MedQuest Monthly - Cognitive

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How is your brain doing today? Did you forget your mother-in-law’s Birthday, discover your keys in the freezer, or forget to feed the cat? Don’t fret if you find yourself feeling absentminded. Brain lapses are a normal part of being human, especially with a busy, stressful lifestyle. Yet, if these types of incidences become a constant occurrence, you may be experiencing symptoms of age-related cognitive decline.

Text of MedQuest Monthly - Cognitive

APRIL 2012


the aging process is inevitable...the changes dont have to be!

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INTRODUCTION ............................. 1 AGE-RELATED COGNITIVE DECLINE ........................................ 2 THE DEVELOPMENT OF ALZHEIMERS DISEASE .................. 2 EXERCISE FOR THE BRAIN.............. 2 WHAT DO YOU EAT FOR BRAIN HEALTH? ......................................... 3 SMART NUTRIENTS ....................... 3 BRAIN-HEALTHY SUPPLEMENTS .. 3 INTELLIGENT RECIPES.................. 4 REFERENCES.................................. 5

INTRODUCTIONHow is your brain doing today? Did you forget your mother-in-laws Birthday, discover your keys in the freezer, or forget to feed the cat? Dont fret if you find yourself feeling absentminded. Brain lapses are a normal part of being human, especially with a busy, stressful lifestyle. Yet, if these types of incidences become a constant occurrence, you may be experiencing symptoms of age-related cognitive decline. Cognitive decline is a normal part of the aging process. In fact, adults can start to experience lower levels of cognitive performance in their 20s or 30s.1 What may seem like a mental meltdown can be frustrating to those that experience the symptoms of memory impairment, poor concentration, and slow information processing. Fortunately, there are simple ways to improve cognition and slow down the rate of age-related cognitive decline. Diet, exercise, and specific nutrients keep your brain functioning and sustain health for your entire body. In this edition, we review the factors that lead to age-related cognitive decline, the development of Alzheimers disease, and examine how exercise, diet, and nutrients can maintain healthy-brain function. Two brain healthy recipes are also included Salmon with Tomato-Olive Salad and Summer Squash with Turmeric Butter.

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Diabetes Glucose metabolism has a major impact on cognitive performance.23 Diabetes has been shown to decrease brain volume and increase dementia risk factors.24 Higher fasting insulin and insulin secretion has been shown to be related to cognitive decline in older men.25 Hormonal Imbalances Steroid hormone receptors are found throughout the brain to help regulate a variety of genes involved in cognition and behavior. When hormones are deficient or unbalanced, cognitive impairments and emotional imbalances can occur.26 Estrogen imbalances can have a significant impact on behavior, cognition, and memory.27,28,29 Higher levels of testosterone are associated with greater cognitive function.30 Testosterone therapy given to men with low testosterone levels has been shown to improve spatial and verbal memory.31,32 Levels of DHEA, a neurosteroid, decline with age, which can significantly inhibit healthy cognitive performance. DHEA supplementation has been shown to improve concentration, memory, and verbal fluency.33,34,35,36 Pregnenolone is another neurosteroid that is highly involved in cognitive function. Alzheimers patients have been shown to have a reduced level of pregnenolone metabolites in the prefrontal cortex to suspect its deficiency may be a factor in the progression of this disease.37,38 Thyroid hormones are related to brain development and cognition. Maintaining healthy TSH, T3, and T4 levels is necessary to healthy cognitive health.39

Deterioration of the brain is a normal part of the aging process. Symptoms of age-related cognitive decline can include forgetfulness, inability to stay focused, and a decrease in problem solving capabilities. Cognitive decline affects people on an individual basis, as the accumulation of oxidative stress and inflammation, decrease in hormone levels, lack of nutrition, or lifestyle habits can all contribute to your state of cognitive health.2,3,4,5,6 The following are some risk factors of cognitive decline: Oxidative Stress The brain is particularly vulnerable to oxidative stress, because it contains a large concentration of phospholipids and consumes about 20% of total oxygen used in the body. As oxidative damage accumulates, it kills neurons in the brain and leads to cognitive impairment.7,8,9 Inflammation Chronic systemic inflammation can develop in the brain from a variety of factors, including poor nutrition habits, disrupted sleep patterns, cigarette smoke, and obesity. When the bloodbrain barrier is healthy, it can prevent inflammatory agents from entering the central nervous system.10 Yet, the accumulation of these agents can compromise the blood-brain barrier and stimulate the production of inflammatory cytokines.11,12,13,14 Hypertension High blood pressure can breakdown capillaries that are needed to sustain healthy blood flow to the brain.15 Cognitive decline has been linked to individuals with blood pressure imbalances.16 Individuals on anti-hypertensive medication have been shown to have lower risks of dementia.17 Obesity The accumulation of adipose tissue releases molecules that influence a variety of functions in the brain.18 As bodyweight increases, brain volume decreases and cognitive function becomes weak.19,20 Visceral abdominal obesity and BMI have been shown to deteriorate the structure of the brain and cause brain volume deficits in the frontal, temporal, parietal, and occipital lobes.21,22

