Whether you have a family history of Alzheimer's disease, are worried about your own forgetfulness, or are looking for ways to help a loved one whose memory is not what it used to be, know that there are actionable steps you can take to improve your cognition.
Working with individuals and families to either prevent or slow the progression of Alzheimer's disease and other forms of cognitive impairment is near and dear to my heart. While the cause(s) of Alzheimer's and other forms of dementia are not fully understood yet, there's more and more emerging research that shows diet and lifestyle changes paired with optimizing key blood markers can not only reduce someone's individual risk, but potentially slow or reverse the progression of cognitive decline.
Like most chronic diseases, prevention is far more desirable than treatment.
Currently, there's no known cure for Alzheimer's or other forms of dementia, though conventional treatments and medications are available. These treatments are unfortunately not always effective. Loved ones who care for spouses or family members with dementia have even referred to current treatments as "false hope" for the impending suffering these neurologic conditions cause. [1]
Reducing your personal risk is possible, however. Keep reading for some actionable steps you can take today to improve your cognitive function and promote optimal brain health.
SIGNS & SYMPTOMS
The earliest signs of dementia are often mistakenly chalked up to "senior moments". While some forgetfulness and slowed recall can be a normal part of aging, difficulty making decisions, following directions, or finishing tasks often points to cognitive impairment.
Some signs and symptoms of dementia include:
problems communicating
poor judgement
difficulty completing simple tasks
misplacing things
confusion with time and place
difficulty solving problems
memory loss
change in mood
personality changes
problems with language
DIAGNOSIS
There are over 100 types of dementia, though Alzheimer's is arguably the most well-known. By the time someone meets the criteria for dementia, their changes in cognitive function are marked enough to interfere with their activities of daily living and there are likely behavioral or personality changes occurring too. Before this stage, if a person is only struggling with remembering names or words or is forgetful of important appointments or recent events, they may be diagnosed with Mild Cognitive Impairment.
An evaluation and comprehensive workup by a skilled neurologist or neuropsychologist can help make the diagnosis and determine if your changes in memory are actually due to stress, normal aging, or something else. There are several in-office assessments a primary care provider can also utilize, though during the pre-clinical phase of the disease, the memory deficits and other changes in cognition may only be noticeable by the patient. This has been referred to as, "the stage where the patient knows, but the doctor doesn't." [2]
Newer theories as to the potential cause of Alzheimer's may hold the key to preventing and treating it successfully, however. Some of these theories point to the possibility that inflammation, autoimmune activity within the brain [3], and/or chronic infections or toxicity play a role in the onset of the disease.
PUTTING THE PIECES TOGETHER
For my patients who have already been diagnosed with mild cognitive impairment or Alzheimer's, and those who are acting proactively and coming to me specifically for prevention, there are a number of comprehensive blood tests I recommend. The recommended tests vary a bit from patient-to-patient depending on their personal risk factors, health history, and current symptoms. I largely base my recommendations on the work of Dr. Dale Bredesen, the author of The End of Alzheimer's and The End of Alzheimer's Program.
A non-exhaustive list, but general overview, of the main categories of tests I recommend are:
comprehensive cardiometabolic risk markers (i.e. lipids, apolipoproteins, HbA1c, insulin, cardiovascular inflammatory markers such as hs-CRP, homocysteine, and uric acid, etc.)
thyroid, adrenal, and sex hormones
nutritional assessment (including, but not limited to: iron, Vitamins D, B12, and folate, magnesium, copper, zinc)
genetic markers, including MTHFR and APOE
titers for various chronic infections
When budget permits, additional functional labs may be indicated and useful for patients, including:
comprehensive stool analysis to screen for intestinal permeability, dysbiosis, and inflammation of the gut
heavy metal, environmental, and/or mold toxicity testing
micronutrient testing
If the patient snores or is chronically fatigued, a sleep study is often recommended too as there is a significant correlation between untreated sleep apnea and increased risk for Alzheimer's disease. [4]
After a thorough workup and evaluation, sometimes including a referral to a neurologist, I'll work with the patient to develop a comprehensive and individualized treatment plan.
We'll address diet, sleep, exercise, and stress management changes to help improve their lab markers. Bioidentical hormones are sometimes indicated, and nutritional and herbal supplementation is also prescribed typically.
WHAT YOU CAN DO
Even if you aren't able to get more than basic routine blood work done, there are still many beneficial changes you can make to your diet and lifestyle to promote healthy brain function [5], [6].
Top 10 Things To Do To Optimize Brain Health:
Follow a low-inflammatory, plant-forward, nutrient-dense diet that's high in fiber and rich in antioxidants
Aim for at least 150 minutes of movement per week
Optimize sleep without use of pharmaceutical sleep aides (i.e. avoid chronic, regular use of benzodiazepines and antihistamines), and treat sleep apnea if you have it
Reduce stress - meditate, spend time in nature, listen to music, etc.
Quit smoking, including vaping
Limit alcohol consumption
Foster a sense of community for yourself; remain socially engaged (and no, sorry, social media doesn't count)
Keep your mind active - learn a new language, play games, etc.
Prioritize your mental wellbeing - practice gratitude, volunteer, seek support if you're struggling with depression or anxiety
Work with a licensed naturopathic doctor to optimize your blood tests and for guidance on specific supplement recommendations
It's important to remember that there is hope in the pursuit of maintaining brain health and reducing the risk of cognitive decline. While Alzheimer's poses significant challenges (for both the patient and their caretakers), we can take proactive steps toward preserving our cognitive abilities and reducing our risk for Alzheimer's disease.
Are you worried about your brain fog or memory? Do you feel like you're having more "senior moments" lately? If you are interested in comprehensive blood work to evaluate your potential risk for Alzheimer's, or you want advice on what supplements are most indicated for you to support brain health, I'd love to work with you.
[1] Reed, Betsy. "'Part of you dies as well': the toll of caring for loved ones with dementia." The Guardian, https://www.theguardian.com/society/2023/may/08/toll-of-caring-for-loved-ones-with-dementia-alzheimers?inf_contact_key=85c6fc69466bddf979669a8cf07a70624dfbc39d7283b2cb89d5189540b69330. Accessed 11 May 2023.
[3] Weaver, Donald. "Alzheimer's May Not Actually Be A Brain Disease, Experts Say." Science Alert, https://www.sciencealert.com/alzheimers-may-not-actually-be-a-brain-disease-expert-says. Accessed 1 April 2023.
[4] Diego Z. Carvalho, et al. Association of Polysomnographic Sleep Parameters With Neuroimaging Biomarkers of Cerebrovascular Disease in Older Adults With Sleep Apnea.
Neurology, (May 2023). DOI: https://doi.org/10.1212/WNL.0000000000207392
[5] Bredesen, Dale. Reversal of cognitive decline: A novel therapeutic program. Aging (Albany NY), (2014 Sep). 6(9): 707–717. doi: 10.18632/aging.100690
[6] Gorelick, et al. Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association / American Stroke Association. Stroke, (2017). https://doi.org/10.1161/STR.0000000000000148