Cognitive Decline

The importance of detecting the underlying reason and building a preventative plan


To date, there is no current treatment that can prevent or cure cognitive impairment. 

Dr. Dale Bredesen’s research helps us understand this complex and devastating condition; better understanding of disease at the molecular level, and underlying pathophysiological mechanisms could provide potential insights to develop novel treatment strategies to manage the cognitive impairment.  

You won’t hear about Dr. Bredesen’s work in reversing the cognitive decline on the 06.00 o’clock news as mainstream medicine still expects one drug to fix a condition that can be characterized by 36 separate contributory causes.

Dr. Bredesen explains that determining whether you have Alzheimer’s disease or not, does not help you to avoid it or reverse it. However, determining why you have Alzheimer’s is key to develop novel treatment options and preventative plans.

Most people who already have Alzheimer’s disease or MCI (mild cognitive impairment, the harbinger of Alzheimer’s) or SCI (subjective cognitive impairment, which precedes MCI) could show between 10-25 contributors to their cognitive decline. ³

Types of cognitive decline

Let’s jump right into Dr. Dale Bredesen’s six types of Alzheimer’s disease: ³

  • Type 1 Alzheimer’s is inflammatory, or hot, and driven by ongoing inflammation. One of the major mediators of the inflammatory response is called NF-κB (nuclear factor kappa-light-chain enhancer of activated B cells), and NF-κB increases the production of molecules that produce amyloid, so this shows a direct link between inflammation and occurrence of Alzheimer’s. ³
  • Type 2 Alzheimer’s is atrophic, or cold, and driven by suboptimal levels of nutrients, hormones, or trophic factors (cell growth factors like nerve growth factor). your brain is not receiving enough of the right building blocks to maintain your brain’s five hundred trillion (500,000,000,000,000) synaptic connections so cognitive problems ensue. ³
  • Type 1.5 Alzheimer’s is glycotoxic, or sweet, and driven by high blood sugar or high fasting insulin. We call this type 1.5 because it has features of both type 1 and type 2: chronic inflammation (type 1) occurs because the glucose attaches to many of your proteins causing an inflammatory response. Reduced trophic support (type 2) occurs because your brain cells become less sensitive to insulin, which is a critical growth factor for them. ³
  • Type 3 Alzheimer’s disease is toxic, or vile, and driven by exposure to toxins such as mercury, toluene, or mycotoxins (yes, exposure to some mold can cause Alzheimer’s through toxins made by certain molds such as Stachybotrys and Penicillium). Since we are exposed to toxins, we all experience this risk to a greater or lesser degree, so the key is to minimize exposure, identify the toxins to which we are exposed, and increase excretion and detoxification of them. ³
  • Type 4 Alzheimer’s disease is vascular, or pale, and driven by cardiovascular disease. Indeed, vascular dysfunction is identified as one of the main causes of the occurrence and development of Alzheimer’s disease. ³
  • Type 5 Alzheimer’s disease is traumatic and driven by head trauma. A traffic accident, a fall, or even repeated minor head injuries during sports could be a cause to develop Alzheimer’s disease. ³

We are all exposed to everyday toxins, the processed foods – the effects of pesticides and fertilizers on natural wildlife and our water supply is well-documented. Americans demand cheap food, so our agricultural policy for the past 30 years has focused on providing large amounts of inexpensive calories; the high-carbohydrate and unhealthy fat content of the standard American diet, the leaky gut syndrome so many of us have, and the lipid abnormalities (“cholesterol,” although the good cholesterol itself is not the problem), most of us have a significant risk for Alzheimer’s disease or some level of cognitive impairment, and yet…

The great news is we can prevent or reverse the problem as soon as we understand the contributors and underlying causes. 

As Dr. Dale Bredesen laid out at The End of Alzheimer’s Program and his protocol, here’s how we do that:

  • First, we address insulin resistance.
  • Second, we get into ketosis.
  • Third, we optimize all nutrient, hormone, and trophic (growth factor) support.
  • Fourth, we resolve and prevent inflammation.
  • Early interventions focused on modifiable lifestyle factors can help prevent and reduce the risk of cognitive impairment during aging.

Exercise/Physical activity

Regular physical activity and exercise can develop a better memory. Regular exercise has long been known to improve and maintain key aspects of cognitive function i.e. attention, learning, and memory.

