A clinical study to evaluate the efficacy of Ashtanga Ghrita in Dementia

ORIGINAL ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 33 A clinical study to evaluate the efficacy of Ashtanga Ghrita in Dementia Shreya Nagesh Moger 1 , V. Rajendra 2 1 3 rd Year Post Graduate Student, Department of Kayachikitsa, Govt. Ayurveda Medical College, Mysore, Karnataka, India. 2 Professor and HOD, Department of Kayachikitsa, Govt. Ayurveda Medical College, Mysore, Karnataka, India. I NTRODUCTION Dementia is a disease of progressive cognitive decline with relatively intact consciousness. International classification of diseases ICD 10 describes it “as a syndrome due to disease of the brain, usually of chronic or progressive nature, in which there is evidence of a decline in both memory and thinking which is sufficient to impair personal activities of daily living, without clouding of consciousness and is commonly accompanied or preceded by deterioration Address for correspondence: Dr. Shreya Nagesh Moger 3 rd Year Post Graduate Student, Department of Kayachikitsa, Govt. Ayurveda Medical College, Mysore, Karnataka, India. E-mail: shreyamoger 1995@gmail.com Submission Date: 09/09/2021 Accepted Date: 15/10/2021 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.6.5.5 in emotional control, social behaviour or motivation [1] If not properly managed, these demented subjects may become helpless, incapable of remembering the names of close relatives, they may wander into dangerous situations, oblivious of their surroundings. Alzheimer’s Dementia is a progressive relentless loss of mental function characterized by degeneration of brain tissue including loss of nerve cells and development of senile plaques and neurofibrillary tangles It’s prevalence in those over 60 years of age ranges between 5-20% in the western nations, Dementia (and Alzheimer’ s Disease) prevalence rate in India 4.86 % (1.91 %) in age > 55 years and 6.44 % (3.56%) in age >65 years [2] The drugs promoting Medha (intellect), Smriti (memory) are termed as Medhya drugs. Ayurveda System of Medicine has mentioned several medicinal plants under the category ' Medhya '. By virtue of improving cognitive abilities major influence several medicinal plants mentioned as 'Rasayana Drugs' in Ayurveda are primarily claimed as ' Medhya '. Further there is a special class of some Rasāyana drugs called A B S T R A C T Dementia is defined as an acquired deterioration in cognitive abilities that impairs the performance of activities of daily living. In Ayurveda literatures this disease is explained under the concept of Jara Vyadhi . In elderly people there will be loss of cognitive abilities viz. Grahana , Dharana and S marana because there is gradual diminution in the qualities of Dhatu and dominance of Vata . An individual can lead a normal happy life if one has a sound intellectual capacity with a good memory. Any impairments to his memory will has an effect on the quality of his living standards, thus this condition is chosen for the present study. Present study is a single group open clinical trial with pre and posttest design on 30 subjects. Subjects were administered with Ashtanga Ghrita for 60 days. The results were obtained on parameter viz. Impaired memory, Visuospatial disorientation, Apraxia, Impaired visuoconstructional drawing, Impaired judgement, Impaired language the result obtained statistically non-significant in the management of Dementia. However, it was observed the symptoms such as anger and irritability were reduced. Key words: Ashtanga Ghrita, Dementia, Jara Vyadhi.

