Brainstorming ways to boost memory and concentration.
Where did I leave my car keys? Why did I walk in the room? What is the name of that actor who was in that movie about that thing?
It’s not uncommon to have the occasional memory lapse or “senior moment,” no matter your age. However, as people get older, they are concerned about maintaining their cognitive health for as long as possible.
Cognitive health is more than just remembering facts and being able to call upon the right words for objects. It is also the ability to learn, to communicate, to process new information, concentrate, make decisions, problem-solve and generally, to think.
“The term ‘cognitive impairment’ is really a continuum from mild impairment—where people may notice changes such as trouble remembering, learning new things, concentrating, or making decisions, to more severe levels—various types of dementia or Alzheimer’s, with loss of ability to function independently,” said Isaac Eliaz, MD, MS, LAc, medical director of Amitabha Medical Clinic and Healing Center in Santa Rosa, CA.
“Mild Cognitive impairment (MCI) needs to be differentiated from early dementia. They both have objective deficits in cognitive domains that are more than expected for age and educational background, but in dementia, there are deficits in more than one domain,” noted Dr. Pauline Jose, a family medicine doctor practicing in Santa Monica; 30 percent of her patients are over 65.
“Patients with MCI, in contrast to mild dementia, usually have no interference with daily activities, but doing more complex tasks like paying bills may take more time,” she continued.” Patients with mild dementia are able to do basic activities of daily living like bathing, grooming and eating, but more than one domain is affected. These domains include learning and memory, language, psychomotor, visuospatial and executive. Dementia always progresses and patients decline, while some patients with MCI may improve cognitively probably because the cause was reversed like a medication with cognitive side effects or a medical illness. Having MCI though is certainly a risk factor for developing dementia.”
The Centers for Disease Control and Prevention (CDC) has said that there are 16 million people living with some form of cognitive impairment. These include not only people with dementia and Alzheimer’s but also people who have a broad range of disorders, stemming from a variety of etiologies.
“Dementia affects an estimated four to five million older adults in the United States and is expected to grow up to three-fold by 2050 worldwide, owing to the large increase in the size of the elderly population. Cognitive impairment without dementia is more prevalent in the United States than dementia,” said Dr. Eliaz.
Cognitive dysfunction has greater implications than for the individual; it can greatly impact family members. Even younger people are becoming more aware of their cognitive health, especially if they’ve witnessed a family member struggle with cognitive impairment.
However, while cognitive decline may be seen as an inevitable part of the getting older, there are many preventative actions to take, even for younger adults, to slow down the aging process and hence, strengthen cognition.
Risk Factors/Causes for Cognitive Impairment
There are a number of risk factors and causes of cognitive decline, not all of which can be modulated.
The greatest risk factor for cognitive impairment is something over which you have no control, and that is the passage of time. People over the age of 65 are most susceptible, and the risks only increase. However even mild cognitive impairment has been reported in people as young as their 40s. Still, it is not a foregone conclusion to expect memory loss as you age, but seniors are at higher risk. It is also important to recognize that not every memory decline is associated with dementia or Alzheimer’s.
“Age is considered the primary risk factor for cognitive impairment, but in my practice, I look carefully at ‘age’ since we have the knowledge to move into a healthy aging process with specific interventions that support systemic health,” said Dr. Eliaz.
Other risk factors that are not within your control are genetics; having suffered a prior brain injury; having suffered a stroke; certain previous bacterial infections; or diseases that can negatively impact cognition, such as Parkinson’s or Huntington’s disease.
Some modifiable behaviors and conditions are also linked to cognitive dysfunction. These include, said Dr. Jose, smoking, high cholesterol, obesity, a high-calorie diet, physical inactivity, and drug or alcohol abuse. “Likewise, deficiencies of many nutrients like zinc, thiamine, folate and vitamins B6 and 12 may play a role. Consumption of omega-3 fatty acids and iron from the diet have affected neurocognitive performance positively according to some studies,” she said.
“Mental health concerns are among the most common reasons people visit natural health practitioners,” said Bree Ponton, BHSc(Nat), technical educator with the Australia-based manufacturer, BioCeuticals. Mental health conditions such as anxiety and depression, in turn, can impact cognitive function. “In the brain, methylation plays a crucial role, and is responsible for the production and metabolism of hormones and neurotransmitters such as melatonin, serotonin, cortisol, adrenalin and noradrenaline. If methylation is impaired, the critical equilibrium between hormone and neurotransmitter production and breakdown is affected, adversely impacting mood and cognition,” explained Ponton.
Dr. Eliaz added that exposures to certain toxins or pesticides might increase the risk as well.
