Alzheimer’s Disease

What is Alzheimer's Disease?

Alzheimer's disease is a progressive brain disease that gradually impairs memory, language, reasoning and behavior, and it accounts for at least two thirds of dementia cases in people aged 65 and older.^[1] It has no cure, although some treatments may ease symptoms.^[1] For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Common symptoms

Short-term memory loss is the first and most common sign. A person may struggle to retain new information while still remembering long-ago events.^[1] Problems with planning, judgment and organizing follow, and early on they affect tasks such as managing money, cooking and driving, followed by trouble with language and visual-spatial skills.^[1]

In moderate to late stages, apathy, withdrawal, agitation and wandering are common, and sleep disturbance tends to appear later in the disease. Eventually people depend on caregivers for personal care.^[1]

Causes and risk factors

The exact cause is not fully understood. The disease involves abnormal amyloid and tau protein build-up in the brain, and these can now be measured with imaging and with spinal fluid or blood markers.^[1] Age is the strongest risk factor, since most cases start after age 65, while early-onset disease before 65 accounts for about 5% of cases.^[1]

Other factors include family history and genes such as APOE e4, heart disease, diabetes, high blood pressure and lifestyle. These come from standard teaching and are covered in the StatPearls chapter.^[1]

How it is diagnosed and treated conventionally

Diagnosis is made by a physician from a history, cognitive testing and an examination, with blood tests and brain imaging to rule out other causes. Biomarkers from PET scans, spinal fluid or blood add certainty in some cases.^[1]

Treatment combines medicines for symptoms, treatment of behavior and mood symptoms, and non-drug strategies. Newer anti-amyloid antibody treatments are available for selected patients and are being fitted into existing care, though many treatments lack strong evidence of efficacy.^[2] A network meta-analysis of 43 trials ranked exercise alongside usual care as the best non-drug option for reducing overall behavioral and psychological symptoms of dementia, with moderate-certainty evidence.^[3]

Why Alzheimer's Disease calls for a whole-person approach

Alzheimer's disease is a brain disease, but the person living with it is also affected by sleep, mood, physical health, stress and the strain on family caregivers. A whole-person plan looks beyond memory tests to comfort and daily life.^{[1, 2]}

Medical care directs treatment of the disease. Supportive care, if added, is aimed at the factors below.

Sleep

Sleep disturbance is common in dementia. A meta-analysis of 27 observational studies found people with sleep problems had about 1.5 times the risk of Alzheimer's disease, and that about 15% of cases in the population might be attributed to sleep problems. This shows association, not proof that poor sleep causes the disease.^{[1, 4]}

Mood, agitation and behavior

Apathy, agitation, anxiety and low mood are among the symptoms that most affect daily life and caregiving.^[1] In a network meta-analysis, exercise was linked to lower overall behavioral symptom scores, massage and music to lower depression scores, and massage combined with aromatherapy or music to lower agitation scores. The certainty of evidence was low to moderate, and no non-drug approach showed a quality-of-life benefit.^[3]

Physical activity and general health

Heart disease, diabetes and blood pressure are linked to risk, and exercise alongside usual care was linked to lower behavioral symptom scores in people who already have dementia.^{[1, 3]} Keeping up with your physician's advice on these areas remains important.

Caregiver strain

Care needs grow over time, and families carry much of the load. Caregivers often benefit from respite, education and support groups in addition to the person's own treatment.

Acupuncture as supportive care in Alzheimer's Disease

What the research shows

Acupuncture has been studied for cognitive symptoms, but trials are few and small, and none shows that it changes the course of the disease.^{[5, 6]}

A 2017 meta-analysis found that acupuncture combined with Chinese herbal medicine was better than Western drugs alone on the Mini Mental State Examination and on overall effectiveness rate, with no difference in activities of daily living. The authors called for larger, well-designed trials.^[5] A 2025 meta-analysis of 13 studies of traditional Chinese medicine therapies found better cognitive scores compared with controls, but no significant difference in neuropsychiatric symptoms or daily living.^[6] Because these reviews combine acupuncture with herbs and other therapies, they cannot isolate what acupuncture contributes.

In an exploratory trial of 87 people with mild to moderate Alzheimer's disease, acupuncture was compared with donepezil. The acupuncture group scored better on a cognitive scale at follow-up, with no differences in daily living or neuropsychiatric scores. The comparison was with a drug rather than a sham or placebo, and the authors described the trial as exploratory.^[7]

In mild cognitive impairment, the picture is mixed. A sham-controlled pilot trial of 30 people found no significant difference from sham acupuncture on the main cognitive score, though a secondary memory measure leaned toward benefit.^[8] A trial of 72 people with amnestic mild cognitive impairment found better cognitive scores than a waitlist group at 12 and 24 weeks, but a waitlist comparison does not rule out expectation effects.^[9]

An acupressure trial (finger pressure on acupoints, without needles) in 92 older adults with cognitive disorders in care homes in Taiwan found better cognition and quality of life scores after 12 weeks.^[10]

How acupuncture may work

How acupuncture might act in the brain is not established. In the 72-person mild cognitive impairment trial, brain imaging showed changes in activity connecting two brain regions, and the change correlated with the cognitive score change, which is an association and not proof of mechanism.^[9]

What treatment involves

Acupuncture would be offered only as supportive care, with your physicians informed. It uses fine, sterile, single-use needles, typically left in place for about 20 to 40 minutes, with a short course of visits and reassessment. Trials have used frequent sessions, for example three times a week for 12 weeks or 24 sessions over 12 weeks.^{[7, 8]} The approach can be adapted to the person's comfort.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[11] Tell the practitioner first if you take blood thinners, have a bleeding disorder, or have a pacemaker (relevant to electroacupuncture). A caregiver should tell us if the person may have difficulty reporting discomfort.

