Reverse Mild Cognitive ImpairmentMarch 2015
By Eric Braverman, MD, and Bruce Scali
Eventually, it happens to almost everyone. You enter a room and can’t remember why. You misplace your keys, fumble for a word, or can’t put a name to a familiar face. You might even experience a noticeable, albeit very slight, delay between deciding to do something and doing it—when changing lanes on a highway, for example. Any of these could be explained away by the fast pace and high stress of the lives we lead.
Or they could be the first signs of a medical condition fraught with complications known as mild cognitive impairment.
A major consequence of the intensive focus on Alzheimer’s disease has been the identification of its early stage, otherwise known as mild cognitive impairment (MCI).
Experts are increasingly viewing MCI as the “gray area” between normal cognitive decline attributed to aging and the onset of dementia.1 Interest in classifying, predicting, diagnosing, and treating MCI has been building since the turn of the century, and is heating up as alarming statistics are being published and confirmed. Estimates on the prevalence of mild cognitive impairment worldwide are as high as 29% with an annual risk of progression to dementia in affected individuals as high as 15%, compared to 2.5% in cognitively healthy adults.2
The progression from MCI to full-blown Alzheimer’s and other forms of dementia is a steady, but slow process that may extend over decades.3 The good news is that total loss of cognitive faculties isn’t a certainty for all of those who have MCI; the bad news is that, on average, approximately 34% will end up that way.4 The worst news of all applies to those who are diagnosed with MCI at 70 years of age or older: These individuals have a 126% increased risk of dying compared to those without MCI.5
Why does all of this matter? Because a lot of people have MCI or will experience it down the road; because the vast majority of us will have to watch or care for someone who loses any semblance of quality of life, and because everyone will have to bear the societal cost of dementia. Dementia has been growing steadily for years, and the 2010 figure for dementia was pegged between $157 and $215 billion.6 Whatever the number is today, it’s about to explode because the Baby Boomers are entering their sunset years.
Sooner or later, one way or another, MCI will likely come your way. No worries, however. There are some things you can do about MCI now—such as determine if you have it, discover why you have it, and decide what you will do about it.
The first course of action item is differentiating between the harmless “senior moments” that can be laughed off and something much more serious that demands attention. Table 1 presents the 12 domains of MCI—the ways in which the brain misfires—and a simple Yes/No self-assessment. If you check “Yes” fewer than three times, MCI probably isn’t an issue for you right now. (But saving the quiz and repeating it annually is a good idea.) Three or more checks in the “Yes” column doesn’t mean you should hit the panic button, but it does mean you should enlist the help of medical professionals to investigate your cognitive status further.
Neurologists, neuropsychologists, neuropsychiatrists, gerontologists, and some primary care physicians qualify cognitive issues using the noninvasive neuropsychometric assessments named in Table 2, which are administered via booklets or digital screens. Your history and symptoms determine which ones are appropriate in your case.
Neuropsychometric assessments provide a wealth of information about the nature and severity of MCI. If the condition is at the earliest stages, it can be treated with lifestyle and dietary changes, plus natural supplements. In advanced cases of MCI, those that have progressed to intermediary stages or have butted up against the boundary of dementia, doctors will want to know more about its nature, so more powerful interventions can be prescribed.
That’s where the 3.0 Tesla MRI (3T MRI) scanner, a diagnostic tool, comes in.
The 3.0 Tesla MRI has two times the field strength of the 1.5T scanner, and 10 to 15 times the field strength of low field or open MRI scanners that are used in hospitals and medical offices.7 The 3.0 Tesla MRI produces high-resolution images.8 That means doctors get more detailed and much clearer pictures of brain anatomy and vascular status. (The pictures are so good in the latter case, they often eliminate the need for more invasive, and therefore more risky, catheter insertions.)
Mild cognitive impairment means your brain is short-circuiting. Electrical messages aren’t getting through fast enough, or at all. For a treatment plan to be effective, the cause of MCI must be explored.
