  • Forgetting details about current events.
  • Forgetting events in one’s life history.
  • Having difficulty doing basic tasks.
  • Having hallucinations, arguments, striking out, and behaving violently.
  • Having more difficulty reading or writing.
  • Using poor judgment and losing the ability to recognize danger.
  • Using the wrong word, not pronouncing words correctly, or speaking in confusing sentences.
  • Withdrawing from social contact.

Severe dementia. People with severe dementia can no longer perform basic activities of daily living, such as eating, dressing, and bathing, recognize family members, or understanding language.1

How Does Dementia Develop In Celiac Disease and/or Gluten Sensitivity?

  • Dementia in celiac disease results from an unclear pathogenetic mechanism.7 that remains elusive.8
  • In celiac disease, nutritional deficiency and coexisting autoimmunity may cause neurologic dysfunction.3
  • The role of trace vitamin deficiencies involving niacin, pyridoxine, and thiamin or disordered biopterin synthesis needs to be investigated in detail. Other deficiencies that can cause dementia include vitamin B12, folic acid, omega-3 fatty acids, omega-6 fatty acids, iron, and copper. 

Does Dementia In Celiac Disease and/or Gluten Sensitivity Respond To Gluten-Free Diet?

Study patients with dementia improved or stabilized cognitively with gluten withdrawal.9

A longitudinal pilot study investigating relationships between cognitive function and mucosal healing in people with newly diagnosed celiac disease at start of a gluten-free diet found that cognitive performance improves with adherence to the gluten-free diet in parallel to mucosal healing.5

6 Steps To Improve Dementia In Celiac Disease and/or Gluten Sensitivity:

Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both mind and gut health.

  • Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
  • A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
  • Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

Recovery from Celiac Disease. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

  • Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
  • Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.10
  • The intestinal lining may take up to a year to heal.
  • 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

  • Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.11
  • Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
  • Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.11
  • Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.11.
  • Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.11
  • Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
  • Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.11
  • Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.11
Here Are Important Anti-Inflammatory Food Types to Promote Health:

  • Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
  • Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
  • High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
  • Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
  • Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
  • Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
  • Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
  • Protective Herbs and Spices.  See below #6 below for examples.
  • 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

  • 4 Manage Your Medications Safely:

Certain prescription drugs cause deficiencies of these nutrients that can cause dementia: thiamin (vitamin B1), niacin (vitamin B3), pyridoxine (Vitamin B6), vitamin B12, folic acid, omega-3 fatty acids, omega-6 fatty acids, iron, and copper. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

ANTI-DEPRESSANTS

  • Adapin®, Aventyl®, Elavil®, Pamelor®, and others depletem Vitamin B12.

ANTIBIOTICS disrupt intestinal permeability.

  • Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins.
  •  Tetracyclines deplete Iron, Vitamin B6.

ANTI-INFLAMMATORIES disrupt intestinal permeability.

ANTICONVULSANTS

ANTIVIRAL AGENTS

CARDIOVASCULAR DRUGS

CHOLESTEROL DRUGS

DIABETIC DRUGS 

DIURETICS

FEMALE HORMONES disrupt intestinal permeability.

MAJOR TRANQUILIZERS  

  • Thorazine®, Mellaril®, Prolixin®, Serentil® and others deplete Vitamin B12.
  • 5Nutritional Supplements To Help Correct Deficiencies:

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

  • Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications. Contains vitamin B1, vitamin B3, vitamin B6, vitamin B12 and folic acid.
  • Vitamin B12 sublingual tablets as prescribed if unable to absorb tablets following blood test for status.
  • Ferrous fumarate or gluconate as prescribed for iron deficiency but do not take at same time as calcium because they compete for absorption.
  • Copper tablets as prescribed following blood test for status.
  • Fish oil to obtain omega-3 fatty acids.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.

  • 6Manage Natural Remedies: 
Hydration is very important in managing dementia:

Research in young men showed that mild dehydration induces adverse changes in vigilance and visual working memory.12

  • Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
  • If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
  • Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
  • What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.

Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

  • Raspberry.
  • Carrot is also a cleansing digestive tonic.
  • Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
  • Redbeets also stimulate and improve digestion and are easily digested.
  • Cabbage also stimulates and improves digestion and is also a liver decongestant.
  • Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
  • Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

  • Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
  • Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
  • Parsley also relieves indigestion.
  • Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
  • Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

  • Cloves are also antispasmodic.
  • Nutmeg is also useful for indigestion.
  • Ginger.
Exercise Helps:

Exercise improves circulation and rids the body of toxins.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.