Then there are those factors that are modifiable: lifestyle. More research is indicating that there is a tie-in between physical health and cognitive health.
Importantly, certain chronic inflammatory-driven conditions, such as heart disease, obesity, hypertension, stroke and diabetes have also been linked to cognitive impairment. “In fact, Alzheimer’s has been dubbed ‘type 3 diabetes’ due to the role of insulin and glucose function in neurological and brain health,” said Dr. Eliaz.
“Recent research on the effects of inflammation on aging and cognitive decline indicate that chronic inflammation is a primary driving force behind the development chronic degenerative diseases that affect every major system: metabolic, cardiovascular, kidney, immune and neurological,” he continued.
As cognitive decline is slow and progressive, it makes sense to address these issues when patients are still young or middle-aged. Preventing or mitigating as many risk factors as possible, then, is crucial.
Currently, there is no effective treatment to reverse dementia, but researchers are working on it.
“The war on Alzheimer’s disease and other cognitive conditions is stimulating an intensive effort to develop new ‘smart drugs’ to improve cognitive functioning. The U.S. Food and Drug Administration (FDA) already has approved a number of these drugs, including donepezil (Aricept), rivastigmine tartrate (Exelon), galantamine HBr (Reminyl) and memantine (Namenda). In addition, the new psychostimulant modafinil (Provigil) improves alertness, a key factor in cognitive performance. Some of these drugs have been found to improve cognition in healthy individuals as well,” said Dr. Eliaz.
Long-term effects of these drugs are still unknown, however, and, as Dr. Eliaz pointed out, that while these drugs may have value, it is unwise to support the maintenance of an unhealthy lifestyle and then rely on expensive and potentially risky medications.
“What I believe would make more of an impact is prevention. Everything that we do for prevention are also the same things we should do when we are afflicted with it to delay progression,” said Dr. Jose. Some of these include:
• Being active
• Challenging the brain/reading
• Reducing intake of saturated fatty acids and increasing intake of legumes, fruits, fish and olive oil
• Consuming green and black tea
• Avoiding excessive sugars and animal fat consumption
• Drinking coffee, which is associated with decreased risk
• Get six to eight hours of sleep
“When it comes to cognitive health, as with other health concerns, practitioners look at genetics, health history, diet, lifestyle, toxin exposure, stress, etc.,” said Laurel Sterling, MA, RD, CD/N, nutrition and educator at Carlson Laboratories, an Illinois-based manufacturer.
“There are many natural supplement options available,” she added. “Some are single nutrient remedies, some are herbal, and others are combination formulas. What remedies a practitioner decides to use depends on the person, their health issues, what other medications they may be on, and so much more,” she said.
“Some of the most exciting research on this subject points to galectin-3, a signaling protein that, at elevated levels in the body, drives numerous inflammatory and pathogenic processes through multiple unique mechanisms of action. More than 8,000 published clinical and preclinical studies show that blocking galectin-3’s pro-inflammatory actions is a critical and effective way halt and reverse some of the most dangerous, degenerative and pro-aging processes in the body,” said Dr. Eliaz.
Recent research has pointed to lifestyle habits that can have a direct and indirect impact on brain health, including exercise such as as yoga and meditation.
“There is research that shows exercise benefits brain health through lowering risk factors of cognitive decline. These cognitive health risk factors are similar to that for cardiovascular disease, such as hypertension, high blood cholesterol level, type two diabetes, obesity, consuming heavily processed food, lack of physical activity and smoking. Therefore, being physically active confers dual protection over brain and heart health—practitioners could advise patients over the benefits of exercise as a natural preventative measure for a ‘Healthy Heart, Healthy Mind’ lifestyle,” said Bryan See, business development manager with ExcelVite, based in New Jersey, “Numerous studies demonstrate the importance of physical activity for protecting and preserving cognitive health,” added Dr. Eliaz. “The positive effects on circulation, mitochondrial function, glucose and insulin balance, cellular respiration and oxygenation, and others, offer critical benefits for cognitive and neurological health.”
Therefore, natural practitioners should encourage exercise and other healthy lifestyle habits in their patients, as that will benefit everything from cardiovascular function to brain function.
The purpose of supplements is to bolster any nutrients in the body and brain that may be lacking naturally, or that cannot be achieved through diet alone.
Many experts agree that omega-3s are effective brain-boosters, and manufacturers have responded with products. These include fish oils and other antioxidant formulas, such as vitamin E and CoQ10. “Some other options include: acetyl-L-carnitine, phosphatidyl serine, MCT oil (coconut sourced), fish or cod liver oil (containing EPA and DHA), methyl-B12, methylfolate and vitamin D3,” said Sterling.