Shreya Nagesh Moger et al. A clinical study to evaluate the efficacy of Ashtanga Ghrita in Dementia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 34 'Medhya Rasayana' which is supposed to be having specific influence on higher brain functions. Keeping in view the above concepts, signify the role of Ghrita in improving mental functions Bruhmana Sneha administration of Ashtanga Ghrita has been selected in this study O BJECTIVE OF THE STUDY To evaluate the efficacy of Ashtanga Ghrita in Dementia M ATERIALS AND M ETHODS Source of Data Subjects were selected from the OPD and IPD of Government Ayurveda Medical College and Hospital, Mysuru, Government Hi - Tech Panchakarma Hospital, Mysuru, Old Age Home in Mysuru, special camps and other referral sources. Inclusion Criteria Subjects of all gender between the age group of 60-85 years with Senile Dementia and diagnosed cases of Alzheimer’s Disease were selected Exclusion Criteria Secondary Dementia caused due to Parkinson’s disease, vascular causes, head injury, alcohol abuse, hydrocephalus, HIV and syphilis were excluded. Subjects suffering from uncontrolled diabetes mellitus (RBS>250 mg/dL), hypertension (>170/100 mmHg), ischemic heart disease and other systemic disorders which interferes with the course of intervention were excluded. Diagnostic Criteria Diagnostic and Statistical Manual-5 (DSM 5) criteria was used for diagnosis, that is - one or more acquired significant impairments (independence lost) in cognitive domains such as: 1 Memory (amnesia) 2 Language (aphasia) 3 Execution of purposeful movement (apraxia) 4 Recognition / familiarity (agnosia) 5 Visuopatial function (topographical disorientation) 6 Self-control / management (executive functions impairment) 7 Other examples: a) Mathematics (dyscalculia) b) Emotional expression /comprehension (dysprosody) c) Writing (agraphia) Assessment Assessment was done based on - The Rowland Universal Dementia Assessment Scale: A Multicultural Cognitive Assessment Scale [3] Statistical Methods The results were analysed statistically by using below statistical methods. ▪ Descriptive statistics ▪ Chi-square test ▪ Paired s ample ‘T’ test ▪ Using SPSS for windows Intervention Bruhmana Sneha Prayoga of Ashtanga Ghrita for 60 days. Dose - 12 gm as a single dose per day Anupana - Hot water Time of administration - (5.30 am- 9 am) before food The assessment was done based on following 3 schedules; Pre-test assessment - Before the commencement of intervention (day zero) Mid test assessment - In the middle of intervention (30 th day). Post-test assessment - After the completion of intervention (60 th day).

Shreya Nagesh Moger et al. A clinical study to evaluate the efficacy of Ashtanga Ghrita in Dementia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 35 O BSERVATION AND R ESULTS The data was collected from the subjects based on diagnostic criteria. The results were analysed statistically using Pearson Chi-Square test. Memory impairment Out of 30 subjects, before intervention 2 subjects (6.7%) had score 0, 4 subjects (13.3%) had score 2, 11 subjects (36.7%) had score 4, and 13 subjects (43.3%) had score 6 on Memory impairment. On 30 th day of intervention, out of 30 subjects, 2 subjects (6.7%) had score 0, 2 subjects (6.7%) had score 2, 15 subjects (50.0%) had score 4 and 11 subjects (36.7%) had score 6 on Memory impairment. After the completion of intervention on 60 th day, 2 subjects (6.7%) had score 0, 2 subjects (6.7%) had score 2, 15 subjects (50.0%) had score 4 and 11 subjects (36.7%) had score 6 on Memory impairment. The result obtained regarding the parameter on Memory impairment showed statistically insignificant result with P value p- 0.919. Visuospatial disorientation Out of 30 subjects, before intervention 30 subjects (100%) had score 5 on Visuospatial disorientation. On 30 th day of intervention, 30 subjects (100%) had score 5 on Visuospatial disorientation. After the completion of intervention on 60 th day, 30 subjects (100%) had score 5 on Visuospatial disorientation. Apraxia Out of 30 subjects, before intervention 1 subject (3.3%) had score 0, 29 subjects (96.6%) had score 2 on Apraxia. On 30 th day of intervention, out of 30 subjects, 2 subjects (6.7%) had score 1, 28 subjects (93.3%) had score 2 on Apraxia. After the completion of intervention on 60 th day, 2 subjects (6.7%) had score 1, 28 subjects (93.3%) had score 2 on Apraxia. The result obtained regarding the parameter on Apraxia showed statistically insignificant result with P value p- 0.673. Impaired visuoconstructional drawing Out of 30 subjects, before intervention 2 subjects (6.7%) had score 1, 12 subjects (40%) had score 2, 16 subjects (53.3%) had score 3 on Impaired visuoconstructional drawing. On 30 