Dementia is a general term for memory loss, language, problem-solving, and other thinking abilities that are severe enough to interfere with daily life. Alzheimer's is the most common cause of dementia.
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Dementia Statistics
There are currently over 55 million people worldwide who have dementia. As the population ages, this number is expected to climb to 139 million by 2050. With this rise in incidence comes an increase in cost; estimating that 2.8 trillion will be spent annually on dementia care by the year 2030
A diagnosis of dementia has a significant impact on the individual, the family, the community, and the healthcare system. Dementia, otherwise referred to as Major Neurocognitive Disorder (MND), is characterized as a group of symptoms that affect various parts of the brain and interfere with performing normal daily activities.
It is important to know that cognitive impairment is not a normal part of aging. A functional medicine approach to dementia involves looking downstream to identify the root causes of dementia and how we can aim to prevent disease onset or, once established, focus on supporting the individual to reduce symptoms and, hopefully, disease progression.
The 3 Regions of The Brain
The brain is an incredible organ composed of 3 regions: the cerebrum, the cerebellum, and the brain stem. Each area of the brain carries its own unique responsibility.
Cerebrum
The cerebrum controls memory, problem-solving, feelings, and movement. The cerebrum contains the cerebral cortex, which has four lobes: frontal, parietal, temporal, and occipital. The hippocampus, located within the temporal lobe, is responsible for making new memories and is often one of the first areas of the brain damaged by dementia.
Cerebellum
Located in the backs of our heads beneath the cerebrum, the cerebellum controls balance and coordination. The outer layer of the cerebellum is the cortex, which is involved with memory, interpretation of sights and sounds, and thought generation.
Brain stem
Under the cerebellum, the brainstem connects our brains to our spinal cords. The brain stem controls body functions like breathing, heartbeat, and digestion.
What Causes Dementia
When there is damage to the brain tissue due to decreased blood flow, head trauma, or a buildup of proteins or cerebral spinal fluid, the nerve cells die or cannot function properly.
As more neurons become damaged, a person will begin to experience difficulties in memory, language, ability to perform daily tasks, reasoning, mood, and/or behavior. By the time a person experiences symptoms that interfere with their typical day-to-day, it can be decades from when the initial pathology began in the brain.
Types of Dementia
There are currently two types of dementia: primary (or neurodegenerative) and secondary.
Primary Dementia
Primary dementia includes Alzheimer's dementia (AD), Dementia Lewy Body (DLB), Vascular Dementia (VaD), and Fronto-Temporal Dementia (FTD). Given that dementia is a collection of symptoms, the types of dementia are not exclusive to each other. For example, a person may suffer from a mixed presentation of both AD and VaD.
Secondary Dementia
Secondary dementias occur as a result of a particular disease or biochemical processes like nutritional deficiencies, heavy metal toxicity, thyroid dysfunction, or mental health disorders. In addition to the above, dementia can also present in conditions like Parkinson's Disease, Wernicke-Korsakoff Syndrome, Huntington's Disease, HIV/AIDS, or Normal Pressure Hydrocephalus. Unlike primary dementias, these are often thought to be reversible causes.
Signs & Symptoms of Dementia
An individual can present quite differently, depending on the type of dementia. Signs and symptoms can include: (1,2)
- Worsening short term memory
- Difficulty with communication. This can consist of trouble speaking, retrieving words, or expressing thoughts/understanding.
- Getting lost or wandering in a familiar area.
- Trouble managing finances.
- Taking longer to repeat everyday daily routines.
- Frequent falls, loss of balance, or a general decline in function.
- Loss of interest in previously enjoyed activities.
- Personality changes include episodes of confusion, irritability, paranoia, or delusions.
- Apathy toward others' feelings.
- Polypharmacy or the initiation of a new medication.