Dr. Jose listed other ingredients in supplements that can be effective, such as vitamins B6, 12, A, D and C, folate; beta carotene, lycopene and selenium. She also named some potentially helpful herbs and nonherbal supplements, such as Gingko biloba, turmeric, choline, glutamine, vinpocetine (or periwinkle), serine and Crocus sativus.
Popular cognitive-friendly ingredients, according to See, include gingko, almonds, fish oil omega-3s and vitamin E. “Natural supplements such as fish oil omega-3s not only benefit cognitive health but it also helps the heart—forming a beneficial healthy aging regime,” he said, adding that naturopaths, chiropractors and herbalists can incorporate it for maintenance of general wellness and antioxidant enhancement.
He added that “natural full spectrum” vitamin E, which comprises all eight isoforms of vitamin E tocopherol and tocotrienol, have been found to lower the risk for cognitive impairment in the elderly. His company’s flagship ingredient for cognitive health is EVNol SupraBio, a bio-enhanced natural palm tocotrienol complex and has been supplying this ingredient to natural product manufacturers worldwide for more than 15 years. “The main unique selling points for these product are the full spectrum tocotrienols and coupled with the SupraBio SEDS system (self-emulsifying delivery system), which ensures the tocotrienols are consistently and significantly absorbed (bioavailable) as well as accumulated in vital human organs, for efficacy,” said See.
Companies that utilize See’s company’s ingredients in the manufacturing of their own products for the practitioner market include Carlson Labs (Tocomin SupraBio), Jarrow Formulas (Toco-Sorb); Life Extension (Super Absorbable Tocotienols); and Swanson Ultra (Tocomin SupraBio), to name a few.
Omax Health in California manufacturers products for the practitioner market that targets brain health: Omax3 Professional Strength Omega-3 supplement and Omax Alpha-Omega Cognitive Boost Supplement. Kristin Chadwick, CEO, said that omega-3 DHA is an “…absolute must for brain health, as most people are deficient, and it directly impact’s the brain’s structure and signaling systems. It facilitates neurotransmitter activity and promotes the ability to think quickly, focus intently and remember clearly.” Another ingredient, alpha-GPC, a precursor to choline, also plays a critical role in neurotransmitters. Her company intentionally combines the two ingredients to create what she says “an advanced brain health cocktail” and allows for maximum bioavailability.
Carlson Labs manufactures several products that are aimed at boosting cognitive health, such as the recently introduced Super DHA with Lutein; which contains three carotenoids as well as omega-3 DHA sourced from deep, cold-water fish. Other products are Acetyl L- Carnitine, Elite DHA and Phosphatidyl Serine.
BioCeuticals focuses on products that are complementary; specifically, those that address both mood and cognition.
“With BioCeuticals’ launch into the U.S. market in 2016, the following practitioner-only cognitive products were introduced: AnxiPlex, Cognition Support, MTHF, Pyrrole Complex, Liposomal GABA with L-Theanine and RestoraCalm,” said Arina Pogossian, head of marketing.
Each does something a little different but all contains established ingredients. For example, the company’s Cognition Support product contains GinkgoSelect, a ginkgo extract which supports memory and brain function.
The market for products has been shaped by the alarming statistics and media coverage of Alzheimer’s and other cognitive impairments, particularly as this issue personally touches many people.
Cognitive issues affect populations as a whole. As See pointed out, “People are living longer these days. Many countries are facing population aging issues, namely, in developed countries like the U.S., Japan, Singapore and E.U. This particular sector of aging consumers is driving the demand for cognitive health products in terms of maintaining acuity, reducing risk of suffering debilitating stroke and age-related memory loss. We observed that it is rising steadily as consumers become better educated. In order to keep our brain and mind healthy and alert while we are extending our lifespan, cognitive health supplements play an important supporting role for this group.”
And the market for supplements is not limited to seniors. “The category of brain health has been surging, and it’s not just the Baby Boomers. Senior citizens tend to be worried about their aging brains, and the possibility of losing their mental sharpness, or getting dementia. They are looking to maintain brain health and prevent disease,” said Chadwick. On the other hand, she said, “Entrepreneurs, professionals and active people are looking to boost their brain power—they are looking to become sharper, clearer and smarter. Millennials tend to be concerned about memory, mood, focus and concentration.”
Tips for Practitioners
If a practitioner suspects that his or her patient may be suffering from a cognitive impairment, there are several tests that can be done, including the CANS-MCI test (see sidebar on page 24). Another test, used by Dr. Jose, is the Folstein MMSE, which tests for all cognitive domains. “Laboratory testing and brain imaging are done as well as a referral to a neurologist but all these are more for determining the cause of the dementia or MCI,” she said.