th day of intervention, out of 30 subjects, 3 subjects (10%) had score 1, 11 subjects (36.7%) had score 2, 16 subjects (53.3%) had score 3 on Impaired visuoconstructional drawing. After the completion of intervention on 60 th day, 3 subjects (10%) had score 1, 11 subjects (36.7%) had score 2, 16 subjects (53.3%) had score 3 on Impaired visuoconstructional drawing. The result obtained regarding the parameter on Impaired visuoconstructional drawing showed statistically insignificant result with P value p- 0.989. Impaired judgement Out of 30 subjects, before intervention 1 subject (3.3%) had score 0, 1 subject (3.3%) had score 2, 1 subject (3.3%) had score 3, and 27 subjects (3.3%) had score 4 on Impaired judgement. On 30 th day of intervention, out of 30 subjects, 1 subject (3.3%) had score 1, 5 subjects (16.7%) had score 3, 24 subjects (80.0%) had score 4 on Impaired judgement. After the completion of intervention on 60 th day, 1 subject (3.3%) had score 1, 1 subject (3.3%) had score 2, 4 subjects (13.3%) had score 3 and 24 subjects (80%) had score 4 on Impaired judgement. The result obtained regarding the parameter on Impaired judgement showed statistically insignificant result with P value p- 0.554. Impaired language Out of 30 subjects, before intervention 1 subject (3.3%) had score 3, 2 subjects (6.7%) had score 4, 4 subjects (13.3%) had score 5, 8 subjects (26.7%) had

Shreya Nagesh Moger et al. A clinical study to evaluate the efficacy of Ashtanga Ghrita in Dementia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 36 score 6, 2 subjects (6.7%) had score 7 and 13 subjects (43.3%) had score 8 on Impaired language. On 30 th day of intervention, out of 30 subjects, 6 subjects (20%) had score 4, 2 subjects (6.7%) had score 5, 8 subjects (26.7%) had score 6, 3 subjects (10%) had score 7 and 11 subjects (36.7%) had score 8 on Impaired language. After the completion of intervention on 60 th day, 4 subjects (13.3%) had score 4, 5 subjects (16.7%) had score 5, 6 subjects (20%) had score 6, 2 subjects (6.7%) had score 7 and 13 subjects (43.3%) had score 8 on Impaired language. The result obtained regarding the parameter on Impaired language showed statistically insignificant result with P value p- 0.804. DISCUSSION According to Charaka Samhitha, Prajna has three components which are Dhee, Dhriti and Smriti. [4] In Dementia there may be impairment of all these components with intact consciousness. The prime component affected is Dhee which can be considered as cognitive decline. As Dhee and Smriti are interlinked with each other along with cognitive decline, memory impairment an important feature of Dementia. According to C haraka Samhitha disease is named based on Prakruthi , site of manifestation, causative factors, and signs and symptoms. Discussed in the context of Vataja Nanatmaja Vikara Vataja Bhrama is a condition which has close resemblance with Dementia. Impairment of Smriti is one of its important features. However specific term for Dementia is not mentioned in any Ayurveda classical textbooks. It is mentioned in Charaka Samhitha that during old age quantity as well as quality of Dhatu is decreased. Role of Agni in Ageing - Dhatu are regularly nourished by dietary substances and Agni is responsible for the conversion of dietary substances into formation of Dhatu . Dominance of Vata Dosha is responsible for Vishamagni which affects the digestion and causes under nourishment of the Dhatu. It may have an impact on low status of Dhatvagni and nourishment for Uttarottara Dhatu . Dementia occurs mainly in Jara , impairment of Prajna occurs due to the effect of Dementia. Since the action of Rasayana is in the whole body, changes occur at both, physical and psychological level. According to various research works nootropic drugs are a heterogeneous group of drugs developed in Dementia and other cerebral disorders . They decrease levels of arousals and stress in the central nervous system. It is suggested to improve attention, learning, memory, and vigilance. Promote healthy brain functioning by repairing damage, promoting nerve growth, and maintaining neuronal health. Many of these supplements are taken for their antioxidant properties and are thought to help maintain optimal cognition and prevent cognitive decline. Medhya Rasayana is type of Rasayana which is said to improve the cognitive functions. The benefits of the Medhya Rasayana are similar to nootropics in few aspects. Ashtanga Ghrita is a well-balanced preparation including the drugs which have Medhya, Rasayana, Smritikara and Ayushya properties [5] The Ingredients of Ashtanga Ghrita includes following drugs as follows: Bakuchi which possesses Rasayana action, dietary total prenylflavonoids from the fruits of Psoralea corylifolia prevents age related cognitive deficits and down regulates Alzheimer’s markers [6] Vidhara also Vrishya, has Rasayana properties and it contains scopoletin: antiamyloidogenic, anticholinesterase, and neuroprotective potential of a natural compound [7] Shankapushpi and Mandookaparni has Medhya action, both are Tikta Rasa in nature. Shatavari has Rasayana properties and its ethanolic extracts from roots possesses an outstanding source for natural nootropic [8] Brahmi also having Medhya , Rasayana action, it contains antioxidant properties to reduce oxidative stress in the ageing brain [9]