A 3T MRI reveals four conditions that result in a diagnosis of MCI:
- Atrophy, or shrinkage, resulting from the loss of cells in the brain,9,10
- Demyelination, the loss of the sheathing that surrounds neurons, which protects them as insulation does copper wiring. Myelination, or the development of the sheath around neurons, continues until age 30; thereafter, demyelination, or deterioration of the sheathing occurs,11
- Ischemia, the restriction of blood flow,12 and
- Calcification, the hardening of tissue resulting from calcium deposits.13
The PATH Foundation NY, with support from the Life Extension Foundation®, conducted a review of 3T MRIs administered to 116 PATH Medical patients, aged 30 to 80, whose domain assessments pointed toward cognitive impairment. Its findings are summarized in Table 3.
In addition to the definitive anatomical explanations for MCI, several contributing factors have been associated with cognitive decline. Aging alone is sufficient cause, which likely doesn’t come as a surprise to anyone. Without direct interventions, there’s no getting around that we burn up, swell up, dry up, and turn to stone—in the brain and everywhere else.
A family history of Alzheimer’s14 or the presence of the ApoE4 gene15,16 that has been linked to it, concussions and other trauma, and drug abuse all play a role in MCI, as do numerous health issues.17-20
Research is also linking vitamin deficiencies with MCI, which will be discussed in Table 4.21,22
No matter which path MCI has taken to your door, there are approaches that can halt it in its tracks, and even turn it around.
What You Can Do About MCI
The prevention and treatment of MCI is a multipronged approach that includes behavior modification, aggressive management of medical conditions, and, when cognitive loss is in its advanced stages, enlisting the support of doctors who are up to speed.
Change Your Life, Change Your Mind
If there is one characteristic of health and wellness (or the lack thereof) that is universal, it’s lifestyle. The choices we make every day about what we eat, whether we exercise, and how we support our brains and bodies have a direct bearing on how long we live and on our quality of life.
The best way to handle any health complaint, including MCI, is to avoid it in the first place. A diet rich in foods that represent every color of the rainbow, regular exercise, and nutritional supplements are the first line of defense that can forestall breakdowns. Healthy living can also reduce the severity of medical issues, and it can be instrumental in reversing them too.
Research on the impact of diet on neurogenesis, or the formation of new brain cells, is one breakthrough that will allow treatment and reversal of MCI. Neurogenesis in the hippocampus, a small seahorse-shaped structure in the middle of the brain that plays a crucial role in memory, is the most studied in this regard.
It probably also comes as no surprise that fish is brain food.38 Specifically, fin fish, such as salmon, sardines, and mackerel that are chockfull of omega-3 fatty acids.39 Other excellent food sources of fatty acids are walnuts,40 pecans,41 Brazil nuts,42 and sunflower seeds.43
Nature is also an abundant supplier of flavonoids, which have been shown to effectively support brain function.44 You can find flavonoids in berries, especially dark ones, fruits and vegetables, dark beans,45 and spices, including dill, parsley, and thyme.46,47 You can even get some flavonoids from a glass of red wine.
While we’re on beverages, one to three cups of coffee improves brain power.48 Caffeine binds to adenosine receptors and in doing so, enhances neuron function, synaptic transmission, and neurotransmitter release in the hippocampus.49
Last but not least, there have been numerous studies on the anti-aging benefits of calorie restriction.50-52 Putting down your utensils and avoiding empty calories also helps those electrical messages get through.53
You also do not need yet another reminder about the salutary effects of getting off the couch, walking instead of driving, taking the stairs instead of the elevator, and resistance training. We’re giving it to you anyway.
Working out your body also gives your brain a workout.54,55 Aerobic exercise fires up primary neurotransmitters—dopamine,56 GABA,57 and serotonin55—and anaerobic exercise builds brainpower as it builds muscle.58
Get going to keep going. Medical schools used to say that we cannot replace neurons once they are lost. We know now that is not the case, as recent studies are showing that exercise boosts brain-derived neurotrophic factor (BDNF), which is critical for neurogenesis.59-62
When it comes to brain function, the good news about dietary supplements is running neck-and-neck with that related to exercise.63-66 In Table 4, you’ll note how vital fish consumption is, as fish oil (EPA/DHA) impacts at least three categories, starting with brain power.67 Vitamin D is also critical. According to a recent major study, low levels of vitamin D result in a 53% increased risk for dementia, and those with a serious deficiency have a 125% higher risk.68
The most recent research reveals how these natural supplements are revolutionizing brain health support:
- Acetyl-l-carnitine arginate is a patented form of carnitine, an amino acid, which improves brain power and contributes to neurogenesis,69,70
- Gastrodin, extracted from the root of an exotic orchid, plays a role in neurogenesis,71,72 rhythm,73,74 blood circulation,75 and neural plasticity,72
- Uridine-5’-monophosphate, a nucleotide (organic molecule) or sub-unit of RNA, also contributes to neurogenesis,76
- Alpha-glyceryl phosphoryl choline, a natural B-vitamin, improves brain speed,77,78 as do magnesium L-threonate (a magnesium salt)79 and methylcobalamin (a form of B12),80
- Ashwagandha (a plant in the nightshade family, known as Indian ginseng, gooseberry, or winter cherry) contributes to a stable brain rhythm,81
- Pregnenolone, a steroid hormone manufactured in the body via conversion of cholesterol, has positive effects on mood,82
- Vinpocetine, derived from the Vinca minor (or lesser periwinkle) plant, increases blood circulation to the brain,83
- Blueberry extract 84 and magnesium L-threonate85,86 have a positive effect on the brain’s plasticity.