What Do Medical Research Studies Tell About Dementia In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“The neurologic significance of celiac disease biomarkers.” This study investigating neurologic phenotypes and their etiologies in patients with either (1) celiac disease or (2) no celiac disease, but gliadin antibody positivity (2002-2012) found that eight patients with celiac disease had dementia and did not have Tg6-IgA/IgG (transglutaminase 6 antibody). Data support causes alternative to gluten exposure for neurologic dysfunction among most gliadin antibody-positive patients without celiac disease. Nutritional deficiency and coexisting autoimmunity may cause neurologic dysfunction in celiac disease.

Neurologic patients included both those with the celiac disease-prerequisite major histocompatibility complex class II human leukocyte antigen (HLA)-DQ2/DQ8 haplotype, and those without. The 3 groups were as follows: group 1 were 44 patients with celiac disease or transglutaminase (Tg)-2/deamidated gliadin immunoglobulin (Ig)A/IgG detected; group 2 were 15 patients who did not carry HLA-DQ2/DQ8 genetic markers and had gliadin IgA/IgG detected; and group  were 9 patients who did carry HLA-DQ2/DQ8 markers, and gliadin IgA/IgG detected. Neurologic patients and 21 non-neurologic celiac disease patients were evaluated for neural and Tg6 antibodies.

RESULTS: In group 1, 42 of 44 patients had celiac disease. Neurologic phenotypes (cerebellar ataxia, 13; neuropathy, 11; dementia, 8; myeloneuropathy, 5; other, 7) and causes (autoimmune, 9; deficiencies of vitamin E, folate, or copper, 6; genetic, 6; toxic or metabolic, 4; unknown, 19) were diverse.

In groups 2 and 3, 21 of 24 patients had cerebellar ataxia; none had celiac disease. Causes of neurologic disorders in groups 2 and 3 were diverse (autoimmune, 4; degenerative, 4; toxic, 3; nutritional deficiency, 1; other, 2; unknown, 10). One or more neural-reactive autoantibodies were detected in 10 of 68 patients, all with autoimmune neurologic diagnoses (glutamic acid decarboxylase 65 IgG, 4; voltage-gated potassium channel complex IgG, 3; others, 5).

Tg6-IgA/IgG (transglutaminase 6 antibody) was detected in 7 of 68 patients (cerebellar ataxia, 3; myelopathy, 2; ataxia and parkinsonism, 1; neuropathy, 1); the 2 patients with myelopathy had neurologic disorders explained by malabsorption of copper, vitamin E, and folate rather than by neurologic autoimmunity.3

“Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity.” This longitudinal pilot study investigating relationships between cognitive function and mucosal healing in people with newly diagnosed celiac disease commencing a gluten-free diet found that in newly diagnosed celiac disease, cognitive performance improves with adherence to the gluten-free diet in parallel to mucosal healing. Suboptimal levels of cognition in untreated celiac disease called “brain fog” may affect the performance of everyday tasks.

Eleven patients (8 females, 3 males) between 22 and 39 years, were tested with a battery of cognitive tests at weeks 0, 12 and 52. Information processing efficacy, memory, visuospatial ability, motoric function and attention were tested. Small bowel biopsies were collected via routine gastroscopy at weeks 12 and 52 and were compared to baseline Marsh scores. Cognitive performance was compared to serum concentrations of tissue transglutaminase antibodies, biopsy outcomes and other biological markers.

RESULTS: All patients had excellent adherence to the diet. Marsh scores improved significantly and tissue transglutaminase antibody concentrations decreased from a mean of 58.4 at baseline to 16.8 U/mL at week 52. Four of the cognitive tests assessing verbal fluency, attention and motoric function showed significant improvement over the 12 months and strongly correlated with the Marsh scores and tissue transglutaminase antibody levels.13

“Celiac disease, brain, and dementia.” This case report describes 5 patients before age 60 with dementia subsequently found to have celiac disease. Intellectual deterioration ranged from moderate to severe, and diffuse cerebral or cerebellar atrophy was found on brain CT. GI symptoms were mild. A gluten free diet improved the neurologic disability in one out of 5 patients. celiac disease may play a role in some cases of pre-senile dementia.14

“Cognitive Impairment and Celiac Disease.” This study investigating dementia in celiac disease found that a possible association exists between progressive cognitive impairment and celiac disease, given the temporal relationship and the relatively high frequency of ataxia and peripheral neuropathy, more commonly associated with celiac disease.