Shreya Nagesh Moger et al. A clinical study to evaluate the efficacy of Ashtanga Ghrita in Dementia ISSN: 2456-3110 ORIGINAL ARTICLE Sept-Oct 2021 Journal of Ayurveda and Integrated Medical Sciences | Sept - Oct 2021 | Vol. 6 | Issue 5 37 Vacha has Medhya action, studies showed that Acorus calamus rhizome extract effect on the neuromodulatory system [10] Guduchi is one among the Medhya Rasayana and research studies showed that it has possesses free radical scavenging and anti-proliferative activities [11] Cow’s milk has Madhura Rasa, Madhura Vipaka , Vatahara properties. It nourishes all Dhatu right down to the Ojas. Ghrita is said to be Vatahara also Smriti Kara, Medhakara , Ayushya and it increases the Agni . It acts as a Rasayana which gives strength to the body. It receives the properties of Samskara ( processing with drugs). Ghee has been considered immensely superior to other fats mainly because of the presence of short chain fatty acids and carrier of four fat soluble vitamins A, D, E, K. Hence by virtue of its lipid soluble property it can cross Blood Brain Barrier thus proving as an effective drug for CNS [12] Majority of the ingredients in Ashtanga Ghrita are having Madhura Vipaka, Medhya , Rasayana , Vatahara properties. It will do the Dhatuposhana helping the management of Dementia. Thus, Ashtanga Ghrita is a neurotropic drug both as a prophylactic and curative medication The results obtained on parameter Impaired Memory impairment, Visuospatial disorientation, Apraxia, Impaired visuoconstructional drawing, Impaired judgement, Impaired language was statistically nonsignificant in the management of Dementia. Reason for statistically nonsignificant results The nonsignificant result obtained may be due to short duration of the intervention. As Dementia is one of the chronic progressive disorders it needs months of regular efforts to delay the progress of the disease Sample size was small to draw the conclusion and generalise it. REFERENCES 1 YP Munjal, AK Agarwal et al, API Textbook of Medicine 10 th ed vol 2, part 2, pp 2225 2 YP Munjal, AK Agarwal et al, API Textbook of Medicine 11 th ed vol 2, part 2, pp 2139 3 The Rowland Universal Dementia Assessment Scale: A Multicultural Cognitive Assessment Scale. (Storey, Rowland, Basic, Conforti & Dickson, 2004). International Psychogeriatrics, 16 (1), 13-31 4 Agnivesha, Charaka Samhita edited by, Yadavji Trikamji Acharya with Ayurvedadipika Commentary by Chakrapanidatta, Varanasi: Chaukhamba Surabharathi Prakashan. Shareerasthana 1/18 5 K R Srikanta Murthy, Ashtanga Hridayam vol 2 Chowkhamba krishnadas academy,Varanasi uttaratantra 39/1 6 Zhi – Jing Chen, Yan-Fang Yang et al., Dietary total prenylflavonoids from the fruits of Psoralea corylifolia L. Prevents age-related cognitive deficits and down regulates Alzheimer’s markers in SAMP 8 mice 7 Priya Kashyap, Heera Ram et al., Scopoletin : antimyloidogenic, Amticholinesterase, and neuroprotective potential of a natural compound present in Argyreia speciose roots by in vitro and in silico study 8 Lakshmi Pravallika Pojka, Krishnan Mohan G et al., Neuroprotective activity of asparagus racemose against ethanol induced cognitive impairment and oxidative stress in rats brain: auspicious for controlling the risk of Alzheimer’s disease. 9 Aimi syamina abdul manap, shantini vijayabalan et al., Bacopa Monnieri, aneuroprotective lead in Alzheimer’s disease. 10 Arunachalam muthuraman, nirmal singh: Attenuating effect of acorus calamus extract: an evidence of anti-oxidative, antiinflammatory, neuroprotective and calcium inhibitory effects 11 Bhuvan Chandra Joshi, Sumitra Uniyal, Pharmacognostical Review of Tinospora cordifolia. 12 Sumeet Goel, Nisha Kumara Ojha, Ashtanga Ghrita: A noble Ayurveda drug for central nervous system, journal of Ayurveda and holistic medicine. How to cite this article: Shreya Nagesh Moger, V. Rajendra. A clinical study to evaluate the efficacy of Ashtanga Ghrita in Dementia. J Ayurveda Integr Med Sci 2021;5:33-37. http://dx.doi.org/10.21760/jaims.6.5.5 Source of Support: Nil, Conflict of Interest: None declared.

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