Mild Cognitive Impairment

Sudesh Prabhakar et al. (2020) · Annals of Indian Academy of Neurology

This trial put Bacopa monnieri (Brahmi), a traditional Ayurvedic memory herb, head-to-head against donepezil, the standard prescription drug for Alzheimer's disease, in people already diagnosed with Alzheimer's or the earlier-stage memory decline called mild cognitive impairment. The goal was to see whether a natural alternative could match the drug doctors currently rely on, since no treatment yet slows the underlying disease. The trial planned to enroll 48 adults over age 50 with brain-imaging-confirmed diagnoses, giving half 300 mg of Bacopa daily and half 10 mg of donepezil daily for a full year, then comparing memory and thinking-skills tests (governing recall, word-finding, and daily-living ability) at regular checkpoints. Because recruitment was slower than expected, the study ran for nearly four years but still only enrolled 34 of the planned 48 participants before it had to close early. On the main measure of cognitive decline (ADAS-Cog, a standard Alzheimer's test), Bacopa and donepezil performed statistically the same at every checkpoint through one year. A second memory test (the PGI Memory Scale) also showed no difference at 3, 6, or 9 months, though the total score did differ significantly between groups at the final 12-month assessment, favoring donepezil, while the individual parts of that same test showed no difference. Because the trial closed early with roughly a third fewer participants than planned, its ability to detect a real difference between the two treatments was limited, and the one late significant result should be read cautiously alongside the many outcomes that showed no difference. The findings suggest Bacopa performs comparably to donepezil on most measures over one year, but the authors themselves call for larger, multi-site trials before drawing firmer conclusions about how the two options truly compare.

Aneesh Basheer et al. (2022) · Interactive journal of medical research

This systematic review pooled the human clinical trial evidence on Bacopa monnieri (Brahmi), a plant long used in Ayurvedic medicine and studied in animal models for its potential to protect brain cells, to ask whether it actually helps people with Alzheimer's disease or the memory decline that often precedes it (mild cognitive impairment). The comparison point was donepezil, the standard prescription drug for Alzheimer's, which modestly eases symptoms but does not slow the underlying disease. The review searched five major databases and trial registries through January 2021 and found only 5 trials, involving a total of roughly 200-plus participants, that directly tested Bacopa in people already diagnosed with Alzheimer's or mild cognitive impairment (most prior Bacopa research had studied healthy adults instead). The trials varied widely in dose, length (2 to 12 months), and whether Bacopa was given alone or mixed with other herbs and nutrients, so the researchers could not statistically combine the results and instead described each trial's findings individually. Study quality was assessed using the Cochrane risk-of-bias tool and graded overall with the GRADE system. The five trials told an inconsistent story. The largest head-to-head comparison against donepezil found no difference between the two through nine months, with donepezil only pulling ahead at the one-year mark in a trial that had to stop early due to poor participant recruitment (34 of a planned 48). Two other trials reported improvement, but Bacopa was just one ingredient in a multi-herb blend in both, so the benefit cannot be pinned on Bacopa specifically. A fourth trial had questionable methods, including dropping 15 participants from the analysis after the fact without explanation. None of the five trials reported serious safety concerns with Bacopa. Overall, the reviewers found no solid evidence that Bacopa monnieri outperforms placebo or donepezil for Alzheimer's disease or mild cognitive impairment, rating the certainty of the existing evidence as very low. This does not mean Bacopa definitely does not help, only that the trials done so far are too few, too small, and too inconsistent to say either way. The authors call for larger, well-designed trials testing Bacopa on its own before any conclusion about its use in dementia can be drawn.