Cognitive ability and impairment, how to improve with natural supplements, herbs and vitamins, role of foods and diet
June 1
1 2018  by Ray Sahelian, M.D.

Definition: Cognition is defined as the ability to learn, perceive, and reason. Although certain cognitive aspects can improve with age, memory does not.

As we age our cognitive ability declines, particularly our memory, followed by attention and visual-spatial abilities. On the other hand, our vocabulary could increase. There are several factors that influence age related cognitive impairment. Among them, educational level, health, life style, and personality. Successful maintenance of cognition during aging is dependent on several conditions: absence of disease leading to a loss of autonomy, maintenance of mental and physical activities, adequate sleep, healthy diet, avoidance of smoking and excessive drinking, avoidance or reduction of certain medications that damage brain tissue, and an active and social engaged lifestyle. Worry, anxiety and depression lead to cognitive impairment. This can be reversed in some people by the appropriate use of certain nutritional supplements and good attention to proper food intake.

Diet and food, do they influence cognition?
Including a wide variety of fruits and vegetables, along with adequate consumption of fish or fish oils is quite beneficial. Those who consume large amounts of sugar and simple carbohydrates, especially if older, are more likely to see a decline in their mental function. There appears to be a slower rate of global cognitive decline over several years in persons with high intake of vitamins C, E, carotenes and flavonoids.

The consumption of marine fishes and general seafood has long been recommended by several medical authorities as a long-term nutritional intervention to preserve mental health, hinder neurodegenerative processes, and sustain cognitive capacities in humans. Most of the neurological benefits provided by frequent seafood consumption comes from adequate uptake of omega-3 and omega-6 polyunsaturated fatty acids and antioxidants. Optimal omega-3 intake allows efficient inflammatory responses that prevent the initiation and progression of many neurological disorders.

Natural supplements that influence cognitive function
There are dozens of herbs and nutrients that can benefit those with cognitive impairment, disorder, or decline. See memory for another article that reviews these supplements.

Mind Power Rx for Cognitive Function enhancement. It combines a delicate balance of brain circulation agents and neurotransmitter precursors with powerful natural brain chemicals that support healthy:

Memory and mood
Mental clarity
Alertness and Focus

The herbs in Mind Power Rx mental enhancement product are: Ashwagandha, Fo-Ti, Ginkgo biloba, Gotu kola Ayurvedic antioxidant, Ginseng, Mucuna pruriens.  The nutrients and vitamins in Mind Power Rx include Acetyl-l-carnitine, Carnitine, Carnosine a combination of two amino acids, Choline, DMAE, Inositol, Methylcobalamin, Pantothenic acid, Tyrosine, and Vinpocetine. This cognitive enhancing formula also has a form of choline called CDP Choline.

Natural supplements, herbs, vitamins, minerals and their benefit, role of food and diet
Seniors who consume lots of carbohydrates and sugar are at increased risk for mild cognitive impairment.

Carnosine supplements
Peptides. 2016. Carnosine ameliorates cognitive deficits in streptozotocin-induced diabetic rats: Possible involved mechanisms.

Creatine supplementation could benefit vegetarians.

Curcumin found in turmeric plant
Advances in Nutrition 2018. Can Curcumin Counteract Cognitive Decline? Clinical Trial Evidence and Rationale for Combining ω-3 Fatty Acids with Curcumin. One potential factor contributing to accelerated cognitive decline is chronic systemic inflammation, because it has been linked to cognitive impairment and increased dementia risk. Certain lifestyle factors, such as excess body weight and sedentary behavior, can exacerbate a proinflammatory state in older adults, resulting in chronic low-grade inflammation. Supplementing the diet with curcumin, an anti-inflammatory polyphenolic compound from the curry spice turmeric, is a potential approach to prevent accelerated cognitive decline by counteracting chronic inflammatory processes.

Vitamin D benefit
Low levels of vitamin D are associated with substantial cognitive decline in the elderly population, which raises important new possibilities for treatment and prevention. Archives of Internal Medicine 2010.

Green Tea
Scientists have found that green tea slows brain aging, helping prevent declining memory, cognitive impairment, dementia and Alzheimer's. Many studies indicate regular tea consumption is associated with lower risks of cognitive impairment and decline.

