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Aging & Longevity, Prevention

Aging and Cognitive Decline

Skye Sturgeon, DAOM |

link to podcast

by Skye Sturgeon

All of us who have reached a certain age have likely walked into a room and asked, “Why did I come in here?” Or, “Where did I leave my reading glasses?” If you haven’t experienced this…yet, you will. At least, many of your patients have, since nearly 20% of the US population is over 65 years old and these questions represent a commonality of experience as people age. One may wonder if this is merely forgetfulness or if it is a sign of developing dementia.

Cognitive decline is a natural characteristic of aging. (See: Longevity, TCM and The Hallmarks of Aging). While it is true that the aging mind and body function less efficiently, it is unnecessary that this process become pathological. There are behaviors and choices that a person can make in order to mitigate the effects of aging. There is now increased focus on research into this question, and much wisdom is offered by traditional Chinese medicine. Early intervention can be critical to arrest the deterioration of one’s cognitive health. Let’s explore.

aging man looking out a window

Misplacing one’s car keys can be a ‘senior moment’ that people of any age can experience, but what are the symptoms of actual cognitive decline and when do those symptoms become signs of dementia? Cognitive impairment refers to difficulty with mental processes like memory, thinking, and decision-making, where one’s brain is running a bit slower than usual, or some of its functions are a tad off-kilter. For example, not recalling a particular word during a conversation. “It will come to me in a minute…maybe if we just continue talking.” Often, it does, in a couple of minutes. Those with slight cognitive impairment might sometimes struggle with their memory but are still able to manage their lives independently. In fact, some cognitive abilities, like vocabulary and general knowledge, often improve with age.

Mild Cognitive Impairment

The exacerbation of normal cognitive decline is termed ‘Mild Cognitive Impairment’ (MCI). You might notice you’re having more “tip of the tongue” moments or struggling to multitask. Amnestic mild cognitive impairment (aMCI) is the memory focused version of MCI. You don’t simply misplace your keys, you don’t remember owning keys or a car. You remember going on a vacation to the beach last year, but you have no memories of what happened during the vacation. Another type of MCI is Non-amnestic MCI in which a person who has trouble with language, visual-spatial skills, or executive function. They cannot navigate their daily tasks without becoming lost, sometimes for just a moment, sometime shaving to retrace steps to reorient themselves.

Common signs of mild cognitive impairment can include:

  • Forgetting important dates or events
  • Asking the same questions repeatedly
  • Getting lost in familiar places
  • Having trouble following conversations or instructions
  • ‘Checking out’ during a conversation or following an internal ’train of thought’ while someone else is talking
  • Struggling with decision-making or problem-solving, even with every day, basic issues

As clinicians, the diagnostic criteria for MCI typically include:

  • Concerns about cognitive changes from the patient, family, or another healthcare provider
  • Objective evidence of impairment in one or more cognitive domains using cognitive testing such as the Five-minute Cognitive Test (FCT), the Mini-Mental Status Evaluation (MMSE), or the Montreal Cognitive Assessment (MoCA). (See References for links)
  • Evaluation of stress, lack of sleep, medication, diet, social isolation, and other factors
  • Neuroimaging, such as MRI, PET, or CT scans may be used to rule out certain pathological conditions
  • Psychiatric evaluation
  • Genetic tests (certain genes may be associated with an increased risk of developing MCI or Alzheimer’s disease)
  • Cerebral Spinal fluid or blood tests to rule out the presence of certain proteins
  • Medical history of head trauma
  • High risk chronic diseases such as diabetes, heart disease, and kidney disease

Dementia

On the other hand, dementia is a more severe condition that significantly interferes with daily life and independence. The loss of cognitive functioning: thinking, remembering, reasoning, and in some people, an inability to control their emotions, and/or personality changes, may occur. It’s not just about forgetting names; it’s about forgetting how to get home or how to dress yourself. MCI can be a precursor to dementia, but it does not always lead to it. Only about 10-15% of people with MCI develop dementia. However, by the age of 85, about one-third of people have some form of dementia. It is important to understand that dementia is not considered a normal part of aging. Many elderly people live into their nineties without any signs of dementia.