Possible Causes of Dementia
Age
The average age of a person diagnosed with dementia is in their mid-80s, with the highest incidence of dementia in those over 90 years of age. Developing dementia is not a normal part of aging. However, it is essential to understand that the brain does undergo many changes throughout its lifespan. These changes include a reduction of brain size, which impairs the function of neurons, along with shifts and hormones and neurotransmitters, which will affect how messages are sent in the brain. The lifestyle choices you make in your earlier decades of life will influence the health of your brain as you age.
Lifestyle Choices & Genetics
The day-to-day lifestyle choices are at the foundation of everyone's health experience. These include choices around food, exercise, stress reduction, sleep quality, and relationships. Those who tend to make less healthy options are at higher risk for developing dementia, especially if there is a genetic predisposition.
The study of epigenetics and nutrigenomics has provided significant insights into how your environment and food choices shape your health outcomes. Researchers have long been studying the genetics of neurodegenerative dementias and the role that specific genes play in disease expression (3,4,5,6). A person may carry the genes for a particular dementia. However, that does not guarantee they will ever develop the disease. Understanding your genetic risk is important as it can help avoid certain lifestyle choices that may be more disease-promoting.
Isolation
Lack of community and social isolation is a risk factors for dementia. Individuals with dementia struggle with the loss of memory, function, and autonomy. Consequently, many are no longer able, nor desire, to socialize as they did prior. This loss of social networks can contribute to a faster disease progression in dementia and other chronic illnesses.
Metabolic Dysfunction
It has been well-documented that metabolic disease, including Hypertension, Hyperlipidemia, Cardiovascular Disease, and Insulin Resistance (IR), is linked to an increased risk of dementia. Insulin Resistance has been associated with AD and is referred to as Type 3 Diabetes. The brain requires a significant amount of energy to perform its complex functions. Brain cells use glucose to fuel mitochondria and produce ATP. When IR is present, neurons are damaged by oxidative stress, amyloid plaques form, and there is an increase in inflammatory mediators resulting from cellular dysfunction. These will result in impairments in brain function (7).
Lack of Oxygen
Diseases that cause a reduction of oxygen to the brain have been associated with AD and VaD. These include Sleep Apnea, COPD, Asthma, Congestive Heart Failure, Anemias, and Cerebrovascular Accidents (CVAs).
Toxicity
This includes heavy metals (lead, mercury, aluminum, arsenic), medications, alcohol, mycotoxins, glyphosate, and chemicals or additives in foods. Pharmaceuticals can be toxic to the body, especially if not metabolized and excreted properly. Moreover, many are known for their ability to cause cognitive decline, especially when prescribed in combination with other medications. Common classes include tricyclic antidepressants, anticholinergics, and antipsychotics. Medications may also directly lower essential antioxidants and nutrients needed for cellular health, like Coenzyme Q10, glutathione, or B-vitamins (2,8).
Nutrient Deficiency
Common nutrient deficiencies are associated with several reversible causes of dementia. These include essential B Vitamins like B9, B12, and B1 (8). These nutrients are vital for cellular health and methylation, and when deficient or even suboptimal, they can contribute to poor brain function.
Hormones
Insufficient levels of hormones can contribute to dementia. In post-menopausal women, studies have found an association between low estrogen and progesterone states and the onset of AD. Impairments in thyroid function and cortisol levels also correlate.
Traumatic Brain Injury (TBI)
Studies over the past several decades have shown the association between moderate to severe head trauma and having an increased risk of developing AD or other dementia types.
Functional Medicine Labs to Test for Dementia
A comprehensive and multidisciplinary approach is required to determine the diagnosis of dementia appropriately and further explore the root causes of cognitive decline.
The diagnosis is made through a combination of cognitive testing and imaging. A standard tool used is the Montreal Cognitive Assessment (MoCA) which assesses the level of arousal, basic attention, executive function, memory, language, visuospatial ability and social/behavioral cues (2).
