Cognitive decline is a concern on the rise among practitioners and patients alike. Characterized by a gradual loss of memory and thinking skills, cognitive decline is thought of as a natural part of aging. However, there is growing evidence that cognitive decline is like any other chronic disease: it is a slowly progressive degenerative condition with risk factors we can identify decades before symptoms arise. Understanding cognitive decline and applying a root cause approach to care using functional medicine can be the first step towards preventing cognitive decline and supporting optimal brain health as we age.

Understanding cognitive decline

Cognitive decline involves a gradual deterioration in cognitive function that can affect memory, thinking skills, and the ability to perform everyday activities. While some degree of cognitive decline is expected with aging, more severe forms stem from pathological changes in the brain. One of the primary changes in the brain during cognitive decline is the accumulation of abnormal proteins such as beta-amyloid plaques and tau tangles. These proteins interfere with neural communication and lead to the death of neurons. The hippocampus, which is crucial for forming new memories, is particularly vulnerable to these changes. As neurons die, the brain’s structure shrinks, leading to a loss of brain volume, particularly in areas critical for cognitive processes.

Cognitive decline is also associated with a reduction in neurotransmitter levels, such as acetylcholine, which is essential for learning and memory. The brain’s blood flow may also decrease, reducing the supply of oxygen and nutrients to neurons. Inflammation and oxidative stress further exacerbate neuronal damage, which can disrupt the brain’s networks, impairing cognitive functioning and leading to symptoms of mild cognitive impairment and Alzheimer’s disease. Conditions like Alzheimer’s disease, Parkinson’s disease, and frontotemporal dementia involve more progressive brain damage, leading to significant cognitive and functional impairments.

What causes cognitive decline?

There are over 30 clearly identified risk factors for cognitive decline and lowered brain function. This includes everything from insulin resistance, genetics, environmental toxins, nutrient imbalances, and everything in between. Many of these risks are not outwardly apparent unless detailed testing is completed.

These factors do not impact brain function alone, rather they impact our health systemically. Factors that can lead to cognitive decline include normal changes in brain structure and function that come with age, such as reduced neuroplasticity and decreased production of neurotransmitters like dopamine and serotonin. Genetic factors like APOE gene variability can increase the risk of developing Alzheimer’s disease, along with poor lifestyle habits, chronic stress, and certain medical conditions that impair brain health by reducing blood flow and causing vascular damage.

Is cognitive decline preventable?

There is a widespread belief that dementia is not preventable. In fact, many providers and patients have steered away from APOE genetic testing for Alzheimer’s dementia as they believe nothing can be done to change their cognitive trajectory.

“This is not true,” according to Dr. Kyle O’Brien, provider at Essential Health – Raleigh & Cary. “We want to identify who is at risk as early as possible so we can be aggressive at reducing these 30+ risk factors before disease becomes apparent.”

Once an individual’s underlying risk factors for poor brain function are identified through specialized testing, a targeted treatment plan can be implemented. Lifestyle optimization is at the foundation of a treatment plan, but it may also include targeted supplementation, body composition optimization, hormone replacement therapy, peptide therapy, IV therapy, hyperbaric oxygen therapy, infrared sauna, red light therapy, or extracorporeal blood ozonation.

“The sooner we intervene, the better the outcome will be. This should be on all our minds (pun intended), whether we are experiencing symptoms of poor brain health or not,” Dr. O’Brien says.

What role can functional medicine play in optimizing brain health?

Functional medicine is defined as the practice of looking beyond a patient’s individual symptom in the pursuit of finding why an illness occurs and addressing the root cause to restore health. Functional medicine motivates physicians to dig deeper, think outside the box, and practice on the cutting-edge of medical science to find healing when conventional medicine falls short. Billions of dollars have been spent in drug development for dementia with extremely underwhelming results to show for it. On the contrary, when a functional medicine approach is used to address the underlying risk factors simultaneously, the clinically published results are very promising. Of course, routine medical check-ups are also foundational in helping manage chronic conditions that could affect brain health, such as hypertension, diabetes, and high cholesterol.

How can someone begin improving their brain health today?

According to Dr. O’Brien, the best advice is the simplest when it comes to brain health. His top recommendations to improve brain health include:

1. Implement a regular exercise routine consisting of both cardiovascular exercise and strength training. Aim for 2-3 days per week of strength training, 2 hours per week of low intensity cardio, and 20 minutes per week of high intensity cardio.
2. Follow a whole foods Mediterranean style diet that is low in processed carbohydrates, added sugar, and alcohol.
3. Sleep! For most people, aim for at least 7 hours of sleep per night.
4. Improve stress management; Meditation, prayer, breathwork, guided imagery are all useful to improve our stress resilience.
5. Find something you are passionate about and pursue this endeavor. Our brains love to work, learn, and grow. We just need to give it a stimulus to do so.

Cognitive decline, while a natural part of aging, can be influenced by various lifestyle factors. By intervening early through advanced testing and applying an integrative approach to brain health that addresses the root cause of cognitive decline, individuals can optimize their cognitive function and potentially delay the onset of significant cognitive impairments over time. Understanding and implementing these strategies can lead to a healthier brain and a better quality of life as we age.

At Essential Health, our goal is to not only prevent and mitigate symptoms of cognitive decline, but to empower our patients to experience optimal brain health and function throughout the entirety of their lives. For more information about our approach to optimal brain health, schedule a Meet & Greet with our experts.