Various neurodegenerative disorders and factors contribute to the development of dementia through a progressive and irreversible loss of neurons and brain functioning. There are several types of dementia including frontotemporal dementia, Lewy body dementia, vascular dementia, and the most common type, Alzheimer’s disease. Other conditions that cause dementia or dementia-like symptoms include hydrocephalus, Creutzfeldt-Jakob disease, Huntington's disease, Chronic traumatic encephalopathy, HIV-associated dementia, chronic heavy alcohol use, traumatic brain injuries, et al.

Dementia results when healthy neurons in the brain fail in function, lose connections with other brain cells, and/or die. While everyone loses some neurons as they age, people with dementia experience far greater loss.

The signs and symptoms of dementia can vary depending on the type and may include:

  • Experiencing memory loss, poor judgment, confusion, and especially recent memories may be inaccessible
  • Difficulty speaking, understanding and expressing thoughts, or reading and writing
  • Wandering and getting lost in a familiar neighborhood
  • Trouble handling money responsibly and paying bills
  • Repeating questions, sometimes after the questions have been answered
  • Inability to track or properly respond to questions asked of them
  • Using unusual words to refer to familiar objects or misnaming family members
  • Taking longer to complete normal daily tasks
  • Losing interest in normal daily activities or events
  • Hallucinating or experiencing delusions or paranoia
  • Acting impulsively
  • Not caring about other people’s feelings
  • Losing balance and problems with movement

Currently, there is no cure for any type of dementia.

Genetic Factors

Alzheimer’s disease exhibits an increased prevalence when a first-degree relative is diagnosed with the disease. More than 100 risk genes are suspected to confer greater susceptibility for developing late-onset (age 65 or older) Alzheimer's disease. Risk genes increase the likelihood of developing the disease but do not guarantee it will happen. APOE-e4 was the first risk gene identified and remains the gene with the strongest impact on risk for some populations. Testing positive for APOE-e4 may not mean the same for Alzheimer's risk across all racial and ethnic groups. Additionally, homozygous expression (two copies, one each from one’s mother and father) of certain higher risk genes bear a greater risk, but it is not determinate or predictive. Researchers estimate that between 40-65% of people diagnosed with Alzheimer's have at least one copy of the APOE-e4 gene.

  • Many of the genes identified as being associated with increased incidence of Alzheimer’s affect processing or production and clearance of β-amyloid, the protein fragment that is the main component of plaques that form in brain tissue. β-amyloid is a prime suspect in decline and death of brain cells. Two biopharmaceutical treatments, donanemab (Kisunla™) and lecanemab (Leqembi®), have demonstrated that removing amyloid from the brain is reasonably likely to reduce cognitive and functional decline in people living with early Alzheimer’s. These drugs are associated with adverse effects that should be researched, especially if a patient is taking anticoagulant drugs.

Alzheimer’s disease has been associated with abnormal buildups of amyloid plaques and tau tangles. However, recent research is exploring whether these proteins are created by the immune system in an effort to repair damaged neurons and that the accumulation of these plaques is a feature of a waste-clearing strategy. Additionally, researchers are exploring whether a gene that produces an enzyme (phosphoglycerate dehydrogenase (PHGDH), previously identified as a biomarker for Alzheimer’s disease, is not just a marker but is rather a direct cause of the disease. (This finding may lead to strategies that result in improvements in medical care.) Otherwise, effective treatment options for dementia (and MCI) are lacking.

Risk Factors for MCI

Several chronic conditions, and modifiable risk factors that can lead to these conditions, may increase the risk of cognitive decline and dementia. Preventing, remedying or managing conditions that increase risk improves quality of life for individuals who may later develop cognitive impairment.

