What is Cognitive Decline?

Due to a number of factors, like the aging population, increased awareness and diagnosis, as well as modern lifestyle factors, cognitive decline has been receiving more attention in recent years.

Cognitive Decline refers to a gradual decrease in cognitive abilities including memory, attention, reasoning, and problem-solving skills. Some degree of cognitive decline is typical as we age, but in some cases, it is associated with neurological conditions such as Alzheimer’s Disease, Dementia, or other forms of cognitive impairment.

What are the Different Types of Cognitive Decline?

Many types of cognitive decline exist, however the main types that are common in the aging population are:

• Dementia: Dementia is an umbrella term used to describe a decline in cognitive function severe enough to interfere with daily functioning. The most common cause of dementia is Alzheimer’s disease, but other causes include vascular dementia, Lewy body dementia, frontotemporal dementia, and others.
• Alzheimer’s Disease: A specific type of dementia characterized by progressive memory loss and cognitive decline, whereas dementia is an umbrella term for a group of symptoms affecting memory, thinking, and social abilities.
• Mild cognitive impairment: a stage between the normal decline of aging and the more serious decline of dementia, where cognitive changes are noticeable to the individual, but may not meet criteria for dementia by standard measures.

Why Do Some People Develop Cognitive Decline?

While mainstream media often presents the progression of diseases like Dementia and Alzheimer’s to be somewhat of a mystery, adding to the anxiety many experience around whether they will develop Alzheimer’s’ or not, many of the factors in healthy brain aging have been identified.

While the science defining the mechanisms behind cognitive decline still have a long way to go, cases of Alzheimer’s and Dementia that are strictly genetic are among the minority and many individuals have the power to prevent cognitive decline and even reverse it, particularly if in its earlier stages and with the right support.

Researchers like Dr. Dale Bredesen from the Apollo institute have dedicated their careers to pinpointing the lifestyle factors that lead to cognitive decline and disseminating this information to health care practitioners and the general public.

When it comes to understanding the underpinnings of cognitive decline, the Bio-Psycho-Social Model is a great place to start.

While Naturopathic and Functional Medicine Doctors tend to emphasize the biological drivers of dementia, some psychological and social contributors exist as well. Below are some of the established drivers of the most common forms of dementia.

Biological Contributors to Cognitive Decline

Genetics

Although there are many genes associated with Dementia, Alzheimer’s, and Cognitive Decline, the main gene many people are referring to when they talk about ‘The Alzheimer’s Gene’ is ApoE.

It’s important to note however, that variations in ApoE alone do not generally determine whether or not you will develop Alzheimer’s Disease, and many more variables are needed to consider when it comes to the development of Alzheimer’s.

Other genes that can play a part in the susceptibility to Alzheimer’s Disease are:

• APP (Amyloid Precursor Protein) where mutations can lead to overproduction or altered processing of amyloid beta protein, which is a physiological driver of Alzheimer’s Disease.
• TREM2 (Triggering Receptor Expressed on Myeloid Cells 2) where variants have been associated with an increased risk of late onset Alzheimer’s Disease.
• CLU (Clusterin), CR1 (Complement Receptor 1) and others where variants in these and others have all been associated with the risk in development of late onset Alzheimer’s Disease, although their exact role in the pathology is still being investigated.

When it comes to early onset familial Alzheimer’s, this tends to be more genetically tied, and typically presents before the age of 65. This type is relatively less common and associated with variations in the genes PSEN1 and PSEN2 (Presenillin 1 and 2)

When it comes to genetics and the development of Cognitive Decline, it’s important to keep in mind that most cases of Alzheimer’s are not strictly genetically driven and that lifestyle factors tend to play an even greater part. This is great news, because it turns out there’s often a lot more we can do in prevention than we think.

Traumatic Brain Injury

Traumatic brain injury contributes to cognitive decline by causing structural damage to the brain, disrupting neural pathways, and impairing cognitive functions such as memory, attention, and executive function.

Sleep Disturbances

Sleep Disturbances contribute to cognitive decline by disrupting the brain’s ability to consolidate memories, impairing attention, concentration, and decision-making abilities, and promoting the accumulation of toxic proteins associated with neurodegenerative diseases like Alzheimer’s.

