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Maintaining Optimal Brain Health

Updated on 5th March 2009 by Dr Charles Tweed and Alistair Tweed.

Stroke, Dementia, Alzheimer’s disease...

If you find the prospect of these disease processes terrifying, then you are not alone. Most surveys suggest it is the loss of brain function, and therefore one’s character, memory, ability to interact with friends and family and being able to look after oneself, that scares people most about getting old.

Unfortunately there is no medical cure for these problems yet, and although new developments are making inroads, it is unlikely that there will be anytime soon.

However, preventative measures are extremely effective at delaying some aspects of age related decline of mental function. Maintaining a fit and healthy brain will guard against these problems. Regular mental agility exercises and taking a combination of supplements specifically designed to increase your brain function reserves will give you the best chance.

It’s a bit like building up a reserve of muscle. Even if you lose 50% of your calf muscle, you can still straighten your ankle. If you keep your brain fit and active it can withstand a bigger insult before any particular function is lost. To illustrate this, we can look at Alzheimer's first.

Alzheimer's Disease
This has been clearly shown on a group of nuns who kindly allowed their brains to be inspected after their death. The nuns who did regular mental exercise, for example reading books and doing crosswords, had far better mental capacity scores than those who did not. What was also exciting was comparing the brains of nuns who had Alzheimer’s. A brain that has Alzheimer’s has “tangles” in it. The worse the Alzheimer’s, the more tangles. In nuns who kept their brains fit, the microscopic damage of Alzheimer’s was far worse than expected i.e. the mental fitness and reserves built up by regular use protected against the effects of Alzheimer’s.

Strokes and Dementia
Most strokes and the other most common forms of dementia are primarily due to vascular disease. What happens is the same process as causes heart disease: the blood vessels supplying the brain get increasingly thickened and furred up so the supply of oxygen and nutrients to the brain is decreased. Often a blood vessel gets completely blocked. If it is a large one a full-blown stroke can occur with a resulting loss of function. The kind of stroke depends on which area of the brain is affected e.g. being unable to move an arm or leg, or being unable to speak. If tiny vessels are involved then there may be no noticeable effect, but as this happens over and over again, the amount of functioning brain matter decreases, resulting in dementia.

Decreasing the risk of strokes is incredibly important. Tight blood pressure control, lowering raised cholesterol and helping keep the blood a little thinner are all crucial in individuals at risk. For a full discussion of the risk factors and the preventative measures we can adopt to proactively intervene in these disease processes, please see our Cardiovascular Health page.

What can you do?

Well, there are a variety of supplements that have very promising results in clinical trials. A full assessment of the following agents is given on this site:

The following agents have a short review given here:

Acetyl-L-carnitine

Modulator of cerebral energy and phospholipid metabolism.
In oral forms acetyl-L-carnitine (ALCAR) can readily cross the blood brain barrier.
Helps prevent pathological brain deterioration under stressful conditions.
Improves attention and memory by regulating the HPA axis (e.g. cortisone and beta endorphin levels).
In animal studies ALCAR has been found to modulate melatonin secretion. [1]
Reduces oxidative stress in the brain by decreasing mitochondrial decay. [2]
Studies have also shown that ALCAR can aid with depression and increase sociability, cooperation and attention to personal appearance. [3]
The acetyl moiety serves to maintain acetyl-CoA levels. [1]

Safety

ALCAR is considered safe to take on doses of up to 3,000 mg a day for cognitive enhancement.
At this dose, dream activity may be intensified.
Use with caution at these levels or avoid in individuals with epilepsy and bipolar disorders. [3]

Phosphatidylserine

A major building block of nerve cells as is located in the membrane systems of these and all other cells in the body. [8]
Important for memory and cognitive decline.
Has been shown to reduce a number of neuronal effects on aging as well as restore normal memory for a number of tasks. [9]
Also acts as a mood enhancer and helps people of all ages to cope better with stress (both emotional and physical). [3]
Capable of regulating a number of neuroendocrine activities including the release of acetylcholine, dopamine and noradrenalin.
Has also been shown to alter tissue responses to inflammation. [10]
Research suggests that long term administration of phosphatidylserine helps counteract the stress induced up-regulation of the hypothalamo-pituitary-adrenal axis. [11]

Safety

Very well tolerated and practically without any side effects. [12]
Considered safe in doses of 600mg a day. [13]
Compatible with most common drugs. [3]

Bacopa (Bacopa monniera)
An Ayurvedic herb renowned for its beneficial effects on memory and cognition:

An Ayurvedic herb renowned for its beneficial effects on memory and cognition. [3]
Aids in the retention of newly learned information [14] and improves the speed at which visual information is processed.
Enhances memory consolidation and reduces anxiety. [15]
Bacopa has also been used in children with noted improvements in learning, immediate memory, perception and reaction/performance times. [3]
In vitro Bacopa has been found to inhibit free radical formation and DNA damage in a dose dependant manner. [16]
Other medicinal actions include anti-inflammatory, analgesic, antipyretic, sedative and antiepileptic agent. [17]

Safety

Generally considered safe and without significant side effects in doses as high as 1.05 grams per day for 3 months. [3]
Bacopa is safe to use in young children, and pregnant and/or nursing women.
Only one double blind study has noted more symptoms of dry mouth, nausea and muscle fatigue when compared with the placebo group. [15]
Exercise caution or avoid with severe liver or kidney disease as safety has not been established in this patient cohort.