  • Diabetes (an independent predictor, increases risk by 1.5X)
  • Hypertension (patients with HTN have a 40% increased risk) (The recently defined upper limit for blood pressure is 130/80)
  • Traumatic brain injury
  • Chronic illness that includes systemic inflammation
  • Midlife obesity
  • Physical inactivity
  • Tobacco smoking
  • Poor sleep quality and sleep disorders including insomnia
  • Poor diet quality
  • Poor dental hygiene/ gum infection
  • Depression
  • Hearing loss
  • Educational attainment (each year of postsecondary education decreases risk by 7% by building cognitive reserve)
  • Socioeconomic status (individuals with lower SES are 2X more likely to develop MCI)

Treatment for MCI

Currently, there is no cure for MCI, although some patients may receive drugs for Alzheimer’s. The focus is on reducing and treating risk factors with the addition of changes to lifestyle that are known to stave off the worst symptoms of cognitive impairment. First, let us explore Traditional Chinese Medicine (TCM).

Traditional Chinese Medicine (TCM)

Author of the 16th century Compendium of Materia Medica (Bencao Gangmu/本草綱目), Li Shizhen stated, “Brain is the house of Yuan Shen (original Mind)”. Otherwise, in TCM theory, the Brain (nǎo/ 腦) is not a component of Zàng Fǔ (脏腑) theory, but rather one of the eight ‘extraordinary organs’ and it is referred to as the “Sea of Marrow”. From the Nei Jing, "If the Sea of Marrow is abundant, vitality is good, the body feels light and agile, and the span of life will be long. If it is deficient, there will be dizziness, tinnitus, blurred vision, fatigue, and a great desire to lie down." Deficiency in this case is caused by inadequate nourishment.

Thinking, emotions, and most activities of the mind are understood as interplay between the Zang Fu organs and not specifically related to the brain. For example, the Sea of Marrow controls intelligence, memory, and the perception of the five senses, but is controlled and produced by the Kidneys. The Sea of Marrow relies on the Heart to nourish the Mind (shén/神), and which also ‘houses’ it, meaning that the Heart is the location of mental activity. In turn, all the functions of the brain are dispersed to five Zang organs and are maintained by comprehensive functional interactions among these organs. Therefore, brain diseases are regarded as systematic diseases in TCM, and their treatments are aimed at normalizing not only the activity of the organs, but also the balance of functional interaction.

When a TCM practitioner wants to support a patient with memory issues, confusion, disorientation, difficulty in speaking or expressing thoughts, or other problems typical of senility, the following syndromes should be considered.

Kidney deficiency

Because of the Kidney-Brain connection and the associated decline of Kidney Jing with aging, both Kidney Yin deficiency and Kidney Yang deficiency should be assessed and treated accordingly.

Qi deficiency

Metabolically, the Brain is the primary consumer of Qi in the body. All activities of the Brain and mind require adequate supplies of Qi. At base, this means attention should be given to Lung and Spleen Qi. The Spleen has a prominent role in thinking and with regard to memory, it specifically functions in remembering things through focusing, studying, memorizing data, and short-term storage.

Qi stagnation

The functioning of Qi should be smooth and orderly. Any obstruction of Qi with regard to the Brain could contribute to memory loss, confusion, disorientation, etc. Qi flows in the vessels of the body and it is easy to understand that this concept can be extended to neural pathways. Since the Liver is deemed responsible for the smooth flow of Qi, it also must be considered in treating dysfunction in the Brain.

Blood deficiency

According to TCM, Heart Blood is the blood that is circulated by the Heart Qi. Not only does blood carry oxygen, nutrients, and Qi to the brain, but it also houses the cells that provide the cellular and humoral components of the innate and adaptive immune system. In addition, regulatory hormones and other signaling molecules are carried in blood. Thus, blood provides the biochemicals that deliver nutrients, regulation, maintenance and repair, and defense against pathogens to the brain. Treatment of Blood deficiency requires attention to both Spleen and Lung function.

Phlegm

TCM extends the meaning of ‘phlegm’ beyond the catarrh of the respiratory system to include the accumulation of ‘congealed’ Dampness anywhere in the body. For example, the plaque in atherosclerosis, and in this discussion, the amyloid plaques and tau tangles found in dementia. In TCM terms, it is described as ‘Phlegm misting the Mind”. One poetic description of cognitive impairment in the elderly is that their minds have become cloudy or foggy. If there is Yin or Blood deficiency, this can give rise to Liver Wind or Yang Rising which can drive Phlegm upward and block the orifices to the mind.

