Kampo therapy and behavioral and psychological symptoms of dementia

Abstract

Behavioral and psychological symptoms of dementia (BPSD) occur in approximately 80–90% of patients with dementia. Although antipsychotics are used to treat BPSD, patients often suffer from parkinsonism and impaired activities of daily living (ADL). In addition, an increased mortality rate has been reported in patients with dementia taking antipsychotics. Thus, Kampo therapy is one alternative to antipsychotic medicines. Yokukansan has been reported to be effective for treatment of agitation/aggression, and irritability/lability in patients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VD), and frontotemporal dementia. In addition, yokukansan is effective for treatment of visual hallucinations in DLB patients. Because DLB patients have hypersensitivity to antipsychotics, and often have severe adverse reactions to these drugs, the beneficial effects and tolerability of yokukansan for DLB patients are particularly significant. Orengedokuto has been reported to be effective for treating irritability and sullenness in patients with VD, and to improve excitement, depression, anxiety, and restlessness in patients with cerebrovascular lesions. Chotosan has been found to be effective for treatment of delirium, insomnia, hallucination, and delusion in patients with VD. Tokishakuyakusan has been reported to improve emotional lability, restlessness, and sleep disturbances in patients with AD and VD. Kampo therapy does not induce extrapyramidal symptoms and anticholinergic symptoms, and has no adverse effects on ADL and cognitive function. In addition, Kampo therapy has been reported to have various neuroprotective effects. Thus, Kampo therapy is safe and promising for patients with BPSD, and should be further utilized for treatment of BPSD.