Brain Longevity: Slowing Cognitive Decline
In her July blog post, Dr. Dominique Fradin-Read introduced the concept of “brain longevity” and the role that hormones play in preserving a healthy brain function.
This month’s blog will address the various interventions and treatments that can be offered to prevent or slow down cognitive decline linked to age. Let’s start with hormones:
Estrogens: still controversial but promising
While there is clear evidence that estrogens exert a neuroprotective effect on brain cells based upon the different aspects of their physiopathology, studies are still lacking to firmly prove the benefits of hormone replacement therapy after menopause, and the use of menopausal hormone replacement therapy (HRT) to support cognitive function remains controversial.
In 2001 The Women Health Initiative study, the only randomized clinical trial to date on hormone therapy and dementia, was carried out in women 65 and older and demonstrated the detrimental effects of hormone therapy on dementia in women initiating the hormone replacement later in life. The products used for HRT were synthetic estrogens associated with synthetic progestins, therefore they could not be compared to the natural bioidentical hormones now recommended for menopausal treatments. The study was later recognized as having been poorly conducted and presenting a lot of flaws in its methodology; the results could not be generalized to a younger post-menopausal population.
More recent literature confirms that estrogens have a clear role in modulating dementia risk, with reliable evidence showing that HRT can have both a beneficial and a deleterious effect.
This new line of research suggests that early initiation of hormone therapy is crucial to provide cognitive benefits, particularly to verbal memory and other hippocampally mediated functions. This notion of the critical period hypothesis for the benefits of estrogen on brain function is under thorough investigation.
A few reports recently offered suggested (although not confirmed) evidence that hormone therapy may be associated with a reduced risk for Alzheimer's disease and may offer some protection against age-associated decline in specific cognitive functions. The majority of these reports are based on observational studies, which are confounded by the "healthy user" bias, the tendency for women receiving hormone therapy to be younger, better educated, and have fewer medical problems. One of these ongoing studies is part of the Baltimore Longitudinal Study of Aging (BLSA). In this sample, it appears that women receiving hormone therapy performed better on tests of verbal and visual memory compared to never-treated women. The two groups also differed in the patterns of regional brain activation evoked during the performance of delayed verbal and figural memory tasks. Furthermore, longitudinal comparisons revealed greater relative blood flow increases over two years in women receiving hormone therapy for the hippocampus and other temporal lobe structures that subserve memory. These findings suggest time-dependent effects of HRT on certain aspects of cognition, with variations based on the formulation of hormones used and timing of initiation.
At this time the use of menopausal replacement hormone therapy to support cognitive function remains controversial underscoring the need for further research with larger samples and more homogeneous study designs.
Testosterone and Progesterone: Little data available so far
With regards to testosterone and progesterone, very few studies have been published regarding the benefits of hormone replacement and brain.
A few studies aimed at evaluating the effect of testosterone replacement therapy (TRT) on cognitive function and depression in men with testosterone deficiency syndrome. In one study, at 8 months after intervention, total serum testosterone levels and erectile function scores had significantly increased whereas the scores for cognitive aging and depression had significantly decreased in the treatment group while no significant improvement in any parameters was noted for the control group. Notably, significant improvement in cognitive function was noted among patients with cognitive impairment at baseline who received TRT.
The case of progesterone is even more complex as studies usually report data using the synthetic progestin medroxyprogesterone as hormone replacement which has proven to have deleterious effects on cognitive function. In traumatic brain injury administration of natural progesterone limits tissue damage, reduces inflammatory response, and improves functional outcome. By analogy, we could expect some benefits of the natural hormones on general brain function after menopause, but no evidence is available to date in the literature.
Other natural options for brain longevity
As expected, a healthy lifestyle is an important component of brain support.
Nutrition has a big role to play
A first recommendation: do not starve your brain. A short occasional fast puts the brain in a temporary metabolic stress mode that can initially have beneficial effects on brain function and improve clarity and focus. Repeated prolonged intermittent fasting can lead to food deprivation and lack of essential nutrients that will alter the functioning of the neurons and cause memory and cognitive issues in the long run.
Here are some foods that can protect the neurons:
Leafy green vegetables: Research suggests that plant-based foods rich in antioxidants can slow down cognitive decline.
Fatty fish rich in omega-3 such as salmon decreases the blood level of beta-amyloid the protein that forms the plaques in the brain of Alzheimer patients.
Berries especially blueberries: a study at Harvard Brigham and Women’s Hospital found that women who consumed two or more servings of blueberries each week delayed memory decline by two and half years. For the anecdote, it is well known by her staff that Dr. Read eats blueberries at two meals per day, at least!