Heat

Internal damage to tissues of the Brain is considered an injury to Yin. This Yin damage engenders inflammation or Yin deficient Heat. The damage may have been caused by a long-term pathogenic process, a decline in Yin due to aging, head trauma, or because of a lingering pathogen (such as Epstein-Barr or Sars cov2 viruses, et al.).

These diagnoses suggest the treatment strategies of:

  • Warming the Kidney Yang
  • Nourishing Kidney Yin;
  • Tonifying the Lung and Spleen Qi;
  • Nourishing Heart Blood
  • Moving Qi and Blood
  • Calming Shen
  • Transforming Phlegm
  • Opening the Orifices
  • Subduing Liver Yang or Extinguishing Liver Wind

Obviously, this treatment plan can be quite complex and requires careful assessment to determine the preponderance of factors that need to be addressed. The first focus of treatment should be to consider constitutional disharmonies. Kidney Yin or Yang deficiency can be treated with classic formulas, as appropriate. Likewise, Qi and Blood deficiency. All require tonification or nourishment.

If a patient’s medical history reveals the possibility of Lingering pathogen, consider the use of Minor Bupleurum /Xiao Chai Hu Tang (MW# 3622) for a couple of weeks to Harmonize the Shao Yang before using an herb formula to Clear Heat or Clear Deficiency Heat. (See: Recovery Formulas for “Lingering Evil Qi” or William MacLean’s course on Lingering Pathogens.)

Bu Nao Pian

To address the major symptoms of MCI, Plum Flower™ Bu Nao Pian is suggested. Also known as Cerebral Tonic Pills (MW# 3926) or Bamboo Pharmacy™ Clear Cognition, Bu Nao Pian is a modern formulation designed to treat multiple organ deficiency patterns with combined emotional and cognitive complaints. The functions for Bu Nao Pian are to nourish the Heart, tonify the Kidneys, clear and benefit the brain, tonify the Blood, open the Orifices, transform Phlegm, extinguish Wind, subdue Liver Yang, and calm the Shen.

This recently reformulated prescription addresses specific emotional and cognitive complaints often found together. The general indication for this unique formulation is Heart Blood and Kidney Essence deficiency with Wind stirring, and Phlegm misting the Heart and obstructing clear perception of the Shen. Possible symptomology includes poor memory, poor concentration, forgetfulness, confusion, disorientation, dull sensorium, mental fatigue, restlessness, insomnia, restless sleep, excessive dreaming, nightmares, anxiety, uneasiness, palpitations, fatigue or exhaustion. Typical signs may include a tongue that is pale, and there may be a thick coat, possibly yellow. The pulse may vary between thready, slippery, wiry, or in some cases, weak.

The herbs in the formula are: Suan zao ren (chao) /Ziziphus jujuba seed, Dang gui /Angelica sinensis root, Rou cong rong (zheng)/ Cistanche deserticola herb (steamed), Hu tao ren /Juglans regia seed, Gou qi zi /Lycium barbarum fruit, Yi zhi ren (yan) / Alpinia oxyphylla fruit (salt-fried), Bai zi ren /Platycladus orientalis seed, Wu wei zi (jiu) /Schisandra chinensis fruit (wine-fried), Yuan zhi /Polygala tenuifolia root, Dan nan xing / Arisaema erubescens rhizome (bile prep.), Zhi Tian zhu huang /Bambusa textilis tabasheer, Shi chang pu /Acorus tatarinowii rhizome, Long gu (duan) / Os draconis mineral (toasted), Tian ma /Gastrodia elata rhizome, and Hu po / Succinum resin.

