Toward safe and efficacious treatment of dementia with Lewy bodies<br>―― Yi-Gan-San in the treatment of DLB-associated BPSD ――

Toward safe and efficacious treatment of dementia with Lewy bodies
―― Yi-Gan-San in the treatment of DLB-associated BPSD ――

Hiroyuki Arai, Koh Iwasaki, Katsutoshi Furukawa, Miho Tsutsui

Department of Geriatrics and Gerontology, Center for Asian Traditional Medicine,
Tohoku University School of Medicine

Behavioral and psychological symptoms of dementia (BPSD) are commonly seen in patients with AlzheimerAlzheimer'srsquo;s disease (AD) and other dementing disorders.　BPSD significantly increase a burden to caregivers and a major reason for an early institutionalization.　Pharmacological interventions including antipsychotics and cholinesterase inhibitors have been considered, but extrapyramidal symptoms and other adverse drug reactions are not uncommon among elderly demented patients.　In particular, neuroleptic super-sensitivity is known to occur as a fatal complication of neuroleptics in the treatment of DLB-associated BPSD.
For thousands of years, herbal medicines have been used with apparent safety and efficacy in Asia in the treatment of dementia.　Yi-Gan San (YGS) had been developed in 1555 by Xue Kai/China as a remedy for restlessness and agitation in pediatric patients and their mothers.　Such restlessness, agitation and possibly BPSD may occur as a result of an impaired balance between excitatory and inhibitory neural networks.　YGS may enhance inhibitory neural transmission (Iwasaki et al., 2005).　After 4-week treatment with YGS in 15 patients with DLB, the neuropsychiatric inventory (NPI) score decreased from 34.7±21.8 to 13.5±14.5 points (p=0.001).　The hallucination subscale of the NPI also improved from 7.5±3.3 to 1.5±1.8 points p<0.0001).　Physical activity as assessed by Barthel index did not deteriorate (Iwasaki et al., 2005).　Neuroleptic super-sensitivity has never been reported.　We conclude that YGS can be taken as a safe and efficacious treatment for controlling BPSD in DLB.

Address correspondence to Dr. Hiroyuki Arai, Department of Geriatrics and Gerontology, Center for Asian Traditional Medicine, Tohoku University School of Medicine (1-1, Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan)