Is it safe to use resveratrol and curcumin supplements in patients over 90 years old with dementia?

Safety of Resveratrol and Curcumin in 90+ Year Old Patients with Dementia

Resveratrol and curcumin supplements are not recommended for patients over 90 years old with dementia as there is insufficient evidence supporting their safety and efficacy in this population, and current clinical guidelines do not recommend any nutritional supplements for cognitive improvement in dementia patients.

Evidence Against Supplementation in Dementia

The ESPEN guidelines on nutrition in dementia provide clear recommendations regarding nutritional supplements for dementia patients 1:

• The guidelines explicitly state: "We do not recommend any other nutritional product for persons with dementia to correct cognitive impairment or prevent further cognitive decline" (Grade of evidence: very low, Strength of recommendation: Strong).

• Specifically regarding curcumin, the guidelines note that "curcumin, a natural phenolic compound derived from the perennial herb Curcuma longa, is well known to exhibit anti-inflammatory and antioxidant activities, and has been claimed to improve cognition. In a recent systematic review, two small RCTs were identified, that did not observe any effect on cognition."

• For all nutrients examined, evidence suggests that supplements are unlikely to be effective in treating dementia.

Clinical Trial Evidence for Resveratrol and Curcumin

Despite promising preclinical research, clinical trials have been disappointing:

• Clinical trials investigating curcumin in Alzheimer's disease have shown insufficient evidence to suggest its use in dementia patients 2.

• For resveratrol, while some studies suggest it might influence the progressive cognitive decline in AD patients compared to placebo 3, the evidence remains limited and inconclusive.

• A review of published clinical trials (five for curcumin, six for resveratrol) found disappointing results that do not allow conclusions about their therapeutic or neuroprotective potential 4.

Safety Concerns in Very Elderly Patients

For patients over 90 years old with dementia, several specific concerns arise:

1. Polypharmacy risks: Elderly patients often take multiple medications, increasing the risk of drug interactions.

2. Altered metabolism: Advanced age affects drug metabolism and clearance, potentially increasing the risk of adverse effects.

3. Swallowing difficulties: Common in advanced dementia, increasing the risk of aspiration.

4. Limited evidence in this age group: Most studies exclude very elderly patients or those with advanced dementia.

Recommended Nutritional Approach for Dementia Patients

Instead of supplements, the ESPEN guidelines recommend 1:

1. Regular nutritional screening and assessment for all dementia patients (Strong recommendation)

2. Close monitoring of body weight to detect changes early (Strong recommendation)

3. Provision of adequate food according to individual needs and preferences (Strong recommendation)

4. Pleasant, homelike atmosphere for meals (Strong recommendation)

5. Avoiding dietary restrictions unless absolutely necessary (Strong recommendation)

6. Oral nutritional supplements (ONS) to improve nutritional status if needed, but not to correct cognitive impairment (Strong recommendation)

Management of Nutritional Issues in Dementia

For patients with dementia experiencing nutritional problems, the guidelines recommend addressing potential causes 1:

• Mastication problems: Oral care, dental treatment, texture modification
• Swallowing problems: Swallowing evaluation, training, texture modification
• Medication side effects: Check medications, reduce/replace medications causing problems
• Psychiatric issues: Adequate medical treatment, pleasant meal environment
• Social problems: Help with shopping, cooking and eating, shared meals

Conclusion

For a 90+ year old patient with dementia, the focus should be on providing adequate nutrition through proper food and addressing any specific nutritional deficiencies that may be present, rather than using supplements like resveratrol or curcumin that lack evidence for efficacy and safety in this vulnerable population.