Other Herbs

Other herbs that have been the subject of research regarding cognitive impairment include:

Radix Morinda officinalis /Ba ji tian

Morinda officinalis is a widely used herb to tonify Kidney Yang. Morinda contains oligosaccharides, anthraquinones, iridoids, flavonoids, amino acids, and trace elements, which confer the herb with anti-inflammatory and antioxidant properties. Neuroinflammation and oxidative stress are hallmarks of neurodegeneration, contributing to cognitive decline.

Semen Cuscuta chinensis /Tu si zi

The seeds of Cuscuta chinensis have been commonly used in TCM as a Yang tonic for preventing aging. Previous studies have found that C. chinensis possesses anti-inflammatory activities in rodents. Cuscuta exhibited a neuroprotective activity against scopolamine-induced memory deficit, cholinergic dysfunction, oxidative damage, and neuroinflammation.

Rhizoma Ligusticum / Chuan xiong

In traditional Asian medicine, Ligusticum chuanxiong is classified as an herb that mildly moves Blood and is mainly used for improving blood circulation or for analgesic and anti-inflammatory purposes, especially for pain disorders of the head and neck. Chuan xiong can inhibit the activation of astrocytes and microglia involved in the inflammatory response in the brain, and effectively inhibit cognitive impairment caused by common carotid artery stenosis.

Radix Rhodiola crenulatae /Hong jing tian

Rhodiola crenulata may help support memory and brain function, potentially offering neuroprotective effects against cognitive impairment, having both antioxidative and anti-inflammatory properties. Research findings indicated that Rhodiola improved the impaired hippocampal neurogenesis in the rat model of Alzheimer’s Disease through protecting neural stem cells by its main ingredient salidroside which scavenged intracellular reactive oxygen species.

Folium Ginkgo biloba

Various parts of the Ginkgo tree possess bioactive compounds, including ginkgolides and bilobalides, as well as flavonoids. More recently, extracts of the dried green Ginkgo leaves have been investigated for treating several medical conditions, particularly those related to diseases of the peripheral and cerebral circulation, including neurodegenerative conditions leading to cognitive decline and dementia. Ginkgo leaf extracts act to reduce oxidative stress, inflammation, and cell death.

Gotu kola / Herba Centella asiatica /Ji xue cao

Known as the ‘herb of longevity’, the Gotu kola plant has potential to enhance cognitive function and protect the brain from age-related cognitive decline. One triterpenoid, asiaticoside, has been shown to support neuroplasticity, especially in the formation of dendrites, the branchy parts of neurons that help transmit information. Gotu Kola has also been shown to improve focus, memory enhancement, neuroprotection, stress reduction, and improved mental clarity.

Bacopas monnieri

Bacopa monnieri is an Ayurvedic herb that research has shown could increase the score of executive function, orientation, calculation, abstraction, delayed recall, visuoperception, attention, verbal fluency and the total score of cognitive function in patients with mild cognitive impairment.

Radix Polygala tenuifolia /Yuan zhi

Polygala tenuifolia polysaccharide improves spatial cognitive deficits in Alzheimer’s disease mice, reduces cellular damage in the hippocampus, maintains the balance of the cholinergic system, and exerts an anti-AD effect in vivo. The molecular mechanism of its action may be related to the reduction of β-amyloid deposition as well as the activation of extracellular signal-regulated kinases pathway-related proteins with enhanced synaptic plasticity.

Radix Panax ginseng /Ren shen

Recent studies on life prolongation with ginseng consumption suggest that those who consumed ginseng for more than 5 years had reduced mortality and cognitive decline compared to those who did not. Clinical studies have also shown that acute or long-term intake of ginseng total extract improves acute working memory performance or cognitive function in healthy individuals and those with subjective memory impairment, mild cognitive impairment, or early Alzheimer's disease.

Rhizoma Acorus tatarinowii /Shi chang pu

Pericytes are specialized cells that wrap around the endothelial cells of capillaries and venules, playing crucial roles in regulating blood flow, maintaining the blood-brain barrier, and supporting vascular stability. Pericytes regulate cerebral blood flow (CBF) and excess amyloid in the brain. Pericyte dysfunction may contribute to the pathology of Alzheimer's disease. Acorus tatarinowii contains β-Asarone, the primary active compound in Shi chang pu, modulates pericyte function, which protects the central nervous system, has the potential to enhance CBF, and mitigate pericellular dysfunction, thereby ameliorating β-amyloid deposition in the brain and improving cognitive impairment.