Ayurvedic medicine as supportive care in Alzheimer's Disease

The Ayurvedic view

Ayurveda describes memory loss in later life as a decline in smriti (memory) and medha (intellect), linked traditionally to aging, aggravated Vata and weak tissue nourishment. These are traditional frameworks, not biomedical diagnoses, and they do not replace a physician's evaluation of memory loss.

Therapies that may be used

Care is gentle and individualized, and may include:

• Regular routines, warm and easily digested meals, and steady sleep and wake times
• Light oil massage, if the person finds it calming and your physicians agree
• Herbs traditionally used for the mind, such as brahmi (Bacopa monnieri), prescribed individually after review of all medicines

Panchakarma is not appropriate for people with advanced age, frailty, dementia or acute illness.

What the research shows

The research on Ayurveda for Alzheimer's disease is very limited. We found no trials of Ayurvedic treatment programs for Alzheimer's disease.

Bacopa monnieri has a long history in Ayurveda. A meta-analysis of nine placebo-controlled trials in 518 people found improved speed of attention on some tests. The authors said a large head-to-head trial is still needed to show efficacy in healthy people or people with dementia.^[12] A review of curcumin, the active compound in turmeric, found promising animal results but human studies that were limited and inconsistent.^[13] A review of randomized trials of natural remedies in Alzheimer's disease reported positive results for several herbs, but its abstract gives no effect sizes or certainty ratings, so the strength of that evidence is unclear.^[14]

Herbal medicine as supportive care in Alzheimer's Disease

Herbs and formulas that have been studied

Chinese herbal formulas, and Ginkgo biloba extract, have been the most studied.^{[5, 15]} In Chinese medicine, memory loss is traditionally linked to weakness of the kidney and spleen, phlegm and blood stasis affecting the brain.^[16] Herbs and formulas are prescribed individually after review of your health and medicines.

What the research shows

The evidence is limited. A trial of 144 people with mild Alzheimer's disease in China found that a Chinese herbal formula improved cognitive scores more than low-dose donepezil over 24 weeks.^[17] This is a single trial that was compared with a low dose of a standard drug rather than placebo, so it cannot be taken as proof of benefit.

A meta-analysis of nine trials of standardized Ginkgo biloba extract found it slowed decline in cognition, function and behavior over 22 to 26 weeks in people with cognitive impairment and dementia. In the Alzheimer's subgroup the results were similar but not statistically better, and the review found no important safety concerns.^[15] The reviews of Chinese medicine in Alzheimer's disease conclude that larger, more rigorous trials are needed.^{[5, 6]}

Safety and herb-drug interactions

People with Alzheimer's disease are often older and take several medicines, so interactions matter. Ginkgo has been reported to cause bleeding when combined with warfarin or aspirin, and danshen has also been linked to bleeding with warfarin.^[18] St John's wort has been reported to lower levels of medicines such as ciclosporin.^[18] Tell us about every medicine, including donepezil, memantine, blood thinners and any sedatives.

Product quality matters. In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[19] Tell us about liver or kidney disease, and a caregiver should supervise any herbs given at home.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine attributes dementia-like symptoms to weakness of the brain, spleen and kidney, with blood stasis and phlegm stagnation.^[16] Researchers who study acupuncture and formulas look at measurable parallels such as brain network activity, amyloid deposition in the hippocampus, which the authors of one herbal formula trial proposed as a possible mechanism.^{[9, 17]}

Ayurveda's aggravated Vata and depleted medha describe forgetfulness and a decline with age. In modern terms this may overlap with neurodegeneration, but no study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

Alzheimer's disease needs diagnosis and ongoing care from physicians, and our care is supportive only. Keep your neurologist, geriatrician or primary care doctor, and do not stop or change prescribed medicines, including donepezil, memantine or any antibody treatment, without your prescriber. We do not diagnose Alzheimer's disease or manage its progression.

Please bring your diagnosis, recent test or imaging results, and a full list of medicines and supplements. If a family member or caregiver helps with medicines, it is useful to bring them to the first visit. New memory changes need medical evaluation first, since some causes of memory loss are treatable.

When to seek urgent medical care

Some changes in a person with dementia need prompt medical attention.

• Sudden confusion, drowsiness or a rapid change in behavior over hours or days, which can signal an infection or another medical problem
• Sudden weakness, trouble speaking, facial drooping or severe headache
• A fall with head injury, or new difficulty walking
• Choking or repeated coughing with eating, fever or trouble breathing
• Talk of self-harm, or severe agitation or aggression that puts the person or others at risk
• A person who is lost, wandering or unsafe alone

If any of these occur, call 911 or go to the nearest emergency department. For thoughts of suicide, call or text 988, the Suicide and Crisis Lifeline.