Noninvasive cranial electrical stimulation (CES), which administers gentle current via electrodes attached to the forehead and left wrist, has been studied for decades. It accelerates the conversion of amino acids into neurotransmitters, increasing the impact of nutrients and nutritional supplements, and it is proving efficacious in reducing anxiety, depression, and insomnia, and for increasing blood flow to the brain and improving attention span.104-107
If you want to nurture your brain, nurture your social interaction skills. Research is proving that connection to others can generate new brain cells, can improve cognition, and can help in the avoidance of harmful addictions.108-110
Manage Your Recovery
It stands to reason that if you overcome medical conditions, or reduce their negative effects, you break their connection to cognitive decline. Although we cannot address all of the conditions that accelerate MCI within the scope of this article, there are some conditions that stand out when it comes to aggressive self-management.
Caloric restriction can have a major impact on obesity and diabetes, and blood sugar level can be brought under control with fiber111 and other supplements, especially chromium,112 DHEA,113,114 lipoic acid,115 EPA/DHA,116 bilberry,117 and liberal use of cinnamon.118,119 Stress and other psychological issues, osteoporosis, and insomnia respond to the supplements listed in Table 4. Toxins can be removed from the body via chelation.
The last point to be made concerns prescription drugs. They are powerful and can be wonderful treatments, but they also have a downside—side effects, which include MCI. If you are taking any, do your homework and discuss each and every one with your doctor with an eye toward reducing a dosage or eliminating one entirely. After all, nature provides a substitute for just about every pharmaceutical.
Get Professional Help
If MCI is more advanced, enlist the support of doctors who have extensive experience with hormone therapies that improve cognitive function. Growth hormone, testosterone, pregnenolone, and thyroid hormone all support neurogenesis; bioidentical estrogen improves brain speed in menopausal women; pregnenolone and progesterone can reduce anxiety, depression, and insomnia; parathyroid hormone impacts osteoporosis; and we now know that the hormone leptin plays a key role in obesity.120-126
Prescription drugs, such as donepezil (Aricept®), can have impacts similar to that of the above hormones, and are indeed effective in the battle against cognitive decline. However, with all of the other weapons at your disposal, they should be your last line of defense.
Mild cognitive impairment is an ever-growing concern that affects many individuals and all of society. It can be recognized, and it can be prevented. MCI can be reversed in its earliest stages by using proactive lifestyle measures, and its advanced affects can be reduced with effective medical treatment.
Our lives can be extended, and we can take our brains along for the ride. Going forward, clinical experience and brain research reveal the path that should be taken: A comprehensive brain health checkup assessing anatomy and function is critical for total health and it should be implemented in primary care. Growing older can mean growing smarter.
If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.
Eric R. Braverman, MD, is the Founder and Medical Director of The Place for Achieving Total Health (PATH Medical) in New York City and of the PATH Foundation, a nonprofit research organization dedicated to brain science. Dr. Braverman is the author of more than a dozen books, including The Edge Effect and Younger Brain, Sharper Mind, which present his brain-based medicine. He has published over 90 research papers presented to the medical community and is a recipient of the American Medical Association’s Physician’s Recognition Award. Bruce Scali has made several contributions to Life Extension magazine and has written or edited numerous books across multiple genres. He has broad expertise with cutting-edge healthcare topics, transforming complex subject matter in a manner that makes it accessible to every reader.
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