Radix Rehmannia glutinosa / Di huang

Rehmannioside A is derived from Rehmannia glutinosa, which is widely used as an important ingredient to treat diseases caused by Kidney deficiency such as cerebral arteriosclerosis, aging-related stroke and dementia in China. Recent studies have proved that Rehmannia glutinosa and Rehmannioside A can improve memory capability and recover nerve damage. Rehmannioside A exhibits the properties of neuroprotection, antioxidant, anti-inflammation and anti-apoptosis for spinal cord injury and vascular dementia.

Huperzia serrata / Qian ceng ta

Huperzia serrata, commonly known as Chinese club moss, contains a compound called huperzine A, which may help improve cognitive function and memory. The accumulation of β-amyloid protein is an important factor in determining the onset of Alzheimer’s disease since it is related to oxidative stress, which is thought to promote neuronal cell death. In addition, the concentration of acetylcholine, a neurotransmitter, decreases. Huperzia serrata and its components prevented cell death and reduced the production of reactive oxygen species. Huperzia serrata and its components also inhibited acetylcholinesterase (the enzyme that breaks down acetylcholine) activity. Huperzia serrata treatment significantly improved arm alternation and latency cognitive dysfunction. Huperzia serrata also decreased lipid peroxidation (oxidative degradation) in the brain.

Cordyceps sinensis / CS-4 / Cordyceps militaris / Dong chong xia cao

Cordyceps mushrooms may help improve cognitive function and memory, particularly in individuals experiencing cognitive impairment. They contain bioactive compounds that support brain health and protect against oxidative stress, potentially enhancing overall cognitive performance. Specifically, Cordyceps may be a potential candidate for the neuroprotection of hippocampus and the recovery of various vascular dementia or neuroinflammatory disorders.

Hericium erinaceus / Lion’s Mane mushroom

Lion's Mane mushroom may help improve cognitive function, particularly in individuals with mild cognitive impairment, as some studies suggest it can promote nerve growth and protect against neurodegenerative diseases like Alzheimer's.

Vinca minor

Commonly known as periwinkle, is a source of vinca alkaloids such as vinpocetine. Clinical trials suggest several potential benefits of vinpocetine including memory improvement, increased cerebral blood flow and metabolism, neuroprotective effects, and reduction of inflammation.

Dietary Supplements

Pyrroloquinoline quinone (PQQ)

PQQ improves cognitive deficit caused by oxidative stress, similarly to vitamin E. Pyrroloquinoline quinone (PQQ), a cofactor of dehydrogenase and amine oxidase, increases the production of the nerve growth factor (NGF), and protects N-methyl-D-aspartate (NMDA) receptors by a direct oxidation of the receptor redox site. PQQ also protects neurons from NMDA toxicity by suppressing peroxynitrite and stimulates NGF production. PQQ also acts as an antioxidant against lipid peroxidation.

Resveratrol

Resveratrol (3,5,4′-trihydroxystilbene) belongs to a family of polyphenolic compounds known as stilbenes, particularly concentrated in grapes and red wine. Resveratrol is able to improve cerebral blood flow, cerebral vasodilator responsiveness to hypercapnia, some cognitive tests, perceived performances, and the β-amyloid in plasma and cerebrospinal fluid. In preclinical models of cognitive decline, resveratrol displays potent antioxidant activity by scavenging free radicals, reducing quinone reductase 2 activity and upregulating endogenous enzymes. Resveratrol also inhibits pro-inflammatory enzyme expression, reduces nuclear factor-κB activation and cytokine release. Treatment with resveratrol can affect multiple signaling pathway effectors involved in cell survival, programmed cell death and synaptic plasticity.

