Cognitive Decline – What Is Alzheimer’s & Dementia
While we may get a bit slower as we age both mentally and physically I don’t think this has to be the case. Alzheimer’s is a form of dementia. It is the most common form accounting for up to 70% of all dementia (Dementia Australia, 2018a). Our enjoyment of life comes in great part from our emotional and mental interaction with people and the world around us and this is why monitoring and combating cognitive decline is so very important.
We can think of dementia as a progression from SCI (subjective cognitive impairment), where only you might know there is something not quite right, to MCI (mild cognitive impairment) where others around you can start to notice changes in the way you think and perform to finally a point where your mind really doesn’t work and you can be officially diagnosed or labelled with the term Alzheimer’s Disease.
In the early stages the symptoms of Alzheimer’s disease can be very subtle. However, it often begins with lapses in memory and difficulty in finding the right words for everyday objects.
Symptoms May Include:
- Progressive, persistent and frequent memory loss or difficulties, especially of recent events.
- Personality change
- Apathy and withdrawal
- Loss of ability to perform everyday tasks.
- Vagueness in everyday conversation
- Apparent loss of enthusiasm for previously enjoyed activities
- Taking longer to do routine tasks
- Forgetting well-known people or places
- Inability to process questions and instructions
- Deterioration of social skills
- Emotional unpredictability
So there is a real and progressive cognitive decline that takes place over many years, at first unnoticed but then it becomes more and more severe.
What Goes Wrong?
Many things can go wrong that can cause Alzheimer’s to develop. The factors that build and maintain neurons are outweighed by the factors that breakdown or reduce neurons. They are actually normal processes found in everyone it is just the balance that changes. As the balance changes it also causes a greater cascade towards either side of the equation and this is why it takes a great deal of effort or changes to be made to even begin to rebalance what is happening.
The 6 main areas or subtypes of Alzheimer’s Disease:
Type 1 – Inflammatory – ‘HOT’
This is when you may have an ongoing infection, such as a gut pathogen, Lyme disease, chronic sinusitis or chronic cold sores, as well as non-infectious types of inflammation, such as autoimmune condition or type 2 diabetes. Interestingly you actually liberate the beta-amyloid (one of the main pathological markers of AZD) as part of an antimicrobial protective response, so the body is trying to protect itself from infectious agents.
Type 2 – Atrophic- ‘COLD’
This is something that happens when you withdraw ‘trophic’ support. Here ‘trophic’ just means a stimulating or building type molecules. This can be in the form of hormones such as oestrogen for women. This can be especially significant when menopause occurs suddenly or abruptly. This is one of the reasons why in 2016 dementia became the leading cause of death among Australian females, surpassing heart disease which has been the leading cause of death for both males and females since the early 20th century (ABS, 2017). Other hormones that are important include testosterone, thyroid hormones, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) . Here again the brain will produce more beta-amyloid as part of a programmed or normal response allowing a downsizing our neural network. Other trophic factors are vitamin D and vitamins and minerals needed for proper maintenance of brain.
Type 1.5 – Glycotoxic -‘SWEET’
If you have glycotoxicity, you have an insulin resistance (IR) or are pre-diabetic or have Type 2 diabetic (T2D). Here 2 main things are happening: you can have excess glucose creating inflammation via advanced glycation end products (AGEs: glucose binds to and damages proteins) and other mechanisms, but also you have ‘trophic’ withdrawal becauseyou are also resistant to insulin (the signal does not get recognised), which is one of the most important trophic supports for the brain. So you unfortunately have a double whammy of ‘type 1’ and ‘type 2’ and is why it is referred to as ‘type 1.5’. This is actually a very common cause of MCI and ultimately Alzheimer’s disease.
Type 3 – Toxic – “VILE’
Type 3 is when you typically have response to toxins such as mercury (& other heavy metals), general anaesthetics, mycotoxins, from chronic Lyme or from other chronic infections. You can also have a bit of type 1 mixed in there as well. This can sometimes be seen this with chronic viral infections, HSV-1 (cold sore herpes virus) and you can become caught in something that has been termed Chronic Inflammatory Response Syndrome (CIRS) where the body cannot process biological toxins produced by the infection or present in the environment. The symptoms of this sub-type will often be quite distinct and the treatment also has very specific needs.
Type 4- Vascular- ‘PALE’
This is about chronic vascular disease i.e. poor flow of blood through your blood vessels with some of the main factors influencing this being high homocysteine and chronically high blood pressure.
Type 5- Traumatic – ‘DAZED’
This occurs when the brain is traumatized from things like a car accident or chronic sporting concussions.
How Do You Make A Difference?
Dr Bredesen talks about up to 36 different holes in the roof of a house with the rain coming in. If you plug up a few holes it will not make much of a difference, the rain is still pouring in. When you plug up more and more of the holes is where you get the magic! Dr Bredesen has found that between 10-20 holes need to be addressed before we can expect a result. Some of the holes are bigger and let in more rain and others are smaller and don’t contribute as much to how wet we get.
Our job is to find the most important, critical imbalances and underlying causes and guide you through how to improve and treat these areas. Everything needs to be considered and the more ‘holes’ we can close the greater the outcome we can achieve.