A structure in the brain known as the hippocampus is linked to learning and memory. The hippocampus is in the medial temporal lobe (MTL), a well-connected hub of brain activity that is particularly sensitive to the effects of exercise. Alzheimer’s disease is often described as a syndrome of disconnection in the brain. Now, a study of healthy older adults aims to assess the effects of exercise on nerve connections within the MTL. ⁴

Exercise is one of the strategies that has been shown to optimize both mitochondrial and cognitive function, potentially decelerating cognitive decline and attenuating neurodegeneration.

Recent meta-analyses and controlled trials have found that several different types of physical activity, including the following, may improve attention, executive function, and memory: ⁶

  • Both low to moderate and high-intensity exercise ⁷, ⁸
  • Short-term interval training and aerobic exercise ⁸
  • Social dancing ⁸
  • Multimodal physical exercise ⁷, ⁸,⁹
  • Mind-body exercises such as tai chi, yoga, and qigong ⁹

And Mind-Body Therapies and Exercises

A 2019 systematic review and meta-analysis of 49 studies covering 4,506 participants found that mind-body therapies can be effective in treating insomnia and improving sleep quality for both healthy individuals and patients. The tested therapies included:¹⁹

  • Meditation
  • Tai chi
  • Qigong
  • Yoga

A Mediterranean or Keto Diet

Both the Mediterranean diet and the keto diet claim cognitive brain health benefits. Let’s take the keto diet, for example. How does the ketogenic diet affect the brain?

The first study, whose results appear in the journal Scientific Reports, looked at the effects of a keto diet on neurovascular function, which includes sensory and motor functions, as well as circulation.

“The keto diet seemed to boost the clearance of beta-amyloid protein in the brain — the “building blocks” that, in Alzheimer’s, stick together, forming toxic plaques which interfere with neuronal signaling.” – Scientific Reports

Nutrition is a key modulator of cognitive health, but what are those specific nutrients and vitamins that support cognition and reduce neurodegeneration?

Multi-pronged lifestyle interventions offer promise for the prevention and delay of cognitive decline. For example, personalized dietary plans that include neuroprotective foods provide nutrients for optimal cognitive functioning and potentially reduce neuroinflammation, as well as improve brain plasticity. ¹⁴

You may ask, what are specific nutrients and vitamins that support cognition and reduce neurodegeneration?

  • Neuroprotective Nutrients such as Q10 (CoQ10), acetyl-L-carnitine (ALC), and resveratrol.
  • Nutrient-dense anti-inflammatory whole diet approaches. Epidemiological and observational studies, as well as clinical trials, continue to demonstrate that higher adherence to specific diets that prioritize plant, whole grain, and healthy fat intake, such as the Mediterranean, DASH (Dietary Approaches to Stop Hypertension), and MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diets, is associated with less cognitive decline and reduced risk of dementia such as Alzheimer’s disease.15-19 For example, a 2021 observational study used questionnaires to evaluate the effect of Mediterranean diet adherence on the cognitive abilities and psychological state of 2,092 men and women (65 years or older) from seven different Greek cities.16 Results from the study indicated that higher diet adherence was significantly associated with both better cognitive status and fewer depression symptoms.¹⁵
  • Plant-rich diets, keto diets were positively correlated with anti-inflammatory microbial species, and animal product–rich diets were associated with a pro-inflammatory microbial profile; however, no association was found between cognition and microbiota composition. ¹⁶ “Research continues to explore the associations between neuroinflammation and gut dysbiosis and what role any alterations in the gut microbiota may play in cognitive health and prevention of neurodegeneration.”¹⁷

Research does suggest that the longer the healthy eating pattern persists, the greater the impact on cognitive function.

Nutrition

Certain nutrients have been shown to protect against oxidative damage to mitochondria, including:

  • Omega-3 fatty acids
  • Antioxidants (including vitamin C and zinc)
  • Members of the vitamin B family (including vitamin B12 and folic acid)
  • Magnesium

Sleep and Cognitive Decline

Several studies have suggested that sleep and sleep-wake rhythm disturbances are associated with an increased risk of incident dementia and cognitive decline in the elderly, independent of multiple confounders. ¹⁸

Sleep disturbances have a significant impact on cognitive and physical functions in individuals with cognitive decline and may be associated with important psychological distress and depression.

As Dr. Elena Klimenko says, ‘when we try to encourage a good night’s sleep for our patients, perhaps we are doing them better than we thought’ Sleep is a physiological necessity and being deprived of it has many harmful health effects. How do functional medicine practitioners can help their patients get more rest and limit the maladaptive mitochondrial changes that occur during states of stress?