Tea and coffee: caffeine when consumed in moderation (less than 3 cups per day) not only offers a short boost on concentration and energy but appears to solidify memory and mental function in the long run.
Turmeric used as a spice regularly was shown in studies to improve memory and mental acuity.
Other foods are also beneficial for brain health such as walnuts, dark chocolate, tomatoes, avocados, and beans.
Sleep
Sleep is an essential element of neuron regeneration. A good night's sleep after studying something new helps strengthen the memory of what you learned throughout the day. Each phase of sleep rejuvenates the brain for optimal function and helps clear the brain from toxins accumulated during the day. It is called synaptic pruning. In addition, sleep can turn on some genes that are off during the waking phase of the day. These genes support the function of the nourishing cells in the brain, called oligodendrocytes, that build the protective sheet around neurons and help electrical conduction between them. This explains why sleep is crucial to maintain good mental function.
Stress
Stress management is another important element for brain longevity. Dr Dominique Fradin-Read often refers to stress as the “silent killer.” Chronic stress insidiously creates imbalances in the body that can turn non-chronic conditions into something irreversible. Chronic stress has a direct shrinking effect on the prefrontal area of the brain responsible for memory and learning. It can increase inflammation that damages neurons, worsening age-related cognitive decline. This is why it is essential to try to reduce the effect of stress in our lives as much as we can. Stressors of all kinds will always exist in our civilized world, each of us needs to find the tools and techniques that work to escape their deleterious effects. Exercise, meditation, and taking some time off for vacation are some methods to explore.
Supplements
Various supplements have been studied to support brain function. Our providers at VitaLifeMD will be happy to help you select what is good for you.
Dr. Dominique Fradin-Read’s brain longevity cocktail includes the following:
EPA/DHA Essentials: a good source of omega-3 for sardines and anchovies
Curcumasorb: a formula of turmeric with enhanced absorption
Plasmalogen Neuro: a special type of phospholipid that plays an important role as a neuroprotector at the level of the cell membrane and as an anti-inflammatory compound. Plasmalogens provide a protective effect against neurodegenerative disease and age-related cognitive decline
NMN (Nicotinamide Mono Nucleotide): A precursor of NAD (Nicotinamide Dinucleotide). Taken orally it can pass through the blood-brain barrier and has a protective action on brain cells. By working at the level of the mitochondria it enhances cellular energy. It increases blood flow in certain areas of the brain supporting the production of serotonin and brain nourishing factors.
Lithium orotate (the supplement, not the strong medication given to bipolar patients!): is becoming very popular as an essential mineral for mental health. It helps with neuroprotection offering a shield against the damage from toxins and oxidative stress to the brain and supports neurogenesis, the growth of new neurons and their connections.
Other supplements that are also beneficial include Vitamin B12, Vitamin D, and Cortisol Calm with adaptogens, able to offer the needed shield to stressors and to help with sleep.
Phosphatidylcholine given via IV improves memory and learning ability by acting as a membrane stabilizer and increasing acetylcholine, the neurotransmitter involved in cognitive functions.
Peptides
Some peptides have been proven to have beneficial properties on brain health.
SS31 (elamipretide) is a novel mitochondria-targeted peptide that demonstrated neuroprotective effects in a variety of neurological diseases. It improves neuron connectivity and energy production and supports increased memory and cognitive functions as a whole. It is administered at home through tiny subcutaneous injections.
The complex Selank/Semax, both administered as a nasal spray, restores some chemicals such as the BDNF (Brain-derived neurotrophic factor) present in the brain for optimal function. These two peptides act synergistically to stimulate the growth of brain cells and regenerate synapse connections. improving memory and response to stress. The complex works extremely well to reduce anxiety and depression symptoms. It enhances focus in patients diagnosed with ADHD.
Cerebrolysin is a multimodal neuropeptide obtained by the purification of young pig brain extracts. The efficacy and safety of Cerebrolysin have been largely studied in randomized clinical trials. Its mechanism of action is multifactorial at the cellular level: it decreases inflammation, it improves neurogenesis and neuroplasticity regenerating both neurons and the nourishing cell oligodendrocytes. Cerebrolysin infusions are becoming one of the most promising treatments to counteract neurodegenerative conditions and stimulate endogenous repair processes.
This treatment is now offered as a series of 15-minute intravenous infusions at VitaLifeMD. It can be administered as a preventive measure for cognitive decline prevention a few times a year.
Questions about brain longevity or cognitive decline treatments? Contact your VitaLifeMD provider today.