Patients with the onset of progressive cognitive decline within 2 years of symptomatic onset or with a severe exacerbation of biopsy-proved adult celiac disease were identified from the Mayo Clinic medical records from January 1, 1970, to December 31, 2005. Thirteen patients (5 women) were identified. The average age at cognitive impairment onset was 64 years (range, 45-79 years), which coincided with symptom onset or exacerbation of diarrhea, steatorrhea, and abdominal cramping in 5 patients. Amnesia, acalculia, confusion, and personality changes were the most common presenting features.

The average initial Short Test of Mental Status score was 28 of a total of 38 (range, 18-34), which was in the moderately impaired range. The results of neuropsychological testing suggested a trend of a frontosubcortical pattern of impairment. Ten patients had ataxia, and 4 of them also had peripheral neuropathy. Magnetic resonance imaging of the head showed nonspecific T2 hyperintensities, and electroencephalography showed nonspecific diffuse slowing. Deficiencies in folate, vitamin B12, vitamin E, or a combination were identified in 4 patients, yet supplementation did not improve their neurological symptoms. Three patients improved or stabilized cognitively with gluten withdrawal. A detailed histological analysis revealed nonspecific gliosis.9

  1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001748/ [↩] [↩]
  2. Murray JA, The widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999;69 (3):354-365. [↩]
  3. McKeon A, Lennon VA, Pittock SJ, Kryzer TJ, Murray J. The neurologic significance of celiac disease biomarkers. Neurology. 2014 Sep 26. pii: 10.1212/WNL.0000000000000970. [↩] [↩] [↩] [↩]
  4. Hu WT, Murray JA, Greenaway MC, Parisi JE, Josephs KA. Cognitive impairment and celiac disease. Arch Neurol. 2006 Oct;63(10):1440-6. [↩]
  5. Lichtwark IT, Newnham ED, Robinson SR, Shepherd SJ, Hosking P, Gibson PR, Yelland GW. Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity. Aliment Pharmacol Ther. 2014 Jul;40(2):160-70. doi: 10.1111/apt.12809. [↩] [↩]
  6. Proctor C, Thiennimitr P, Chattipakorn N, Chattipakorn SC. Diet, gut microbiota and cognition. Metab Brain Dis. 2016 Oct 5. [Epub ahead of print] [↩]
  7. Collin P, Pirttilä T, Nurmikko T, Somer H, Erilä T, Keyrilainen O. Celiac disease, brain, and dementia. Neurology. Mar 1991;41(3):372-5. [↩]
  8. Hu WT, Murray JA, Greenaway MC, Parisi JE, Josephs KA. Cognitive Impairment and Celiac Disease. Arch Neurol. 2006;63:1440-1446. [↩]
  9. Hu WT, Murray JA, Greenaway MC, Parisi JE, Josephs KA. Cognitive Impairment and Celiac Disease. Arch Neurol. 2006;63:1440-1446. [↩] [↩]
  10. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
  11. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
  12. Ganio MS, Armstrong LE, Casa DJ, McDermott BP, Lee EC, Yamamoto LM, Marzano S, Lopez RM, Jimenez L, Le Bellego L, Chevillotte E, Lieberman HR. Mild dehydration impairs cognitive performance and mood of men. Br J Nutr. 2011 Nov;106(10):1535-43. doi: 10.1017/S0007114511002005. [↩]
  13. Lichtwark IT, Newnham ED, Robinson SR, Shepherd SJ, Hosking P, Gibson PR, Yelland GW. Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity. Aliment Pharmacol Ther. 2014 Jul;40(2):160-70. doi: 10.1111/apt.12809. [↩]
  14. Collin P, Pirttilä T, Nurmikko T, Somer H, Erilä T, Keyrilainen O. Celiac disease, brain, and dementia. Neurology. Mar 1991;41(3):372-5. [↩]

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