Omega 3 fatty acids

Prospective studies and three new meta-analyses suggest that fish oil or omega-3 polyunsaturated fatty acids intake are associated with a reduction in development of mild cognitive decline and Alzheimer's disease. Supplementation with docosahexaenoic acid (DHA) in randomized controlled trials in those with mild cognitive impairment showed benefit on cognitive decline and coronary artery disease.

Vitamin D

Vitamin D is a neurosteroid hormone that regulates neurotransmitters and neurotrophins in addition to its definitive role in bone health. It has anti-inflammatory, antioxidant, and neuroprotective properties and increases neurotrophic factors such as nerve growth factor which further promotes brain health. Moreover, it is also helpful in the prevention of amyloid accumulation and promotes amyloid clearance.

Magnesium

Magnesium is an essential mineral involved in numerous enzymatic reactions and critical for neuronal bioactivity in the context of neuroinflammation and cognitive decline. The potential neuroprotective effects of magnesium include the mechanisms of neuroprotection by magnesium through maintaining neuronal ion homeostasis, reducing inflammation, and preventing excitotoxicity. Magnesium glycinate, known for its high bioavailability, ensures that magnesium is efficiently absorbed into the bloodstream and, consequently, available to the body and brain. Magnesium supplementation also may help improve sleep quality by promoting relaxation and balancing neurotransmitters that affect sleep.

Inositol

Epi- and scyllo-inositol isomers are capable of stabilizing non-toxic forms of β-amyloid proteins, which are characteristic of Alzheimer’s disease and cognitive dementia in Down’s syndrome, both associated with brain insulin resistance.

Glycine

Glycine is the smallest nonessential amino acid and has previously unrecognized neurotherapeutic effects. In the study (see the References section), the underlying mechanism regarding the neuroprotective effect of glycine against neuroapoptosis, neuroinflammation, synaptic dysfunction, and memory impairment resulting from d-galactose-induced elevation of reactive oxygen species during the onset of neurodegeneration was examined in the brains of mice.

Nattokinase

Nattokinase (NK), a protease found in fermented soybeans has been extensively studied because it displays powerful neuroprotective abilities. NK supplementation can alleviate the cognitive impairment related to blood-brain-barrier dysfunction, reduce brain inflammation, and improve cognitive ability.

NAD+

Based on animal models, NAD+ precursors have been identified as a promising treatment strategy for several conditions; principally, age-related cognitive decline (including Alzheimer’s disease and vascular dementia), but also diabetes, stroke, and traumatic brain injury. Candidate factors have included NAD+ itself, its reduced form NADH, nicotinamide (NAM), nicotinamide mononucleotide (NMN), nicotinamide riboside (NR), and niacin (or nicotinic acid).

Lifestyle practices

Since there is currently no ‘cure’ for either cognitive impairment or dementia, the wisest course is to choose behaviors and practices that stave off the deterioration that accompanies aging. There is ongoing research about what a person can do to mitigate the identifiable risks. Here are some of the current suggestions, many of which follow a theme to prevent or diminish most of the challenges of aging.

