A Chiropractic Rationale to Mitigate Dementia and Alzheimer’s Disease

Written by: James Demetrious, DC, DABCO

Diplomate, American Board of Chiropractic Orthopedists
Diplomate, International Academy of Neuromusculoskeletal Medicine

Dementia and Alzheimer’s

Dementia is characterized by a progressive loss of cognitive brain function that adversely affects memory and judgment.

Alzheimer’s disease is a type of dementia that slowly destroys memory, reasoning, and eventually, the ability to carry out the simplest tasks. Alzheimer’s disease accounts for 60-80% of dementia cases.

The CDC ranks Alzheimer’s as the 7th leading cause of death in the United States.

CSF Flow Obstruction and Intracranial Pressure…Under-Appreciated Causes of Neurodegeneration

Recent research affirms the mechanisms with which chiropractic care may afford relief to dementia and Alzheimer’s patients:

  • In their paper, neurosurgeons Khachatryan et al. describe the possible impact of cervical stenosis on cephalad neuronal dysfunction. [1]
  • Mayo Clinic neurosurgeons alleviated symptoms of normal pressure hydrocephalus through spinal decompression. [2]
  • Trager et al. offer insight into the association of trigeminal neuralgia and degenerative cervical myelopathy. [3]

Impaired CSF Drainage is Key

Brain viability is dependent upon the production, circulation, utilization, absorption, and outflow of cerebrospinal fluid (CSF).

This system relies upon:

  • Arachnoid granulations;
  • Venous drainage;
  • Glymphatic drainage;
  • Craniospinal outflow.

Decreased CSF reabsorption and drainage produce increased intracranial pressure with resultant apoptosis and neurotoxicity. 

Progressive neurodegeneration of brain parenchyma can be explained by the following perturbations:

  • The cells of the brain are susceptible to pressure described by the Monroe-Kellie doctrine.
  • Impairment of arachnoid granulation absorption, venous, glymphatic, and craniospinal drainage can increase intracranial pressure.
  • The prevalence of spinal stenosis as patients age correlates to impaired craniospinal outflow and chronic intracranial hypertension.
  • Increased intracranial pressure may produce extravasation of CSF through the blood-brain barrier, depositing antigenic protein into susceptible brain parenchyma.
  • Small and progressive increases in intracranial pressure over decades are associated with neurodegeneration.
  • Neurodegeneration is often characterized as perivascular changes, white matter changes, and cortical atrophy associated with age described on MRI.

Decades of progressively worsening and fluctuating intracranial pressure causes damage that is attributable to cognitive and functional decline.

Causes of Impaired CSF Outflow

Impedance of CSF reabsorption and outflow are well recognized:

  • Normal Pressure Hydrocephalus;
  • Chiari malformations;
  • Spinal stenosis;
  • Chiropractic subluxations;
  • Microgravity effects documented by NASA.

Is it Possible to Improve the Dynamic CSF Outflow and Mitigate Increased Intracranial Pressure?

The following procedures may alleviate intracranial pressure and improve neurologic function:

  • Ventriculoperitoneal shunt;
  • Chiari decompression surgery;
  • Decompressive spinal surgery to alleviate spinal stenosis;
  • Chiropractic spinal adjustments and mobilization;
  • Postural changes.

Means to Objectively Measure the Efficacy of Mitigating Care

How can we possibly measure the objective benefit of the above-mitigating care?

  • Imaging:
    • Real-time, phase contrast CINE MRI to evaluate craniospinal velocities and pressure;
    • Ventricular measurements;
    • MRI assessment of posterior eye flattening and optic nerve tortuosity;
    • Transocular US to assess Optic Nerve Sheath Diameters;
    • fMRI BOLD imaging;
    • Diffusion Tensor Imaging – Tractography;
    • Fonar Upright Imaging.
  • Lab:
    • Beta-Amyloid ratio;
    • pTau181;
    • Neurofilament Light Chain.
  • Comprehensive neurologic assessment.
  • Epidemiologic evaluation of dementia and Alzheimer’s in the lifelong chiropractic patient cohort.

Chiropractic Contribution

The motion associated with chiropractic care is a vital element in improving CSF flow and preserving neurologic integrity. Further research is desperately needed.

Conclusion

The burden of dementia and Alzheimer’s on our population is overwhelming. Time is truly of the essence. Once neurodegeneration reaches a point of no return, our patients, family members, and friends are doomed. A multi-disciplinary approach to improve the understanding and mitigate this life-robbing condition is necessary.

Chiropractic and other forms of ancillary medical care may be vital, safe, non-invasive, and effective means to alleviate intracranial pressure, restore CSF outflow, and mitigate the progression of dementia and Alzheimer’s disease.

References

  1. Khachatryan et al. Medical Hypotheses 118 (2018) 13–18.
  2. Richter et al. . Cureus 12(7): e9311.
  3. Trager et al. Neurol Clin Neurosci. 2023;00:1–7.

We offer extensive CE coursework related to this topic at: PostGradDC.com 

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is an internationally distinguished board-certified chiropractic orthopedist, educator, author, and editor. Register for coursework at PostGradDC.com.