These tests can determine the degree of cognitive impairment along with what particular areas of the brain are most affected. A score greater than 26 is considered normal. Mild cognitive impairment is scored between 18-25, moderate cognitive impairment is 11-17, and severe cognitive impairment is scored 10 or less. Additional imaging, including head CT, MRI, and PET scans, is often pursued as part of the diagnostic work-up. An evaluation for the presence of sleep apnea is also recommended.
Blood tests and other biomarkers are helpful in the work-up of dementia. They can help identify possible reversible etiologies and areas in which a person may be at higher risk. These include:
Metabolic Dysfunction
Understanding your cardiovascular risk and level of systemic inflammation is an important step in reducing your risk of cognitive decline. The Cardiac Health Panel includes a lipid panel and inflammatory markers (i.e., C-Reactive Protein, Homocysteine, and oxidized LDL).
Looking for the presence of insulin resistance is recommended by checking Fasting Insulin, Hemoglobin A1c, and fasting glucose. When these values are elevated, even suboptimally, it can indicate that damage is already beginning to occur to blood vessels and tissue within the brain, impairing its functions.
Microbiome
The health of the microbiome is associated with the health of the brain and nervous system. The GI Map + Zonulin stool test looks for microbial imbalances that may be at the root cause of the cognitive impairment. In addition, it tests a marker called Zonulin which, if elevated, will identify the presence of enhanced intestinal permeability (or leaky gut).
Hormones
Thyroid hormones, cortisol, estrogen, progesterone, testosterone, and DHEA levels can be obtained through a Comprehensive Thyroid Panel and a Dutch Complete. The Dutch Complete will also provide information about the degree of oxidative stress you are experiencing at a cellular level, your Vitamin B12, glutathione sufficiency, and levels of important neurotransmitters.
Toxicity
We have learned that certain toxic exposures can increase one's risk of developing dementia. The Total Tox Burden will provide information about the toxic burden, metabolic processes, and amino acid health.
Neural Zoomer
To explore the presence of antigens that may predispose a person to several neurologic diseases, the Neural Zoomer Plus is helpful. It also includes genetic testing for the ApoE genotype, which can help identify your risk of developing AD.
Functional Medicine Treatment for Dementia
Pharmaceuticals
There are currently three classes of drugs on the market for the pharmacologic treatment of dementia. Cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and NMDA receptor antagonist (memantine) act upon chemical messengers, acetylcholine and glutamate, respectively, to improve how messages are sent within the brain cells.
Aducanumab is an anti-amyloid antibody that works to target the buildup of amyloid plaques, a hallmark in AD. Unfortunately, although these medications can be helpful in the short term in delaying disease progression, they have not been shown to reverse or stop disease progression.
Pharmaceuticals, of all classes, have their role in managing many disease states; however, certain ones have known adverse effects on brain function, especially as you age. For example:
- Anticholinergic drugs like Benadryl have been linked to an increased risk of dementia.
- Statin medications, like Lipitor, deplete coenzyme Q10, an important antioxidant needed for mitochondrial health and energy production.
- Metformin, used in managing Type II Diabetes, is associated with Vitamin B12 deficiency.
This is an important reminder that, although pharmaceuticals may be the standard of care, it is prudent to understand how they may be contributing to impairments in cognition.
Nutrition
The greatest medicine is the food you choose to nourish your body with. When filling your plate with fresh fruit, vegetables, grass-fed, organic meats, and healthy fats, you give your body the necessary nutrients to fuel brain cells.
If there is a presence of insulin resistance, avoiding processed carbohydrates is an essential first step in helping to regulate blood glucose levels.
Eat slowly and chew your food. This will help improve digestion and absorption of your food to ensure your body can absorb important nutrients for brain health, like Vitamin B12 and Folate.
The MIND Diet
The MIND Diet is the most common nutrition plan recommended for preventing dementia. The name is short for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay. It encourages eating from 10 healthy food groups. Evidence supporting the MIND diet comes from observational studies of more than 900 dementia-free older adults, which found that closely following the MIND diet was associated with a reduced risk of synapse loss and a slower rate of cognitive decline.