  • Certain significant risk factors can be eliminated by choice, especially smoking, recreational drug use, and limiting alcohol consumption.
  • Diabetes is a common disease that is often cited as carrying the highest risk for developing cognitive impairment. Diabetes causes the development of advanced glycation end-products (AGEs) which are proteins or lipids that become glycated after exposure to high blood sugar. These AGEs ravage the tissues of the body, and this damage causes inflammation, resulting in atherosclerosis, chronic kidney disease, age-related macular degeneration, cognitive impairment and Alzheimer's disease. Maintaining glucose control through diet, exercise, and medications is paramount. Aim for a HgbA1c of 6.0. Modern medications can help significantly in arresting the progression of the disease. A continuous glucose monitor can provide valuable biofeedback regarding the effects of various foods, exercise, and the efficacy of medications.
  • Hypertension is a major risk factor for cognitive decline in elderly patients. Current recommendations are that blood pressure needs to be maintained below 130/80. For most adults, there's no identifiable cause of high blood pressure and it develops over many years. Many of the risk factors already defined contribute to hypertension including obesity, tobacco and alcohol use, kidney disease, diabetes, sleep apnea, stress, too much sodium (salt), and too little potassium in their diet. Uncontrolled high blood pressure may affect the ability to think, remember, and learn. Often, those with hypertension have narrow or blocked arteries which can limit blood flow to the brain, and this can cause vascular dementia. Medications (including herbs and dietary supplements), dietary changes, weight loss, regular exercise, and stress reduction can moderate hypertension.
  • Obesity is a significant risk factor in developing cognitive impairment. Studies show that maintaining a healthy weight increases one’s chance of living to be 90 years old by 50-100% Eating a restricted calorie, balanced diet, heavy in whole foods, legumes, fruits, and vegetables, with the Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diets suggested. The importance of eating organic food as much as possible and avoiding highly processed foods cannot be underemphasized. Stay hydrated. Drinking clean water and avoiding sweetened drinks (even ones with artificial sweeteners) such as soda (soft drinks) and fruit juices are likewise recommended.
  • Exercise is critically important. Physical inactivity is a major risk factor. Start bywalking for 20 minutes (or more!) every day. Breathing practices such as qigong, tai chi, or yoga can play a prominent role in brain health. Likewise, increased lean muscle mass is better for the brain than just one’s weight or body mass index (BMI). So, strength training should also be a focus. This includes weightlifting, body weight exercises, resistance bands, Pilates, et al.
  • Adequate rest and sleep are required to maintain homeostasis. Research has shown that mitochondria in the brain absolutely require the recovery period that sleep provides. One should aim for 7-9 hours each night. Poor sleep, insomnia, and trying to make up the deficit by napping or sleeping more on the weekend come with a greater risk of cognitive impairment. Investigate good sleep hygiene practices rather than medications for sleep.
  • Exercise your cognitive skills by reading, writing, and playing games. Engage new skills such as taking up a musical instrument, expand your computer knowledge by learning new software programs, learn to sew, knit, or quilt. Keep your mind active and stop watching television, looking at your phone, or streaming on your computer or tablet. Go back to school to engage your mind in learning new information which creates new neural pathways. Becoming a life-long learner will help maintain your cognitive status.
  • Maintaining your mental health with meditation or contemplation helps with maintaining mental fitness, as does avoiding social isolation, stress, and depression. Participating and volunteering in your community can foster a sense of purpose and create a positive mental effect. Having gratitude for your relative health and longevity makes every day worthwhile. Enjoy the wonder of Nature. Where can you experience awe in your everyday environment?
  • Engage in leisure activities and hobbies such as hiking (or walking), biking, traveling, music, theater, dance, creative writing, and other participatory arts can improve older adults’ quality of life and well-being. It is so important to have fun and to stay involved in life.
  • Avoid social isolation by joining groups in your community that focus on activities that interest you. Maintain and develop friendships and widen your social circle. Social media does not substitute for real social interactions.
  • Stay current with medical care. As one ages, lack of medical care, dentistry, vision correction, and hearing loss are all associated with poorer outcomes with regard to cognitive health.
  • Shingles is an all-too-common disease of elderly patients, and the effects can be excruciating. A vaccine is available and importantly, research has demonstrated that vaccination for Herpes zoster has a causal relationship with preventing dementia.

While cognitive decline is a feature of the aging process, significant cognitive impairment and dementia can be avoided by making choices that promote healthy living. Conscious awareness of risk factors and mitigating their impact can result in a happy, healthy, high-quality life as one celebrates their elderhood.

References

About the Author

Skye Sturgeon, DAOM is the Quality Assurance Manager and Special Consultant for Mayway, USA. Skye was the former Chair of Acupuncture & East Asian Medicine and core faculty member at Bastyr University, core faculty member and Faculty Council Chair at the American College of Traditional Chinese Medicine, and President and Senior Professor of the Acupuncture & Integrative Medicine College, Berkeley. Before making Chinese medicine his career choice, Skye held various positions in the Natural Foods Industry for 12 years and prior to that was a clinical biochemist and toxicologist.

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