Rhodiola (Rhodioloa rosea)
An adaptogenic and ergogenic herb that has been found to improve cognition, decrease fatigue and improve endurance:

An adaptogenic and ergogenic herb that has been found to improve cognition, decrease fatigue and improve endurance. [18]
Helps reduce side effects that can arise from short term or chronic overwork.
Such symptoms include irritability, fatigue, reduced work performance, poor appetite, sleep disturbances, headaches and hypertension. [19]
Decreases fatigue associated with stressful conditions. [20]
In one human study, Rhodiola was found to significantly increase physical work capacity and decrease fatigue when compared to control subjects. [21]

The mechanism by which Rhodiola exerts its cognitive effects is yet to be fully elucidated. One hypothesis is that Rhodiola increases serotonin levels in the frontal cortex while Russian studies propose that the herb increases brain neurotransmitters. [18]

Safety

Considered a safe herb without side effects at doses up to 340 mg. [20]
Supplementation up to 2 grams a day (standardized to 2% rosavin) has in some individuals resulted in increased irritability and insomnia.
To date, no studies have been performed in pregnant or lactating women with Rhodiola. [19]

Cognitive Enhancement

As you can see from this summary, many of the benefits of these anti-aging supplements are not just as neuroprotectants. The documented effects include a significant improvement and increase in mental performance, not only in older people already suffering from age related cognitive impairment, but also in younger people. Taking these supplements will make you more productive in your job and more effective in your life generally. Although this combination of supplements has been put together to combat age related cognitive decline, it should also be noted that it is a cognitive enhancer that will significantly increase mental performance.

References

(Back) Pettegrew, J.W., J. Levine, and R.J. McClure, Acetyl-L-carnitine physical-chemical, metabolic, and therapeutic properties: relevance for its mode of action in Alzheimer's disease and geriatric depression. Mol Psychiatry, 2000. 5(6): p. 616-32.
(Back) Poon, H.F., et al., Proteomics analyses of specific protein oxidation and protein expression in aged rat brain and its modulation by L-acetylcarnitine: insights into the mechanisms of action of this proposed therapeutic agent for CNS disorders associated with oxidative stress. Antioxid Redox Signal, 2006. 8(3-4): p. 381-94.
(Back) Kidd, P.M., A review of nutrients and botanicals in the integrative management of cognitive dysfunction. Altern Med Rev, 1999. 4(3): p. 144-61.
(Back) Gold, P.E., L. Cahill, and G.L. Wenk, The lowdown on Ginkgo biloba. Sci Am, 2003. 288(4): p. 86-91.
(Back) Shen, J.G. and D.Y. Zhou, Efficiency of Ginkgo biloba extract (EGb 761) in antioxidant protection against myocardial ischemia and reperfusion injury. Biochem Mol Biol Int, 1995. 35(1): p. 125-34.
(Back) Hoyer, S., Memory function and brain glucose metabolism. Pharmacopsychiatry, 2003. 36 Suppl 1: p. S62-7.
(Back) Vale, S., Subarachnoid haemorrhage associated with Ginkgo biloba. Lancet, 1998. 352(9121): p. 36.
(Back) Kidd, P., Phosphatidylserine, number one brain booster. 1998, New Canaan, CT: Keats Publishing.
(Back) McDaniel, M.A., S.F. Maier, and G.O. Einstein, "Brain-specific" nutrients: a memory cure? Nutrition, 2003. 19(11-12): p. 957-75.
(Back) Kingsley, M., Effects of phosphatidylserine supplementation on exercising humans. Sports Med, 2006. 36(8): p. 657-69.
(Back) Monteleone, P., et al., Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men. Eur J Clin Pharmacol, 1992. 42(4): p. 385-8.
(Back) Cenacchi, T., et al., Cognitive decline in the elderly: a double-blind, placebo-controlled multicenter study on efficacy of phosphatidylserine administration. Aging (Milano), 1993. 5(2): p. 123-33.
(Back) Jorissen, B.L., et al., Safety of soy-derived phosphatidylserine in elderly people. Nutr Neurosci, 2002. 5(5): p. 337-43.
(Back) Roodenrys, S., et al., Chronic effects of Brahmi (Bacopa monnieri) on human memory. Neuropsychopharmacology, 2002. 27(2): p. 279-81.
(Back) Stough, C., et al., The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl), 2001. 156(4): p. 481-4.
(Back) Russo, A., et al., Nitric oxide-related toxicity in cultured astrocytes: effect of Bacopa monniera. Life Sci, 2003. 73(12): p. 1517-26.
(Back) Russo, A. and F. Borrelli, Bacopa monniera, a reputed nootropic plant: an overview. Phytomedicine, 2005. 12(4): p. 305-17.
(Back) Walker, T.B. and R.A. Robergs, Does Rhodiola rosea possess ergogenic properties? Int J Sport Nutr Exerc Metab, 2006. 16(3): p. 305-15.
(Back) Kelly, G.S., Rhodiola rosea: a possible plant adaptogen. Altern Med Rev, 2001. 6(3): p. 293-302.
(Back) Darbinyan, V., et al., Rhodiola rosea in stress induced fatigue--a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine, 2000. 7(5): p. 365-71.
(Back) Spasov, A.A., et al., A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen. Phytomedicine, 2000. 7(2): p. 85-9.
(Back) Sitges, M., L.M. Chiu, and V. Nekrassov, Single and combined effects of carbamazepine and vinpocetine on depolarization-induced changes in Na+, Ca2+ and glutamate release in hippocampal isolated nerve endings. Neurochem Int, 2006. 49(1): p. 55-61.
(Back) Liu J, Atamna H, Kuratsune J, Ames BN - Delaying brain mitochondrial decay and aging with mitochondrial antioxidants and metabolites.
(Back) Liu J, Head E, Gharib AM, Yuan M, Ingersoll RT, Hagen TM, Cotman CW, Ames BN - Memory loss in old rats is associated with brain mitochondrial decay and RNA/DAN oxidation: partial reversal by feeding acetyl L-carnitine and/or R-alpha-lipoic acid.