It is vitally necessary to identify each of the holes for determining how and what we treat.
What Are Some Of The ‘Holes”?
The key is that the whole program works together, so there is a threshold effect.
Some Of The Major Areas We Need To Consider:
- Reversing insulin resistance
- Optimizing sleep
- Exercising regularly
- Eliminating toxic exposures (especially for Type 3 AZD)
- Optimizing hormonal support (including bio-identical hormone replacement)
- Optimizing nutrition (e.g., avoiding high homocysteine, low vitamin D, low vitamin B12, low magnesium, etc.)
- Addressing pathogens (e.g. Gastrointestinal infections and dysbiosis including SIBO; Borrelia/ Lyme)
- Reducing inflammation (but most importantly, removing the cause(s) of the inflammation)
- Optimizing brain training
- Reducing stress.
You are insulin resistant (IR), pre-diabetic or even frankly diabetic (T2D).
We address ways to lower your insulin levels and control your blood glucose levels. Using a lower carbohydrate diet, actually a ‘ketogenic’ diet, is a vital way of controlling your blood glucose. It also allows a very important alternative fuel source to be created and used by the brain. Ketones can replace much of the brains need for glucose and can also protect of neuron’s survival and function. Fasting or ‘intermittent’ fasting is another important way of lowering insulin and blood glucose and it also simulates a kind of recycling and regeneration of the body and brain called ‘autophagy’.
You have a chronic gastrointestinal (GI) infection, dysbiosis or even an autoimmune disease such as Coeliac Disease (CD) that is causing inflammation and inability to absorb all the nutrients in your food.
We find what is causing the GI infection through pathology testing and treat it using anti-microbial or anti-parasitic herbs. If it was CD a strict avoidance of gluten will be necessary and we can also guide you into other possible foods that have been shown to sometimes cross react with our immune system and gastrointestinal system as if it were gluten. We then maintain and rebuild a healthy digestion and microbiome (normal gut bacteria, fungi and viruses) using specific types of foods, probiotic and other potential supplements.
What Can I Do About It?
We have introduced a program that we call RCD (Reversing Cognitive Decline) and is based on the work and training of Dr Dale Bredesen from UCLA and the Buck Institute for Research on Aging, CA, USA. It is a tailored program to optimize cognitive function and prevent or reverse neurodegeneration, especially in Alzheimer’s dementia.
Dr Bredesen has been working for the last 28 years on understanding Alzheimer’s and finding a way of treating it.
For most of this time he was looking for a singular cause and singular cure. He finally realised his wife had been correct all along and that a systems based, comprehensive and personalised program was needed to address the many underlying dysfunctions or imbalances that are part of how the disease begins and progresses.
Symptoms By Stages Of Dementia
Dementia Australia (2018b)
- Appear more apathetic, with less sparkle
- Lose interest in hobbies and activities
- Be unwilling to try new things
- Be unable to adapt to change
- Show poor judgement and make poor decisions
- Be slower to grasp complex ideas and take longer with routine jobs
- Blame others for “stealing” lost items
- Become more self-centred and less concerned with others and their feelings
- Become more forgetful of details of recent events
- Be more likely to repeat themselves or lose the thread of their conversation
- Be more irritable or upset if they fail at something
- Have difficulty handling money.
- Be more forgetful of recent events. Memory for the distant past generally seems better, but some details may be forgotten or confused
- Be confused regarding time and place
- Become lost if away from familiar surroundings
- Forget names of family or friends, or confuse one family member with another
- Forget saucepans and kettles on the stove. May leave gas unlit
- Wander around streets, perhaps at night, sometimes becoming lost
- Behave inappropriately, for example going outdoors in nightwear
- See or hear things that are not there
- Become very repetitive
- Be neglectful of hygiene or eating
- Become angry, upset or distressed through frustration.
- Be unable to remember occurrences for even a few minutes, for instance forgetting that they have just had a meal
- Lose their ability to understand or use speech
- Be incontinent
- Show no recognition of friends and family
- Need help with eating, washing, bathing, toileting and dressing
- Fail to recognise everyday objects
- Be disturbed at night
- Be restless, perhaps looking for a long-dead relative
- Be aggressive, especially when feeling threatened or closed in
- Have difficulty walking, eventually perhaps becoming confined to a wheelchair
- Have uncontrolled movements
- Have permanent immobility, and in the final weeks or months the person will be bedridden.
We look forward to supporting you in ‘Reversing Cognitive Decline’.
- Dementia Australia (2018a) https://www.dementia.org.au/about-dementia/types-of-dementia/alzheimers-disease. Accessed 3-2-18
- Dementia Australia (2018b) https://www.dementia.org.au/about-dementia/what-is-dementia/progression-of-dementia. Accessed 7-2-18
- Mufson E. J. et al (2012) Mild cognitive impairment: pathology and mechanisms. Acta Neuropathology 2012;123:13-30
- Australian Institute of Health and Welfare (2012). Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW
- Australian Bureau of Statistics/ ABS (2017) Causes of Death, Australia, 2016 (cat. no. 3303.0)
- The National Centre for Social and Economic Modelling/ NATSEM (2016) Economic Cost of Dementia in Australia 2016-2056