Psychological Contributors to Cognitive Decline

While cognitive decline is largely physiologically driven, there are components of our psychology that can have an impact such as:

• Chronic stress
• Depression and anxiety
• Cognitive Stimuli and engagement

Social Contributors to Cognitive Decline

In addition to the psychological drivers of cognitive decline, factors such as the following can play a role in its progression:

• Social isolation and loneliness
• Education and Socioeconomic Factors
• Social Engagement
• Quality of Social Relationships

Individuals who remain socially engaged, and have supportive and close relationships, tend to have more cognitive resilience.

Higher levels of education and socioeconomic status are linked to cognitive health and access to healthcare, and recreational and social services can impact cognitive health outcomes.

How Can Naturopathic Medicine Help in the Prevention and Treatment of Cognitive Decline?

Your primary care physician or Naturopathic Doctor can assist in early screening for cognitive decline and some clinicians may administer preliminary tests such as the

Montreal Cognitive Assessment (MoCA), one of the most well-validated tools in cognitive decline assessment.

A Naturopathic Doctor with experience a clinical focus and experience with cognitive decline can use a variety of lifestyle factors to lessen the overall risk of cognitive decline, while also improving overall health as a side benefit.

The following are a few of the common interventions for prevention of and treatment of early-stage cognitive decline, although this list is by no means exhaustive and the emphasis will vary, depending on the individual and their particular condition.

Diet:

An anti-inflammatory and low glycemic (low in added sugar and refined grains) diet is typically recommended, and in some cases a paleo-ketogenic type diet may be required if the patient is already experiencing signs of cognitive decline and this type of diet is deemed suitable for them.

Supplements:

Supplements can vary a lot depending on individual client needs, as well as their stage of cognitive decline. Supplement recommendations for cognitive decline may include some of the following:

• Fish oil with adequate dose of EPA and/or DHA
• B12 either through sublingual form or through injections
• B vitamins such as B9, B6, and B1
• Prebiotics and probiotics, if gut health requires
• Supplements that can optimize mitochondrial function like: CoQ10 or ubiquinol, a-lipoic acid, PQQ, Acetyl-L-Carnitine, zinc, resveratrol, and vitamin C
• Botanical supplements like: turmeric, ashwaghanda, and bacopa
• Supplements that act as antioxidants like: mixed tocopherols and tocotrienols, and blueberry extract, and selenium, and NAC

When it comes to nutritional supplementation, the correct supplement(s), sourcing, dosing and timing is key to efficacy, so consulting with a Naturopathic Doctor would be your best bet in knowing your supplements protocol is going to work for you, not against you.

Stress Reduction:

Stress is very personal and therefore an individualized approach is required. Stress reduction strategies can include lifestyle activities such as: yoga, meditation, music, or specific activities the individual finds relaxing such as gardening or crochet.

Sleep Optimization:

• Ensuring 7-9 hours of quality sleep per night and ruling out sleep apnea if suspected are the general recommendations.
• Supplements and sleep hygiene recommendations may be included.

Exercise:

• The general recommendation is 30-60 minutes per day, 4-6 days per week of exercise.
• This can include cardiovascular exercise, yoga, walking, or strength training.

Brain Stimulation:

Examples of brain stimulation can include Neurofeedback, a form of biofeedback, as well as science backed brain games, and mentally stimulating activities like playing bridge, reading, or doing crossword puzzles.

Optimization of lab values:

While the list below is by no means exhaustive, and the level of investigation required will depend on the individual case, the following labs can be included in a workup for cognitive decline:

• Serum B12
• CRP, an important marker of inflammation
• Fasting insulin, HbA1C and other markers related to blood sugar dysregulation
• Thyroid hormone testing such as free T3, free T4
• Hormone testing such as for testosterone, estrogen, pregnenolone, and cortisol
• Stool testing to assess gut health
• Urine testing for heavy metals to exclude toxicity

What to do if you or someone you care about is struggling with Cognitive Decline?

If you or someone you care about is struggling with cognitive decline that interferes with your or their ability to function on a day-to-day basis, or significantly impairs functioning at work or in relationships, seeking professional help is critical.

In addition to preliminary screening through a Primary Care Doctor or Naturopathic Doctor who is trained in screening like the Montreal Cognitive Assessment, you can also complete a ‘Cognoscopy’ screening through the Apollo Institute to assess your risk of cognitive decline. In addition, your Naturopathic Doctor or Primary Care Doctor can refer you to a Neuropscyhologist or Neurologist for more in depth assessment where needed.

In addition to a thorough neuropsychiatric assessment through a qualified health professional, a Naturopathic Doctor with a background in cognitive health and the treatment of cognitive decline is a great place to start.

Disclaimer: The information provided in this article is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.