Is Lion's mane (Hericium erinaceus) effective in treating dementia?

Lion's Mane for Dementia: Evidence-Based Assessment

Lion's mane (Hericium erinaceus) is not recommended for treating dementia as there is insufficient evidence supporting its effectiveness and it is not included in established clinical guidelines for dementia management. 1, 2

Current Evidence on Lion's Mane for Dementia

Clinical Evidence

• Only one very small, double-blind, placebo-controlled trial has shown temporary improvement in cognitive function in patients with mild cognitive impairment, and these findings have not been replicated 3
• No human clinical trials have specifically evaluated Lion's mane for treating dementia
• A 2022 study found that Lion's mane supplementation (10g daily for 4 weeks) had no impact on cognitive performance in healthy college-age individuals 4

Preclinical Evidence

• Some laboratory research suggests potential mechanisms that might be relevant to dementia:
  • Compounds from Lion's mane (erinacerin A and hericenone B) have shown potential as acetylcholinesterase inhibitors in computational models 5
  • Animal studies have demonstrated anxiolytic effects in tau mouse models of Alzheimer's disease, but without improvements in spatial memory 6

Guideline-Recommended Treatments for Dementia

The American College of Physicians and American Academy of Family Physicians guidelines recommend:

1. FDA-approved medications as the primary pharmacological treatments for dementia 1:

   • Cholinesterase inhibitors (donepezil, galantamine, rivastigmine)
   • Memantine

2. Individualized assessment when initiating pharmacological therapy 1

3. Selection of agents based on 1:

   • Tolerability
   • Adverse effect profile
   • Ease of use
   • Cost

Nutritional Supplements in Dementia

The ESPEN guidelines specifically state:

• Persons with dementia should NOT be offered micronutrient supplements unless there is an indication of deficiency 1
• No controlled intervention study has demonstrated cognitive benefits from supplementing single nutrients in persons with dementia 1
• Even combinations of nutrients have not shown convincing evidence of effectiveness 1

Clinical Implications

• The absence of Lion's mane from dementia treatment guidelines reflects the lack of robust clinical evidence supporting its use
• While some preclinical research suggests potential mechanisms of action, these have not translated to demonstrated clinical benefits in dementia patients
• Patients interested in Lion's mane should be informed that:
  • It is not a substitute for evidence-based dementia treatments
  • The safety profile in dementia patients has not been well-established
  • One case of anaphylaxis has been reported with fresh Lion's mane mushroom consumption 3

Bottom Line

Focus on established treatments for dementia that have demonstrated effects on morbidity, mortality, and quality of life. While Lion's mane appears relatively safe as a supplement, there is insufficient evidence to recommend it for treating dementia. Patients should be directed toward evidence-based pharmacological treatments and appropriate non-pharmacological interventions.