Summary .....

Summary of the study

The present study is "To evaluate The efficacy of selected Ayurvedic formulations in degenerative Diseases of the Nervous System - with special reference to Parkinsonism and Alzheimer's disease".


For the present study P.D. patients were categorized into 3 groups
# Group C - control group taking Modern medicines only (13 patients)
# Group A - Patients receiving Ayurvedic medicines only. (19 patients)
# Group AE - Patients receiving Ayurvedic drugs along with allopathic medicines. (18 patients)

The patients were selected according to the inclusion criteria, and they were assessed before starting the treatment, and after 3 months of treatment. P.D. patients were assessed by UPDR scale and scores were recorded in clinical proforma. For diagnosis and assessment, the patients were referred to the Neurology OP of Medical College Hospital, Trivandrum, and they were re-assessed after 3 months of treatment.


For the assessment, Activities of daily living (ADL), Mentation, Behavior and mood, Memory, Motor system examination, complications of therapy modified Hoen and Yahr staging, modified Schwab and England activities of daily living were considered. The patients from Group A and AE were provided with Ayurvedic medicines. The principles adopted were pachana, deepana, samana and rasayana.


For Alzheimer's Disease, only three cases were got and they were assessed using MMSE. The selected patients were referred to the MCH, Thiruvananthapuram, for assessments before and after treatment. The scores were recorded in separate clinical proforma. All the patients were diagnosed cases of AD who were previously under allopathic medication.


Findings of the study
Section A - Demographic characteristics
Fifty patients with PD below the age of 80 were selected for the study. The majority of patients (40%) were in the age group 50-59 years followed by 30% in 60-69 years. The data showed a positive correlation between the age of the patient and the incidence of P.D. 74% of patients were males and the remaining 26% where females. Thus the male to female ratio is 3:1. In the present study 64% of patients were Hindus, 20% Muslims and 16% Christians which is similar to the percentage by religion of Kerala. Thus it appears that the occurrence of Parkinsonism is irrespective of religious status. More than 50% of patients were sedentary workers and 30% were farmers. Out of the 13 females studied, 10 were housewives. In fact, those who were engaged in sedentary work had more risk of getting the disease. 64% of patients were from rural area and 36% from urban area. It is observed that Parkinsonism is mostly a disease of the middle/high socio economic status group. Out of the total 50 patients studied, only 16% were from low socio-economic status, eventhough the majority of population belongs to this group.
Section B - Data related to Parkinson's disease and Response to Treatment
Modified Schwab and England ADL-Scale were done to assess the % improvement in ADL. The details were attached along with case sheet proforma. While considering the % ADL, the control group showed no difference at all during the entire period of treatment. With regard to the Ayurvedic regime of treatment, it was remarkably good in improving the % ADL, because it has increased to 83.4% after treatment from 73.7% before treatment. At the same ime in the AE group, initially the mean % of ADL was 73.3, which has increased to 85% after the treatment. The improvement noted in both the group A and AE happened to be highly statistically significant. In other words it appears that both treatment methods A & AE were having more or less similar effect in improving the % of ADL. In further analysis, it is observed that the mean improvement obtained in Group A was more consistent due to minimum standard deviation. (SD= 3.53 in-group A compared to 8.22 in AE).

The statistical tests for equality of means (student 't' test) showed the difference insignificant. (P>0.05). Thus it is proved beyond doubt that group A and AE have same effect in improving the % ADL.

The actual ADL score considered in both the groups A & AE were also found to be equally effective.
While analyzing the scores of mentation, behavior and mood, the control group only have the maintaining effect whereas the group A and AE showed remarkable reduction in mean score. In either case the reduction noted was highly statistically significant.

While comparing the scores of Motor examination, Group A & AE showed considerable improvement after treatment whereas the control group continued to be as such. Initially, the mean score was 16.11 in group A and 19.11 in Group AE which has come down to 10.05 and 12.17 after the treatment. In either case the reduction was highly statistically significant.

Complications of therapy, Dyskinesias, clinical fluctuations and other complaints were also assessed. The control group and group AE were already subjected to some allopathic treatments and hence they were having various complications due to therapy. In control group the complication of therapy score continued to be the same (Mean=5) throughout the entire period of treatment. But in group AE it was 2.72 before treatment but showed a reduction and has attained a mean score of 1.61 after treatment. In this case the reduction noted happened to be statistically insignificant. Here group A happened to be superior in keeping the patients free from other complications of therapy. Other complaints like nausea, vomiting and sleep disturbance showed a reduction of 10% after treatment. The general health of the patients in groups A also improved considerably. Thus in this respect treatment of group A appeared to be superior to AE.
While considering all the variables of assessment together, the mean total score with control group remained as 39 before and after treatment. In group A, it reduced to 20.16 after treatment form 32.16 prior to treatment. In-group AE, the initial mean total score was comparatively high (mean=41) which has come down to 25.78 after treatment. In either group the reduction was significant at a very high level.

Modified Hoen and Yahr staging (MHYS) scores were also analysed. In group A and Group AE the mean MHYS was identical before treatment. In either case there was significant reduction and the M.H.Y.S score declined to 1.79 in-group A and 1.56 in Group AE after treatment. The paired 't test' showed the differences are highly statistically significant.

The datas were further compared to see the improvement if any in the memory score. In-group A, the mean memory score prior to treatment was 1.47, which has come down to 1.11 after treatment. Thus there was an improvement of 0.36 after treatment, which was significant at 5 % level, (t= 3.2; df= 17; p<0.05). At the same time the reductions noted in-group AE was only 0.16 (reduced to 1 from 1.16). This difference happened to be insignificant statistically. In other words it is quiet evident that treatment A alone had a significant improvement in the memory score statistically.

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