Advances in Nutrition, 2017. Nutritional Factors Affecting Adult Neurogenesis and Cognitive Function. Adult neurogenesis, a complex process by which stem cells in the hippocampal brain region differentiate and proliferate into new neurons and other resident brain cells, is known to be affected by diet. Intrinsic factors such as aging, neuroinflammation, oxidative stress, and brain injury, as well as lifestyle factors such as high-fat and high-sugar diets and alcohol and opioid addiction, negatively affect adult neurogenesis. Conversely, many dietary components such as curcumin, resveratrol, blueberry polyphenols, sulforaphane, salvionic acid, polyunsaturated fatty acids (PUFAs), and diets enriched with polyphenols and PUFAs, as well as caloric restriction, physical exercise, and learning, have been shown to induce neurogenesis in adult brains. Nutritional approaches provide promising prospects to stimulate adult neurogenesis and combat neurodegenerative diseases and cognitive decline.

Combination formulas that have been researched
Clin Drug Investig. 2014. Management of cognitive determinants in senile dementia of Alzheimer's type: therapeutic potential of a novel polyherbal drug product. The objective of the present study was to evaluate the efficacy of a polyherbal formulation on cognitive functions, inflammatory markers and oxidative stress in healthy elderly as well as senile dementia of Alzheimer's typepatients. The polyherbal test formulation along with a placebo was given to healthy elderly subjects while patients with cognitive decline received either the test formulation containing extracts of Bacopa monnieri (whole plant), Hippophae rhamnoides (leaves and fruits) and Dioscorea bulbifera (bulbils) at a dose of 500 mg or donepezil drug (Aricept) at a dose of 10 mg, twice daily, for a period of 12 months. The results of this study demonstrate the therapeutic potential of this novel polyherbal formulation for the management and treatment of cognitive decline.

J Alzheimers Dis. 2015;. A Nutritional Formulation for Cognitive Performance in Mild Cognitive Impairment: A Placebo-Controlled Trial with an Open-Label Extension. Thirty-four individuals with mild cognitive impairment were randomized for 6 months to a nutraceutical formulation (Nutritional formulation: folate, alpha-tocopherol, B12, S-adenosyl methioinine, N-acetyl cysteine, acetyl-L-carnitine) or indistinguishable placebo, followed by a 6-month open-label extension in which all individuals received NF. The NF cohort improved in the Dementia Rating Scale. The placebo cohort did not improve. These findings extend prior studies of nutritional formulation efficacy for individuals without cognitive impairment and with Alzheimer's disease.

People with a history of high blood pressure are at an increased risk of developing cognitive impairment. Hypertension treatment in old hypertensive subjects may offer some benefit against dementia and cognitive decline. However, there may be risks to hypertension treatment with potent drugs, and caution is advised to use drugs that are safe and do not cause significant side effects.

People with high diastolic blood pressure, which is the bottom number of a blood pressure reading, are more likely to have thinking or cognitive impairment, or problems with their memory, than people with normal diastolic blood pressure readings. For every 10 point increase in the reading, the likelihood of a person having thinking problems is seven percent higher. Neurology, 2009.

Cognitive Decline associated with Age Related Macular Degeneration
Worsening of age-related macular degeneration (AMD), a degenerative eye disorder that is the leading cause of blindness in the elderly, appears to be associated with some cognitive impairment. An association is logical because both are both chronic neurodegenerative disorders affecting persons as they age. Furthermore, worse vision affects daily functioning and social interaction, and that the resulting predisposition to depression and social isolation could indirectly exacerbate cognitive impairment.

Age related cognitive impairment
It's nearly impossible to avoid cognitive impairment as we age, but, in addition to certain lifestyle changes, the use of low dose mind boosting supplements could well reverse certain aspects of mild cognitive impairment, and perhaps even moderate ore severe cognitive impairment. Cognitive disability affects not only the person suffering the condition, but family members responsible for taking care of this individual.
   Elderly women who watch daytime soap operas and talk shows are more likely to suffer from cognitive impairment than women who abstain from such fare. It's not clear if watching these TV shows leads to weaker brainpower, or vice-versa.
   Elderly diabetics with poor blood sugar control have a high prevalence of undiagnosed cognitive dysfunction, depression and functional disabilities.
   Certain aspects of brain function, such as abstract reasoning, mental speed and puzzle-solving, begin their decline in one's late twenties. Declines in memory generally became apparent in a person's late thirties. Indicators of a person's accumulated knowledge -- like performance on tests of vocabulary and general knowledge -- keep improving with age. Neurobiology of Aging, 2009.
   The majority of men who receive hormone deprivation therapy for prostate cancer will experience some degree of cognitive impairment, such as in the ability to concentrate. Cancer, 2008.