THE DEVELOPMENT OF ALZHEIMERS DISEASEApproximately 5.4 million Americans have Alzheimers disease, which is the sixth-leading cause of death in the United States. What causes Alzheimers disease? How does it affect the brain? Alzheimers disease develops when amyloid plaque builds around nerve cell tissue to cause deterioration of healthy neurons in the brain. Oxidative stress and inflammation are considered to form this amyloid plaque.40 It is also believed that high levels of glutamate or homocysteine in the brain can overstimulate neurons to release inflammatory cytokines; thus, increase inflammation and free radical damage. What are the signs of Alzheimers? It starts slowly with forgetfulness and memory lapses, which begin to interfere with daily activities. Of course, such symptoms are common with most people. Yet, as the disease progresses language skills, comprehension, and spatial functioning become primary issues. Researchers find that stimulating the release of acetylcholine, a neurotransmitter, helps to carry impulses along the nerve fibers in the brain.

EXERCISE FOR THE BRAINDiet and exercise may be considered important factors for maintaining a healthy weight, but they are also imperative to healthy brain function.

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Exercise can have positive effects on the brain by improving cognition. Researchers found that aerobic exercise can benefit all ages. It can improve cognitive abilities in children and expand multi-tasking skills, memory, and brain volume in older adults.41 Exercise has a variety of benefits that can be seen from the molecular to behavioral level. It increases oxygen to the brain and increases the release of hormones that encourage healthy brain cell development. Even 20 minutes of exercise can encourage memory function and information processing.42 Various forms of exercise can have different impacts on the brain. Cycling is shown to enhance brain function during and after a workout. Running can have a positive impact on lowering stress hormones and improve mood. This is known as a runners high. Researchers found that running is a natural antidepressant, as it increases cellular growth in the hippocampus to improve mood.43 Dancing requires strong mental and physical demand with the use of coordination, rhythm, and strategy to benefit cognitive function.

Ashwagandha As a nightshade plant found in India, Bangladesh, and Sri Lanka, ashwagandha is used in Ayurvedic medicine to strengthen physical and mental health.48 Studies have been conducted to review ashwagandhas effect on neurodegenerative ailments, finding the herb may significantly improve antioxidant activity and lessen the formation of oxidative stress that causes neurological degeneration.49 A research review of ashwagandha found this potent herb can inhibit the development of neurodegenerative diseases by sustaining neuronal function.50 B Vitamins B Vitamins improve cognition by helping homocysteine levels remain low.51,52 Deficiency in B vitamins, especially folate, vitamin B6, and vitamin B12, have been related to the development of mild cognitive impairment and Alzheimers disease.53 Blueberry Fruit Diets rich in antioxidants can help lower the risk of neurodegenerative diseases. Polyphenolic compounds and anthocyanins found in blueberries may help restore neuronal activity and lower oxidative stress.54,55 One study found blueberrys antioxidant activity improved memory by activating learning and memory receptors in the hippocampus.56 Blueberry supplementation also deterred aging effects on the brain by improving neuronal signaling and motor behavior.57 Furthermore, researchers found blueberry extract improves cognitive function by altering specific stress signals in the brain.58 Curcumin Curcumin is an anti-inflammatory compound found in the popular Indian spice turmeric. It has been shown to directly reduce the formation of amyloid plaque, oxidative stress, and neural synapses damage.59 This helps to protect memory and inhibit symptoms related to Alzheimers disease. Ginkgo Biloba As a powerful antioxidant, ginkgo biloba can improve circulation, reduce inflammation, and modulate neurotransmitter function.60 Insufficient oxygen in the brain can lead to a proliferation of oxidative stress. Ginkgo biloba is able to promote circula