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Ask an expert - neuro and psycho logical - dementia - Alzheimers

3 questions

As far as the use of acupuncture treatment for Alzheimers is concerned the evidence is not good. As a review published three years ago concludes
 
http://www.ncbi.nlm.nih.gov/pubmed/19490197
 
there are insufficient trials available on which to base conclusions and those that do exist are not that encouraging. However, it is very difficult to design trials of acupuncture which meet the western standards of proof, the randomised double blind control trial, at the best of times, but when the target group on trial are difficult to define precisely this makes the task even harder.
 
The best one can say of any treatment of problems such as Alzheimers is that it slows down the progress of the condition, and whether it is effective or not is very often a unique judgement best made by those who are most closely involved in the patient's care. A family, for example, are often finely tuned to the nuances of someone's behaviour and able to assess 'good' and 'bad' days in ways which might not be amenable to formal analysis. We have certainly heard anecdotal evidence that the qualoty of life of people with Alzheimers seems to have improved with regular treatment, but there is no formal evidence which would enable us to give a formal recommendation. The best advice we could offer would be to discuss each case individually with a local BAcC member, and seek their view, based on a face to face assessment within the terms of Chinese medicine, of whether they felt they might be able to achieve some positive outcomes.
 
The evidence for the use of acupuncture and OCD is even more sparse. You may find the occasional study, as
 
http://www.ncbi.nlm.nih.gov/pubmed/19684500
 
which seems to be encouraging but there are very few.
 
However, a key word in Chinese medicine is the word 'appropriate', and with it an important diagnostic consideration about whether an emotional response to a situation is disproportionate in scale or time. From a Chinese medicine perspective, grieving deeply for a dead relative for a few months or a year is normal, but for a decade or more isn't. Worrying whether you have locked the front door and checking once is normal; worrying to the extent that you check twenty times isn't. If there are clear diagnostic signs that the driving force behind an OCD presentation may have a root in an imbalance which might be treatable, then a practitioner might believe that a short course of treatment might be worthwhile, with carefully designed outcome analysis and a clear end point for review. Acupuncture treatment could, in theory, have an impact if the factor driving the OCD could be tied directly to presentations which are clearly understood within the Chinese medicine framework.
 
Our overall view, however, is that the treatment of OCD is not something for which we would recommend acupuncture treatment, and we would be more inclined to refer patients on to forms of hypnotherapy or psychotherapy which might complement the various conventional therapies and treatments such as CBT already being used.
 
 
 
 
 
 
 

 Q:  I care for someone with vascular dementia. She is also suffering depression. I wondered if acupuncture would help her?

 

A:  There is some evidence that acupuncture may have a role to play in helping with vascular dementia. A Cochrane review published in 2007
 
http://www.thecochranelibrary.com/userfiles/ccoch/file/Acupuncture_ancient_traditions/CD004987.pdf
 
seemed to show that there were benefits, but that the evidence was not of sufficiently good quality to make definite claims. Similarly with depression, as our factsheet shows
 
http://www.acupuncture.org.uk/index.php?option=com_k2&;view=item&id=1277:depression&Itemid=106
 
there is some evidence that acupuncture can help, but the trials are not yet designed with enough clarity to make a definite claim to efficacy.
 
The real strength of Chinese medicine, though, is not that it treats named conditions, but that it treats people with named conditions, and its increasing popularity is in quite a direct way related to the time spent and care taken in finding out what makes this individual patient tick, and of looking at ways of balancing the body's energies to make the whole system function better. The interaction with the patient is integral to this, and older patients are often helped a great deal simply by the fact that their health professional is prepared to spend more time with them. This is not unique to Chinese medicine, and the best western medicine can do the same. In the Chinese medical approach this time and attention is a part of what the average practitioner does as a matter of course, and the reality is that what is occasionally dismissed as a 'non-specific effect', not to do with acupuncture itself but how it is delivered, can be a very powerful force for encouraging improvement.
 
There are a number of issues on which your question doesn't quite provide enough information for comment - would the person need home visits or are they mobile, are they able to give informed consent to treatment, are they taking serious medications, etc - which might determine how available treatment was. If your client is interested, however, we are sure that a BAcC member local to you will be happy to give specific advice and help you to identify a practitioner able to provide what your client may want. 
 
 
 

Q. hello, my mother has recently been diagnosed with Lewy Body Dementia of an alzheimer type with parkinsons. She is prone to shakes, getting quite anxious over small changes to her routine , plus currently in a low mood. I am looking to see if something like acupuncture can provide her with some help. ...and then finding a practioner who is experienced in dealing with this type of condition with acupuncture. Can you help me out at all with some advice. Thanks!

 

A. This is a very difficult problem for which to give advice. It is highly unlikely, given the severity and number of the symptoms, that acupuncture will have a great deal of effect on your mother's physical deterioration.

 

 

There is little or no evidence that acupuncture has a well-documented effect on conditions such as these, and it would be irresponsible of us to create false expectations by suggesting so.

 

What we do hear very often, however, is that acupuncture treatment appears to help people to cope better with difficult conditions. Whether this is the treatment itself or the care and attention which our members give is disputed by detractors, but inside the profession we often hear reports back of people feeling 'better in themselves and better able to cope' so there may some benefit to your mother of this kind.

 

All of our members are equally well-qualified to deal with any person asking for their help, although it is fair to say that when dealing with progressive and deteriorating conditions it helps to have had some experience of working with similar cases. If you contact BAcC members local to you for advice we are sure that they will give you an honest assessment of whether they are equipped to deal with your mother's case and if they feel it is beyond their limits of competence to recommend someone who may be able to help.