A Promising TCM Approach to Curbing Dementia in the Elderly

If you are past middle age, you probably know dementia firsthand, because among your elders there is sure to be someone afflicted by it. They were once sharp-minded, cheerful, and vigorous; now they have failing memory, slow reactions, anxiety and depression, stubborn temperaments, and few words — utterly different from the young people you remember.

As societies age, dementia occupies an ever larger share of the spectrum of human disease. The risk rises gradually from age 60; among people over 80, roughly 40% suffer from some form of dementia. Alzheimer's disease accounts for about 50% of dementia cases, vascular dementia about 20%, Lewy body dementia about 15%, and other types 15%.

Beginning about ten years ago, elders around me began developing dementia one after another; watching their children exhaust themselves caring for them moved me deeply. About three years ago, when I sensed early warning signs in my own father, I became immediately alert.

In the summer of 2023, after my son finished the college entrance exam, I took the family on a trip to Hong Kong and Macau. Passing through Shenzhen, we reunited with my older brother's family. When I left Shenzhen, my father and brother saw me to the metro station; after we waved goodbye and they had just exited the station, my father asked my brother: "Your brother left for Beijing yesterday — I wonder if he has arrived yet?"

My brother and I were both shocked that his memory had declined so far. My father was extremely bright in his youth; without exaggeration, his IQ was perhaps the highest of any elder I have known. Almost self-taught, he mastered the qin, chess, calligraphy, painting, medicine, martial arts, and arithmetic. He played the erhu well, painted beautifully, and once headed our village committee, keeping the accounts flawlessly. His reasoning was meticulous; he had a chivalrous streak, was warm-hearted, and often helped those in distress.

When my father began working at the village committee — still in Mao's era — he worried that, because of the family's class background, others would not accept him. He said he would take the post only if every adult in the village signed in support. In the end every adult signed, which shows how respected and well-liked he was.

But from age 75 his personality changed: he became withdrawn, his memory often failed him, and he was no longer as openhanded as before. He worried about this and that, was plainly lacking in confidence, and slept even worse, often lying awake all night. Once, on the home camera, I saw him looking unsteady as if he had even forgotten how to close a door. The moment I saw that, I booked the earliest bullet train home and took him to the hospital.

Imaging showed marked atrophy of both white and gray matter and lacunar infarcts — though, of course, these findings are common in the elderly and represent normal physiological atrophy and degeneration rather than a serious problem. Moreover, when he occasionally analyzed a problem, his reasoning remained incisive and put me to shame, showing his intellect had not entirely declined.

By then I had studied medicine fairly deeply and had researched neurology for nearly twenty years; I knew these signs pointed toward dementia. Both my uncle and my aunt suffer from it; my 86-year-old uncle no longer recognizes people. Since my father is blood-related to them, he would very likely, like his siblings, develop more severe dementia after 80.

I designed a comprehensive regimen for my father aimed mainly at preventing further rapid decline, including medication, exercise, and social engagement.

First, drawing on my professional knowledge, I thought medication should act on several fronts. One: unblock the cerebral vessels, using Chuanxiong (Ligustici Rhizoma), Baizhi (Angelicae Dahuricae Radix), Manjingzi (Viticis Fructus), Jingjie (Schizonepetae Herba), Ruxiang (Olibanum), Moyao (Myrrha), and Gegen (Puerariae Radix) to improve cerebral circulation — these herbs genuinely have that effect. Two: improve sleep, using Suanzaoren (Ziziphi Spinosae Semen), Baiziren (Biotae Semen), Yuanzhi (Polygalae Radix), Hehuanpi (Albiziae Cortex), and Shouwuteng (Polygoni Multiflori Caulis). Three: repair neurons, using Tianma (Gastrodiae Rhizoma) and Shichangpu (Acori Tatarinowii Rhizoma), which traditional TCM says "opens the orifices" and which modern pharmacology shows can repair the nervous system. In addition, I used Bajitian (Morindae Officinalis Radix), Xiangfu (Cyperi Rhizoma), and Meiguihua (Rosae Rugosae Flos) to improve his mood. Combining Chinese and Western reasoning this way addresses his symptoms systematically. To make long-term adherence easy, I made the herbs into pills. I also gave him vitamin E (to protect and repair the vascular endothelium and as an antioxidant) and vitamin C.

My father was initially reluctant to take medicine, but his insomnia troubled him severely, so he eventually agreed. After starting the pills his sleep improved markedly; once he saw the benefit, he cooperated much better. As sleep quality improved, his mood also lifted. Although his memory is still not what it was, it has not deteriorated further in the past two years. He now writes important things down in a notebook to avoid forgetting.

He even began to feel the improvement himself. He told me that two years ago his brain always felt as if it were not obeying him, as if resisting his will; over the last two years it has been much better. I had heard this same description from other patients — they said their brain felt as if it were not their own, that they clearly wanted to do something but the brain would not cooperate.

To assess the effect, when I go home I sleep in the same bed as my father and watch his sleep at night. He no longer tosses and turns as before; I soon hear his snoring. I have listened to my father's snoring for over forty years, but it has never sounded so reassuring as it does now.

As far as I know, cerebral decline in the elderly almost always begins with difficulty falling asleep and worsening memory. Many doctors prescribe sleeping pills, but they work poorly in older people. I think this is because the approach is one-sided: poor sleep in the elderly results from brain atrophy and impaired cerebral circulation, so it must be combined with vessels-unblocking herbs and only then supplemented appropriately with calming, sleep-aiding herbs. The same logic applies to declining memory and worsened emotional control — the so-called "second childhood" phenomenon.

Besides medication, I urged my father to socialize more. Having improved, he now lives alone in the village, fully self-care; he has regular companions, often cycles around neighboring villages chatting with old friends, grows some vegetables at home, and gets a certain amount of exercise every day.

I do not know whether I can ultimately keep my father from dementia, but early intervention has surely slowed his decline and improved his quality of life in his later years.

Because elders in my family have these problems, I myself, from middle age, have focused on preventing brain decline, not wanting to end up demented and burdening my child. Every day I study modern science and memorize vocabulary and knowledge points. According to some views in modern neurology, exerting effort to learn and memorize prompts the Nissl bodies in neurons to secrete more memory proteins, which can slow brain aging. I also take vitamins E, C, and B. In temperament I take after my mother, with good emotional control and a quick onset of sleep. Perhaps with these measures I can escape the fate of my father's siblings in old age.

Preventing dementia is best begun as early as possible. The moment we suspect that we or a loved one may develop dementia, we should take comprehensive measures without delay. Recent brain science shows that dementias like Alzheimer's can be effectively contained if intervened at an early stage; once they reach the middle and late stages, the prospect of improvement is slim.

Whether middle-to-late-stage dementia offers any hope of improvement I cannot yet say. As far as I know, current approaches are too single, too conservative, and too one-sided; systematic pharmacotherapy for dementia has been little studied. Yet the hope for treating such diseases may lie precisely in systematic combination therapy.