Mental Stimulation

Mental exercise is one simple, yet effective, strategy. Exercise also changes chemical signaling in the brain, even in the short term. If you want to improve memory, increase focus, and feel sharper check our favorite platform called luminosity; you will learn a lot about how your brain works depending on how much you sleep, how much exercise you get, and more.

Manage Stress and Anxiety

Stress triggers inflammation in body that can lead to cognitive decline; stress management is helpful to overcome cognitive decline.

Stress and anxiety management another way to cure the cognitive declining diseases as researchers showed that psychological stress is the primary risk factor for the development of cognitive decline and dementia. 20 The physical or psychological stress can activate the peripheral process and neuronal circuits that can lead to triggering of inflammation and ultimately cognitive decline.21 Daily basis stress has also been linked with stimulation of release of inflammatory cytokines that’s why both stress need to manage to overcome the brain disorders and cognitive decline.

Environmental Toxins and Cognitive Decline: 5 Steps to Reduce Your Risk

In today’s world, we are all exposed to some level of toxins. These appear in our food, water, air, as well as in everyday items found around the home.
Research has shown that low-dose toxic exposure over long periods of time can add up, eventually contributing to cognitive decline disease. According to researchers, the top environmental toxin categories associated with cognitive decline are heavy metals, mold & mycotoxins, plastics, as well as pesticides.

  • Mercury – Mercury sources include dental fillings, contaminated fish, and air polluted from the combustion of fossil fuels and coal.)
     
  • Aluminum – Aluminum is the most abundant metal found on Earth; it’s used in many different daily-use products, including, cosmetics/personal care products, over-the-counter and prescription products, food additives and fillers, cookware, food packaging, etc. Studies now show that aluminum impairs our central nervous system
  • Mold & Mycotoxins – Mold is a fungus that usually grow at humid and damp environment. The poisons produced by mold can stimulate the inflammatory responses in the body. The exposure of toxic mold has been linked to the memory loss, depression, anxiety, brain fog and insomnia. Detoxification from toxic mold can help to treat these conditions and can treat cognitive decline effectively. 
  • Pesticides (Most conventionally farmed foods are exposed to some level of pesticides. Pesticides are substances that are used to kill insects, rodents, and weeds that may affect crop yield during food production.
  • Plastics – Use of plastic utensils, food containers, wrappers, water bottles, linings of cans/containers, coffee pods, to name a few sources, can cause bio-accumulation (build up in our bodies) from the leaching of plastic particles into food and beverages. Plastics are known “endocrine disrupters”, contributing to hormonal imbalances. They have also been linked with health risk including neurological diseases, like Parkinson’s Disease and cognitive decline.

Reducing your risk:

  • Upgrade your diet. (Include more nutrient-dense foods to enhance detoxification. Foods like dark leafy greens, cruciferous veggies (including broccoli, kale, and cabbage), and sulforaphane-rich foods like garlic and onion contain high concentrations of nutrients that increase our detoxification capacity. Load up on fiber and mineral-dense foods, which help trap and eliminate toxins through your digestive system. Last but not least, add cilantro, turmeric, and green tea to ramp up detox pathways.)
  • Incorporate detoxification practices into your daily routine. (Epsom-salt baths, sauna, lymphatic massage, sweat-inducing workouts*, and dry brushing are some examples of practices that improve detoxification. Daily bowel movements are essential. If you don’t have consistent bowel movements, consider working with a nutritionist to help you improve motility and, in turn, enhance your body’s natural ability to eliminate toxins.)
  • Live plastic FREE life. (It may be overwhelming at first, but slowly start to switch to glass bottles, paperware, or eco-friendly and plastic-free packaging.
  • Check your home Switch your home cleaning supplies to more natural alternatives, test your water for contaminants,, and get your home tested for possible air pollutants including mold and other toxic materials).

Conclusion

Overall, this article represents the importance of understanding contributing factors and underlying causes of cognitive decline disorders i.e., Alzheimer’s disease. A better understanding of disease at the molecular and biological level could lead to the development of novel treatment strategies to manage cognitive diseases. Some cognitive decline disorder management strategies include regular exercise, physical activity, keto diet, regular sleep, and management of stress and anxiety. These cognitive decline disease management strategies have proven as successful to manage the disorders such as Alzheimer’s disorder. 

If you would like to get more information about cognitive decline preventative treatment or to schedule an integrative medicine consultation, please contact us.

