Welcome to this month’s HEALTHY LIVING BLOG with Choice Nutrition’s Dr. Evan McCarvill, ND Lets talk about an issue that all of us have to face after a certain point in our lives: COGNITIVE DECLINE.
As we grow and develop from children to young adults, there is a palpable upward trend in our mental development and ability, and there is a sense that we are always growing to some greater height. Unfortunately, this trend can’t go on forever, and it is all too clear as the decades progress, that our minds are never going to be quite what they were.
Some of the Questions we face
- What is the process behind this gradual cognitive decline?
- What are the factors involved? Are there any in our control?
- Can we slow or stop this process in order to preserve our quality of life?
Let’s break it down.
What is the cognitive decline?
Cognitive decline is something that is generally known to happen as people age, but there are degrees of decline that can be considered excessive and unhealthy.
There is no universally accepted definition of successful cognitive health in elderly individuals, but cognitive health is generally defined as “the development and preservation of the multidimensional cognitive structure that enables ongoing social connectedness, sense of purpose, and the ability to function independently” (1). That, broadly speaking, is the definition of the standard of cognitive ability that we all should be able to enjoy for our entire lives.
Cognition encompasses a broad range of mental processes, which are often taken for granted until they are lost. There are two essential forms of cognition:
There is “fluid” cognition, which relies on short-term memory to process information when solving new problems, using spatial reasoning and when identifying patterns.
There is also “crystallized” cognition, where knowledge and life experience accumulate, and this relies more on long-term memory (2)
Fluid cognitive abilities are thought to peak in the mid-twenties, and then very gradually decline over a period of years until about age 60, when the decline tends to become more rapid. But this is only for fluid cognition, while crystallized cognition continues to increase over the life span through education and life experiences.
Pathological cognitive decline is something that tends to be seen earlier than expected, or it hits the individual harder than expected, resulting in disruption of social connectedness, and individual autonomy.
Mild Cognitive Impairment (MCI) is a condition presenting with memory deficits that are below what is considered normal. This condition can often foreshadow the onset of frank dementia, and early detection is very important, so that preventative measures may be taken to stem the progression of the condition.
Signs & Symptoms of MCI (Mild Cognitive Impairment)
Symptoms are often vague and can include the following:
- Language disturbance (eg, difficulty in finding words)
- Attention deficit (eg, difficulty in following or focusing on conversations)
- Deterioration in visual-spatial skills (eg, disorientation in familiar surroundings in the absence of motor and sensory conditions that would account for the complaint)
Cerebrovascular disease (CVD) is defined as brain lesions caused by vascular disorders. This can be something as dramatic and severe as a stroke, where there is cessation of blood flow to a particular part of the brain, usually caused by a blood clot. But then there is also vascular dementia.
Vascular dementia is a chronic progressive loss of cognitive function, due to multiple small infarcts (4). These can be thought of as very small mini-strokes that only affect minor sections of brain tissue at a time. By themselves, each one of these little infarcts doesn’t have a huge impact on cognitive function, as the brain is able to re-route to other neural pathways that bypass the section affected by the mini-stroke.
However, over a period of years, as these mini-strokes accumulate, the available pathways the brain is left with become ever more restrictive, and so because of this you see a progressive decline in cognitive function.
Prevalence of Dementia
In 2005, the global population suffering dementia was estimated to be 24.3 million people, and there are around 4.6 million new cases diagnosed every year (3). It is expected that this population will double every 20 years, with an alarming 81.1 million dementia patients in 2040 (3). A major consequence of this is an increased burden on the healthcare system, with higher rates of hospitalizations, surgeries and visits to the doctor, leading to spiraling healthcare costs.
Dementia & Chronic Inflammation
Chronic systemic inflammation is the underlying culprit of many such chronic conditions, including heart disease, diabetes, cancer, and this very form of progressive damage to the brain.
Increased chronic inflammation means greater chances of clotting factors activating, and causing the aforementioned “mini-strokes” that promote cognitive decline. Therefore, eating an anti-inflammatory Mediterranean type diet, avoiding simple sugar and carbs, avoiding fried foods and ensuring adequate intake of Omega 3 fatty acids, are some of the basic means of helping to preserve cognitive function as we mature.
In other words, less chronic inflammation, less clotting factors floating around in the system, less potential for oxidative damage, all equals less chance of a mini-clot causing these kinds of tiny infarcts in the brain.
There is a growing body of research demonstrating that adherence to a Mediterranean type diet significantly reduces risk of developing Mild Cognitive Decline, and risk of progression to Alzheimer’s Disease. (5)
In general, the Mediterranean diet, which is low calories and rich in fruits and vegetables, has the greatest benefit for reducing inflammation. Data show that high dietary fiber, which is typically a sign of a low glycemic load diet, was associated with lower levels of various inflammatory markers (6).
The dietary pattern most consistently associated with a reduction of CVD is predominantly plant-based, emphasizing fruits, vegetables, whole grains, nuts, fiber, and sources of Omega 3 fatty acids.
Another way to keep the brain functioning well, is just to make sure you are using it well. The brain tissue is very plastic, meaning that it always hast the ability to form new connections, and keep existing connections strong, as long as you challenge it with tasks to do.
Evidence is not conclusive, but it is generally believed that exercising the brain by reading, doing crossword puzzles, and brain teasers can help to prevent, delay, or reduce cognitive decline. These should always be fun, stimulating activities that you enjoy doing, so that you will want to do them a lot.
Moderate Physical Exercise
Not only is moderate exercise a well established, and yet all too often overlooked, means of reducing chronic inflammation in the body (7), there is a growing body of evidence indicating that it can help prevent mild cognitive impairment as we age.
Vitamin D has been shown to be deficient or insufficient on pandemic levels, and lower levels are associated with several chronic diseases. It serves as a significant factor in a number of physiologic functions, specifically as a biological inhibitor of inflammatory hyperactivity (8, 9, 10). Vitamin D produces dose dependant reductions of several inflammatory markers, and supplemental benefit has been shown for osteoarthritis, multiple sclerosis, type 1 diabetes, Graves Disease, ankylosing spondylitis, SLE, and rheumatoid arthritis (8, 9, 10).
Data from the National Health and Nutrition Examination Survey (NHANES) from 2001-2004, involving more than 8000 human subjects, showed that those with vitamin D levels below 30 ng/ml were more likely to be at high risk of cardiovascular disease.
A good quality fish oil supplement will be standardized to have large quantities of EPA and DHA, in a 3:1 or 3:2 ratio for adults. These omega 3 fatty acids promote the formation of anti-inflammatory eicosenoids that become incorporated into our cell membranes, helping them to remain fluid and pliable (11). This can help prevent heart disease and any associated cerebrovascular disease in the brain.
Natural Antioxidants and Anti-inflammatories
Although a diet rich in fruits and vegetables is generally anti-inflammatory, some foods seem to exert some specific benefit along these lines. These include Blueberries (Vaccinium myrtillus), chocolate (dark), cranberries (Vaccinium macrocarpon), garlic (Alliu sativum), ginger (Zingiber officinalis), grape (Vitis vinifera), green tea (Camellia sinsensis), and turmeric (Curcuma longa).
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