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Dementia and Cognitive Decline: Can We Reverse It, Prevent It, Slow It Down, or Do We Just Roll the Dice?

Dementia and Cognitive Decline:  Can We Reverse It, Prevent It, Slow It Down, or Do We Just Roll the Dice?

As our population ages, an ever-growing threat to our quality of life is the disease state of Alzheimer's, Cognitive Decline, or simply put Dementia. In the United States, about 6.5 million Americans 65 and older have dementia. Not only is this disease devastating to the individuals who have it, but the financial costs to the healthcare system and immediate family can be enormous. Sadly, since this disease process was first described, very little meaningful treatment options in the form of medications have been available to stop, slow down, or prevent the inevitable disease process. So, does that mean that we must simply sit-back, roll the dice and see if we develop dementia as we get older? The quick answer to this is NO!

Over the past 5-10 years, much more research and information has become available to help us determine who might be at higher risk for dementia and what factors play a role leading to dementia. Through the work of doctors like Dale Bredesen, M.D., and Richard Isaacson, M.D., the possibility to prevent, delay, or even reverse this devastating disease is now in reach. Sadly, it is not until more later states of the disease that the diagnosis is made, making treatment more difficult. For most physicians, once diagnosed the treatment often involves expensive medications with possible negative side effects and little if any real clinical benefit. So what are the risk factors for this disease?

Like many things in medicine, a multi-modal approach must be taken when looking at the causes and treatment for disease. In the case of dementia, it has become ever more present that factors such as elevated blood sugar, sedentary lifestyle, elevated insulin levels, hypertension, vascular disease, smoking, head trauma, heavy metals, certain genetic factors such as ApoE4, potential environmental and pesticide exposure, stress, lack of sleep, and deficiency in micronutrients (certain vitamins) can increase our risk for cognitive decline. The association of elevated blood sugar, diabetes, and elevated insulin seem to increase risk so much, that some people have termed dementia as “type 3 diabetes.” So what can we do now to prevent this devastating disease?

As with most disease processes that we face today, diet, proper nutrition, exercise, and lifestyle modification remains paramount in treatment and prevention. Early detection is also key. For individuals with a strong family history of dementia, particularly at more early ages, genetic testing may be beneficial to risk stratify and determine their APO E status. For the rest of us, it is never too early to start making changes, and research has shown the following interventions to be important to prevent and possibly reverse early cognitive decline.

  • Pursue diet low in sugar and processed food and carbohydrates, and rich in plant nutrients, lean protein, and good fats like omega-3-fatty acids.
  • Avoid head trauma
  • Stop smoking
  • Limit alcohol - long-term mild to moderate drinking can lead to shrinkage of memory centers in the brain and decreased brain volume.
  • Regular exercise
  • Keep blood pressure down and treat if elevated
  • Avoid stress where possible
  • Maintain quality sleep, treat sleep apnea if present.
  • Optimize hormones where necessary, as low levels can lead to cognitive decline.
  • Optimize micronutrients (ie: Vitamin D, B12, Folic Acid, B6) and consider boosting Omega-3-Fatty acids with a good quality fish oil capsule about 2 grams daily if ok with your doctor as studies have shown improvement in cognition with simple multi-vitamins, and Omega-3-Fatty acids when other nutrients are optimized.

The notion that dementia is a long death sentence does not need to be the norm, and recent and ongoing studies have shown that today people can prevent and delay cognitive decline. It is important that each of us take an active role in our health and not wait for a disease process to strike, but rather partner with health care providers to determine realistic and personalized strategies to prevent and treat disease. If your doctor spends more time looking at a computer screen and writing you a prescription as opposed to discussing lifestyle and nutrition, it might be time to get a new doctor. You deserve better. The pharmaceutical industry has made many advancements in medical care, but the human body is complex and a simple cure will likely not come from treating one specific pathway, and with dementia this has clearly been shown after billions of dollars and decades of time…we don’t have a magic bullet.