Resources:

  1. The Impact of Age on Cognition
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906299/

2. Smoking, dementia and cognitive decline in the elderly, a systematic review  https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-8-36

3. https://www.apollohealthco.com/the-six-types-of-alzheimers-disease/

4. https://www.health.harvard.edu/blog/more-movement-better-memory-202105172457

5. Cellular and Molecular Neurobiologyhttps://link.springer.com/journal/10571/volumes-and-issues/36-2

6. Exercise, Mitochondrial Health, and Brain Fitness
https://www.ifm.org/news-insights/neuro-midlife-strategies-for-brain-health/

7. Moreau D, Chou E. The acute effect of high-intensity exercise on executive function: a meta-analysis. Perspect Psychol Sci. 2019;14(5):734-764. doi:10.1177/1745691619850568

8. Zaenker P, Favret F, Lonsdorfer E, Muff G, de Seze J, Isner-Horobeti ME. High-intensity interval training combined with resistance training improves physiological capacities, strength and quality of life in multiple sclerosis patients: a pilot study. Eur J Phys Rehabil Med. 2018;54(1):58-67. doi:10.23736/S1973-9087.17.04637-8

9. Bouaziz W, Schmitt E, Vogel T, et al. Effects of a short-term Interval Aerobic Training Programme with active Recovery bouts (IATP-R) on cognitive and mental health, functional performance and quality of life: a randomised controlled trial in sedentary seniors. Int J Clin Pract. 2019;73(1):e13219. doi:10.1111/ijcp.13219

10. Hsu CL, Best JR, Davis JC, et al. Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment. Br J Sports Med. 2018;52(3):184-191. doi:10.1136/bjsports-2016-096846

11. Vaccaro MG, Izzo G, Ilacqua A, et al. Characterization of the effects of six-month dancing as an approach for successful aging. Int J Endocrinol. 2019;2019:2048391. doi:10.1155/2019/2048391

12. de Oliveira Silva F, Ferreira JV, Plácido J, et al. Three months of multimodal training contributes to mobility and executive function in elderly individuals with mild cognitive impairment, but not in those with Alzheimer’s disease: a randomized controlled trial. Maturitas. 2019;126:28-33. doi:10.1016/j.maturitas.2019.04.217

13. Zou L, Loprinzi PD, Yeung AS, Zeng N, Huang T. The beneficial effects of mind-body exercises for people with mild cognitive impairment: a systematic review with meta-analysis. Arch Phys Med Rehabil. 2019;100(8):1556-1573. doi:10.1016/j.apmr.2019.03.009

14. Poulose SM, Miller MG, Scott T, Shukitt-Hale B. Nutritional factors affecting adult neurogenesis and cognitive function. Adv Nutr. 2017;8(6):804-811. doi:10.3945/an.117.016261

15. Mantzorou M, Vadikolias K, Pavlidou E, et al. Mediterranean diet adherence is associated with better cognitive status and less depressive symptoms in a Greek elderly population. Aging Clin Exp Res. 2021;33(4):1033-1040. doi:10.1007/s40520-020-01608-x

16. an Soest APM, Hermes GDA, Berendsen AAM, et al. Associations between pro- and anti-inflammatory gastro-intestinal microbiota, diet, and cognitive functioning in Dutch healthy older adults: the NU-AGE study. Nutrients. 2020;12(11):3471. doi:10.3390/nu12113471

17. Yuan C, Fondell E, Bhushan A, et al. Long-term intake of vegetables and fruits and subjective cognitive function in US men. Neurology. 2019;92(1):e63-e75. doi:10.1212/WNL.000000000000668

18. Tranah GJ, Blackwell T, Stone KL, Ancoli-Israel S, Paudel ML, Ensrud KE, Cauley JA, Redline S, Hillier TA, Cummings SR, Yaffe K; SOF Research Group: Circadian activity rhythms and risk of incident dementia and mild cognitive impairment in older women. Ann Neurol 2011;70:722-732.

19. Wang X, Li P, Pan C, Dai L, Wu Y, Deng Y. The effect of mind-body therapies on insomnia: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2019;2019:9359807. doi:1155/2019/9359807

20. Sussams R, Schlotz W, Clough Z, Amin J, Simpson S, Abbott A, Beardmore R, Sharples R, Raybould R, Brookes K, Morgan K. Psychological stress, cognitive decline and the development of dementia in amnestic mild cognitive impairment. Scientific reports. 2020 Feb 27;10(1):1-1.

As an Integrative Medicine Doctor, Elena Klimenko provides patients with well-rounded treatment - fusion of conventional Western and alternative holistic medical practices. This integration allows her to address the source of each patient’s illness and to treat a vast array of ailments and medical conditions. Functional Medicine Doctor Klimenko is an American board certified doctor licensed in Internal Medicine and Acupuncture.

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