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TOKYO, JAPAN. There is increasing evidence that cognitive decline and dementia are associated with a
deficit of the neurotransmitter acetylcholine. Acetylcholine is essential for the proper transmission of nerve
impulses. Acetylcholine is synthesized from choline and acetate with the aid of the enzyme choline
acetyltransferase and cofactor A. Once it has done its job acetylcholine is broken down to its constituent
parts through the action of the enzyme cholinesterase. A current, not very successful, strategy for the
treatment of Alzheimer's disease (a prevalent form of dementia) involves the use of cholinesterase inhibitors
so as to increase the level of circulating acetylcholine. Another way of increasing acetylcholine levels would
clearly be to promote the activity of choline acetyltransferase. Japanese researchers now report that they
may have found a way of doing just that using an ancient Chinese herbal remedy.
The traditional Chinese remedy ba wei di huang wan (BDW), also known as eight ingredient pill with
Rehmannia, has been used for at least 2000 years in Chinese, Japanese and Korean medicine to treat
mental decline and dementia. It has now been subjected to a randomized, double-blind, placebo-controlled
clinical trial involving 33 patients diagnosed with dementia. The patients were assigned to receive placebo
pills or 20 pills (2 grams) of BDW three times a day after meals for 8 weeks. At the end of the trial the
patients on BDW became more cheerful and quicker to respond to caregivers, whereas no change was
noted in the placebo group. Two clinical measures of dementia state, the Mini-Mental State Examination
(MMSE) and the Barthel Index, also showed marked improvement in the BDW group, but no significant
change in the placebo group. No adverse effects were noted in the BDW group, but its beneficial effects did
disappear 8 weeks after the cessation of treatment. The researchers conclude that BDW is an effective
treatment for dementia.
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