The Keto-Flex Diet
The KetoFLEX diet is a plant-based, mildly ketogenic diet studied by Dr. Bredesen, a world-class neuroscientist. It focuses on whole, nutrient-dense foods and emphasizes local, organic, and seasonal non-starchy vegetables from every color of the rainbow, combined with an adequate amount of protein and generous amounts of healthy fat. This diet requires a 12-hour fast, with at least 3 hours of fasting before bed (hence the 12/3 in the name).
To date, Dr. Bredesen has used the KetoFlex diet with thousands of Alzheimer's participants. He just finished a clinical trial on the KetoFLEX in early 2021. During the clinical trial, 84% of participants had improved cognitive results.
Eliminate Toxins
Toxins are ubiquitous. For those who have dementia, the buildup of toxin(s) can have devastating and long-lasting effects. Steps you can take to reduce your toxic exposure include eating organic food and fish low in mercury (examples are salmon, sardines, anchovies, haddock), avoiding plastics, adding air filters and plants to your home to improve air quality, exploring the EWG database for healthier alternatives to current cosmetic and household products and exchanging synthetic fragrances for high-quality essential oils.
If you have mercury amalgam fillings, consider finding a holistic dentist who can safely help you to remove these.
Community
It has been well-documented that social isolation and loneliness contribute to chronic illness, including dementia, and increased mortality. Maintaining relationships, attending community or family gatherings, becoming a member of a local gym, card group, or organization that brings you joy, or joining virtual groups of common interest are ways to continue to maintain a social network.
Commit to Regular Movement
Finding time within your day to prioritize movement will have positive effects on brain health and is beneficial in the prevention of dementia. Moreover, the cardiovascular benefits of exercise in relation to its association with VaD are equally important. The best exercise is one that you enjoy doing and that you can commit to regularly. These can include strength training, HIIT, jump roping, running, walking, hiking, dancing, yoga, Pilates, or cycling. A sense of community is often established within an exercise regimen and will have the added benefit of reducing social isolation.
Stress Reduction
A root cause for many disease dynamics is chronic stress, which has been associated with dementia. By reducing your stress, you will shift from a sympathetic, fight or flight state to a parasympathetic, rest and digest state, which reduces inflammation and helps to shift the HPA axis back into balance. Ideas for stress reduction include finding a hobby that evokes passion and joy, deep breathing exercises, meditation, journaling, faith or spirituality practices, singing, dancing, snuggling with a pet or loved one, or time outdoors looking out at the horizon.
Prioritize Sleep
Sleep is critical for all stages of life. It is incredibly restorative for your brain, as it combines the information that was created throughout the day through a process called consolidation.
Suboptimal sleep can lead to impaired memory, difficulty focusing, poor execution of tasks, and reduced concentration. Listening to your body and going to bed when you feel tired is a great start to establishing a routine. Options to help with sleep hygiene:
- Keep the lights dim at night.
- Avoid bright screens before bed.
- Avoid caffeine past noontime.
- Use a sleep machine or earplugs to avoid extraneous noises in your home.
- Avoid alcohol
- Keep the bedroom cool.
- Explore calming teas or essential oils
- Try a bedtime meditation.
Consider Supplementation
Depending on the type of dementia and degree of impairment, along with the guidance of lab work and biomarkers, supplementation can be beneficial in supporting the body while you are also working to address some root causes. Common supplements used are Co-Enzyme Q10, Vitamins A, B, C, and E, high-quality omega-3 fish oil, Vitamin D, Curcumin, and Magnesium.
Summary
Countless memories are created throughout one's lifespan. As you age, you likely will experience moments of memory loss. By incorporating a functional medicine approach of a healthy diet, lifestyle choices, and understanding your unique biomarkers, you have an opportunity to prevent a diagnosis of dementia or reverse a process that may already be at play.
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