An entire physical workup, including information about family history, is in order to determine if the patient is lacking any specific nutrients, and a holistic outlook, one that examines emotional and psychological health, as well as physical concerns and lifestyle, will be the most beneficial.
However, even if a patient does not share any concerns, or maybe not even have any concerns about his or her cognition, practitioners should consider broaching the subject regardless, particularly as intervention and prevention is key, as is the first step: education and helping patients see the larger picture.
“Understanding what causes inflammation and how to reduce it with lifestyle, diet and targeted, researched supplements, such as MCP to inhibit galectin-3, a broad-spectrum probiotic to promote a healthy microbiome, and time-honored botanicals and other nutraceutical agents can make a clear difference in mental, emotional and physical health over the long-term,” said Dr. Eliaz.
Before a practitioner can educate his or her patients about preserving or treating cognitive function, self-education is key. Some manufacturers, such as See’s company, makes scientific studies available to practitioners, nutritional supplement companies and end consumers.
It is also important for practitioners to realize that physical health, mental health and cognitive health are all intertwined, which is why a holistic approach is warranted, said Sterling.
Also, when practitioners carry products to help boost cognitive function, they can usually rely on manufacturer support in the way of educational materials, dosage charts, clinical guidelines and access to studies.
Identifying Cognitive Impairment
It may be challenging for patients, and practitioners, to diagnose the extent of cognitive impairment and whether it even exists or is just a matter of sporadic forgetfulness.
Kevin Wolfe is the founder and managing member of Healthy Practice Solutions, LLC, a company based in Wisconsin. Healthy Practice Solutions, LLC is contracted by Screen, Inc. to distribute the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment—also called the CANS-MCI, a test that was marketing after seven years of development and several clinical trials.
Wolfe explained the mechanics of the test, which can be used by practitioners:
“The CANS-MCI is unique because it talks to the patient who responds by using their finger to touch the computer screen; no computer knowledge or skills are required, which makes it very user-friendly. Simply enter basic patient demographic information, and the computer will verbally instruct the patient how to take the test and provide practice examples for the patient to make sure the patient understands the instructions. When the patient has demonstrated they understand, the computer administers the test. This process is repeated for eight separate tests to comprehensively measure a person’s cognitive skills in memory, symbol fluency and executive functions. By combining tests of these separate cognitive dimensions into a single test battery, the statistical ability to predict MCI of all kinds is greatly enhanced. At the end of the testing process, the computer instructs the patient to exit the room and uploads the data to neuropsychology testing experts with graduate degrees who score the results and create the reports.”
The report is delivered promptly and tracks changes.
“If a patient has previously taken the CANS-MCI, the patient’s test results are plotted longitudinally so that any changes in cognitive ability from their baseline can be detected. This is extremely important because longitudinal results allow for precise predictive detection of early cognitive decline in people who still test above average despite their decline and would not likely be identified as MCI by a neuropsychologist until the decline eventually results in below average performance. The results are plotted on easy-to-understand graphs, providing an objective measurement of decline over time or a positive response to treatment. The report also provides recommendations for follow up testing, need for further medical/neuropsychological evaluation, and support resources.
Wolfe said that the CANS-MCI is important and groundbreaking in part because:
- The CANS-MCI can objectively and affordably identify patients who are in need of the Bredesen protocol or similar cognitive therapy programs, which create ancillary revenue for your practice.
- The CANS-MCI can objectively and affordably measure the patient’s response to your cognitive impairment treatment program to document your success and bring peace of mind to your patients.
- It is an opportunity for people to receive a confidential, objective, evaluation of their cognitive health; patients who elect to take the test on their own will receive the results confidentially from HPS. If a provider orders the test, then the provider will receive the results.
- Because it measures decline from the patient’s baseline, the CANS-MCI can identify a patient in the earliest stages of decline when the likelihood of reversal is the greatest and long before the patient is seriously impaired.
Healthy Take Aways:
• Cognitive health is a broad spectrum term that covers everything from memory loss due to aging or diseases to concentration and processing issues.
• The mind-body connection warrants taking a holistic approach in treating and preventing cognitive decline; practitioners should recommend exercise and other healthy life habits to help stave off cognitive impairment.
• Supplements, such as those with omega-3s, can play an important role in boosting cognitive function.
For More Information:
Carlson Labs, www.carlsonlabs.com
Healthy Practice Solutions, www.healthyps.com
Omax Health, https://omaxhealth.com