Joe Biden is visiting a nursing home. He walks up to an old lady and asks, ‘Excuse me madame, do you know who I am?’. She looks at him, pauses for a while and responds, ‘No I don’t. But if you ask the nurse she will tell you’.
It is a terrible thing to lose your memory. A lifetime of experiences and friendships can drift away, taking with it so much more than mere recollections. It is equally painful to watch a loved one part from their senses. Somebody so key to your life and journey can vanish in front of you, taking a lifetime of meaning with them.
Cognitive decline is the loss of our higher functions and thoughts. It describes a loss of memory, control over behaviour, regulation of mood and skills to speak, listen, translate, move and other dexterous activities. It may occur temporarily, such as a hangover or fatigue, or more chronic such as dementia or Alzheimer’s disease.
Memory is a function of our brain cells. Brain cells require optimum conditions of nutrition and wellness to flourish and function. When we are well and healthy, our minds are sharp, creative and powerful. Conversely, a brain cell under duress will eventually weaken and lose the capacity to heal and regulate and result in a loss of cognitive powers; all resulting eventually in a loss of mental faculties.
Our brain exists in a delicate harmony with the rest of the body. It relies on our gut for nutrition and hormonal regulation, the liver to clear toxins and our behaviours and environment to ensure adequate sleep and stress management.
You can read about relevant brain health topics by clicking the article below:
- The Body and the Mind; medical factors for mental health
What are the causes of cognitive decline?
Dementia and cognitive decline are all broadly caused by the same thing; a decline in brain function. This may be structural, such as the deposition of plaques in the brain such as amyloid or lewy bodies. It can also be due to a lack of blood supply due to blocked or constricted vessels, either as a one off big stroke or years of small ones. This is called vascular dementia.
Years of toxic stress such as heavy alcohol, drugs, nutritional deficiencies in the diet, chronic inflammation, a lack of helpful hormones to assist the brain to repair damage, poor sleep, sleep apnoea (which is a lack of oxygen overnight due to obstructed airways), heavy metals and other pollutants and emotional stress can slowly attack the brain.
In a way, our cells are like fish in a pond. If the pond is clean and healthy, they do well. If conditions are poor, they dwindle.
How can we prevent cognitive decline?
Prevention remains a vital part of the arsenal against cognitive decline. Given the tenets of functional medicine and cell ageing, it might even be said that cognitive decline, as a disease of ageing, is probably only properly dealt with in the prevention phase.
Preventing cognitive decline means having the body in as good a position across the board as possible. Multiple inputs create the risk for cognitive decline.
The things to assess include:
- The balance of oxidant to antioxidants in the body
- The profile of lipids (cholesterol) and whether oxidised, the size (small is more damaging for LDL)
- The genetics of lipid metabolism and whether somebody carries Apoe4 (a higher risk gene for cholesterol related vascular disease)
- Vitamin and mineral status to ensure no deficiencies (Magnesium and zinc are typically deficient in the western diet)
- Assessing insulin status; insulin is a potentially inflammatory hormone in the body
- Assessing the omega 3 to 6 ratio and other inflammatory lipid states
- Measuring the blood pressure with 24 hour monitoring
- Sleep studies to assess oxygenation over night and indicators of sleep disease Food diary and dietary assessment to ensure high fiber,
- high nutrient diet
- Emotional wellness
- Weight and BMI
- The role of gut hormones for brain tissue repair
What lifestyle should I adopt to prevent cognitive decline?
The best lifestyle is one that supports good nutrition, sleep and mood to help the brain recover and prosper. The role of gut hormones, major vitamin absorption or malabsorption, circadian rhythm, stress and environment on the balance of neuroactive chemicals is complex. There is a link between depression and cognitive decline that would have its common denominator at brain health level; repair, nutrition and so on.
This starts with the diet; supplements alone will not cover the breadth of biochemical changes needed to counteract insults to the brain. A balance of omega 3 to omega 6 which does not deplete either of the enzymatic metabolism it needs, as well as the plethora of other fats is important. Behind this are the fat soluble vitamins which turn up later in the same pathways. A diet rich in good fats like the Mediterranean diet with a vast variety of greens and minimal meat and animal products with regular fasting is the most studied diet for longevity.
that are often used to help with brain function
- P5P or vitamin B6
- Magnesium
- Zinc
- Phosphatidyl Choline (helps brain cell walls)
- Fish Oil
- Omega 3
- 5HTP
What tests should I have for assessing cognitive decline?
It is not feasible to run every test due to cost. However, the prevention of cognitive decline, given the considerable complexity of its causes and the high trauma of it as a disease, is often a case where investigations are necessary in order to be thorough.
Looking at lipid patterns including oxidised LDL, HDL, TAG, microparticle analysis, cytokines reflecting endothelial dysfunction, methylation, magnesium, vitamin D, zinc, DUTCH testing (cortisol), heart rate variability, 24 hour blood pressure monitoring, Hba1c and fasting insulin (ideally, the oral glucose insulin test) dietary assessment, GI Map (looking at gut bacteria) and genetic testing for ApoE and perhaps other metrics would give a sound set of data to patients.
Who should be assessed for cognitive decline risk?
An assessment for the risks of cognitive decline is all the more important where there is a family history of dementia or memory problems or if a patient is concerned about their memory. Sadly, this is often when prevention becomes worth the cost for a patient. The benefit of MRI and full cognitive assessment is often apparent by this stage, however it might be more beneficial to bring this topics up with patients at an earlier age such as 40 to offer the most effective prevention.
