Cognitive Decline Prevention
Aging is the single most important risk factor for the development of Dementia. It is estimated that 4.5 million people had some type of dementia in the year 2003 and that the numbers will continue to rise as the U.S. population age 65 and over is expected to double in size within the next 25 years. The encouraging news is that according to a recent study supported by the NIH, cognitive impairment dropped from 12.2 percent in 1993 to 8.7 percent in 2002 among people 70 and older. The decrease in the incidence of cognitive impairment was more significant in those individuals that built and maintained cognitive reserve through higher education and continued cognitive stimulation during work and leisure. (19) These findings support the notion that we can create ‘more brain’ and reverse brain aging by a process called Neurogenesis. Alzheimer’s Disease (AD) comprises 75% of all dementias and upon onset, it is incurable. Therefore research has focused on trying to identify those individuals with Mild Cognitive Impairment (MCI), a form of cognitive decline on neuropsychological testing in patients who otherwise do not meet the criteria for dementia, but who will convert to dementia in rates of 5 to 35 percent per year. In these high risk individuals, prophylactic treatments may slow or totally arrest the progress toward AD.
The present article is not meant as a comprehensive summary of all preventive measures but a succinct review of the most important means of reversing brain aging.
A healthy counterbalance of a certain genetic map with a healthy environment is the crucial component of any prevention program. Exercise in any degree is critical. A diet rich in fruits and vegetables with 10% less calories, and supplemented with certain antioxidants is key to keeping a brain young. Obesity has been clearly linked to dementia through an inflammatory process mediated via adipocytokines, and it needs to be aggressively targeted. Diabetes and blood pressure are strong predisposing risk factors if not adequately controlled. The pursuit of higher education and the constant exercise of human intellectual abilities cannot be over emphasized. We must also treat high Homocystein as it is an indication of lack of several members of the B vitamin family, vital food for the brain physiology. Sleeping out of synchrony with our internal biorhythms is associated with impaired learning ability, attention deficits and abnormal melatonin levels. (21) Moderate alcohol drinking has been proposed as a protective factor against MCI and dementia in several longitudinal studies, but contrasting findings also exist.
First we must evaluate the brain measuring levels of neurotransmitters and hormones prior to balancing them. There are 10 small-molecule neurotransmitters. The following six will have the greatest effect on prevention of dementia:
Dopamine
This neurotransmitter is responsible for thought processing speed, memory, attention and problem solving. It can be replenished by taking Tyrosine, its precursor. This aminoacid is found in food sources such as meat, dairy, eggs as well as almonds, avocados and bananas, but only oral supplements can provide significant daily intake. Phenylalanine is another precursor that the body will turn into Tyrosine.
Acetylcholine
This Neurotransmitter synthesized in the body from choline is responsible for learning and memory. Choline is needed for fetal neural tube closure and brain development and it may facilitate learning in the infant. Choline is found in a variety of foods such as liver, eggs, and wheat germ where it exists as phosphocholine, glycerophosphocholine, phosphatidylcholine, and sphingomyelin. Unfortunately, most foods rich in choline are fatty foods. This is another example where oral supplements are indispensable. Also Phosphatydilserine is considered a good source of Acetylcholine.
Improving Serotonin levels with 5HTP and balancing GABA, Glycine and Taurine will improve cognition and in many cases treat mild to moderate depression, another important risk factor for AD.
Certain hormones have also been associated with improved cognition and replenishing them should be part of any dementia prophylaxis regimen: Testosterone trials in elderly men with and without dementia suggest that some cognitive deficit can be prevented when adequate levels of Testosterone are maintained.
DHEAs. Higher levels have been associated with greater memory, concentration, and executive function.
Pregnenolone seems to protect the brain against the excitotoxic effect of neurotransmitters like glutamate while increasing brain levels of acetylcholine. Proper levels of Growth Hormone are important for Neurogenesis. It has been dubbed the ‘repair hormone’ of the brain. Thyroxine levels influence on brain function have been well established for decades.
Epidemiologic data suggest that antioxidants may be associated with a lower incidence of AD. A large clinical trial of moderate AD patients found that vitamin E and selegiline were effective at slowing the progression of moderate AD (15)
Phospahtydilserine (PS) in animals, has been shown to attenuate many neuronal effects of aging, and to restore normal memory on a variety of tasks. For older adults with moderate cognitive impairment, PS has produced consistently modest increases in recall of word lists.
Idebenone has produced significant improvement on the Mini Mental Status Exam scale in patients with mild and moderate dementia.
Acetyl L Carnitine (ALC) (7) in animal studies shows a reversal of the age-related decline in the number of neuron membrane receptors. Studies of patients with probable Alzheimer’s disease have reported nominal advantages over a range of memory tests for ALC-treated patients relative to placebo groups.
Vinpocetine increases blood circulation and metabolism in the brain. In three studies of older adults with memory problems associated with poor brain circulation or dementia-related disease, vinpocetine produced significantly more improvement than a placebo in performance on global cognitive tests reflecting attention, concentration, and memory.
Ginko Biloba in prior dementia clinical trials have suggested efficacy in manifest Alzheimer disease (AD), [5] (3 y 4)
Polyphenols (5) A recent study suggests that grape seed-derived polyphenolics may be useful agents to prevent or treat AD.
Caffeine: protective effects are observed in women only, and notably in the area of verbal skills. A recent study concludes that women with a high rate of caffeine consumption show significantly less decline in verbal cognitive functioning, over a 4-year period, than women who are low or nonconsumers (20).
I firmly believe that brain aging can be reversed through the proper integration of a mentally and physically active lifestyle inspired by a physician versed in balancing neurotransmitters, hormones and nutraceuticals who also focuses on treating body inflammatory conditions.