A decline in thinking or cognitive function with age is not inevitable. Many adults maintain their cognitive function as they grow older. Dr. Alexandra Fiocco of the University of California, San Francisco, found that adults who did not smoke, exercised once a week, were socially active, had at least a high school education and a ninth grade literacy level, were more likely to maintain cognitive skills through their 70s and 80s. People who exercise moderately to vigorously at least once a week are 30 percent more likely to maintain their cognitive function than those who do not exercise that often. Those who had at least a high school education are nearly three times as likely to stay sharp as those who with less education. Elderly with a ninth grade literacy level or higher aer nearly five times as likely to stay sharp as those with lower literary levels and non-smokers are nearly twice as likely to stay sharp as those who smoked. Neurology, June 9, 2009.

Taking certain types of medication to deal with heartburn and excess stomach acid increases the risk of cognitive impairment in the elderly. The drugs in question -- called histamine-2 receptor antagonists or H2As -- include popular medicines such as Zantac and Pepcid.

Head trauma
NFL players who started playing tackle football before the age of 12 are more likely to suffer from cognitive problems later in life, a 2015 study by researchers from the Boston University School of Medicine.

Sleep and insomnia
Men and women who suffer from sleep disturbances throughout life are more likely to develop cognitive impairment than people who usually get plenty of uninterrupted sleep.

Cognitive decline due to prescription medications
Anticholinergic drugs, antihistamines
People who take anticholinergic drugs -- which affect the nervous system and are in antihistamines and some bladder control medications -- are more likely to develop dementia. Allegra, Benadryl, promethazine, Tussionex (active ingredients are chlorpheniramine and hydrocodone).

Anxiety medications
Older adults taking psychiatric medications such as the benzodiazepines Valium or Xanax are at increased risk. These medications are used to treat symptoms of anxiety and sleep disorders. Examples: Alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), flurazepam (Dalmane), lorazepam (Ativan), midazolam (Versed), quazepam (Doral), temazepam (Restoril) and triazolam (Halcion).


Blood pressure lowering medications
Even some ACE inhibitor drugs such as lisinopril, benazapril have mild anticholinergic activity and can cause delirium, confusion, and hallucinations, especially when combined with other drugs that have anticholinergic activity.

Fam Med. 2014. Beta-blockers and depression in elderly hypertension patients in primary care. Our findings show that primary care hypertension patients who use a lipophilic beta-blocker are more likely to have higher depression scores than those who do not use a lipophilic beta-blocker.

Cholesterol lowering drugs
Atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

Depression treating meds
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of falls in nursing home residents. Older antidepressants, such as tricyclics, Elavil as an example, are more likey to cause cognitive decline.

Stomach acid drugs
Stomach acid drugs such as ranitidine (Zantac) have anticholinergic activity and can cause delirium, confusion, and hallucinations. The list includes: Omeprazole (Prilosec), lansoprazole, rabeprazole, and esomeprazole, Lansoprazole (Prevacid) Rabeprazole (Aciphex) Pantoprazole (Protonix) Esomeprazole Nexium purple pill are Proton pump inhibitors (PPIs) used widely in the management of acid-related disorders. Chronic use may cause delirium, dementia, confusion and other cognitive problems and deficits.

Acetylcholine blocking drugs and cognitive decline
Elderly people who take commonly prescribed drugs for incontinence, allergy or high blood pressure are less able to take care of themselves, function worse than others in the same age group who don't take these drugs, and walk slower. Drugs that block acetylcholine, which is important for memory, hasten cognitive decline in elderly people.

Does tongkat ali improve cognitive decline?
   I doubt it. There are many other herbal and nutritional option for improving cognition.

I have read your book Mind Boosters and would like to know if you could advise a formula that would be beneficial for a child with Fragile X. I would like to boost is cognitive function and memory skills. He is not on any other medications however all the information I have looked at is generally in reference to increasing mental clarity in adults and not children. Some educated guidance from you would be very much appreciated.
   I have not treated any children with Fragile X syndrome. If supplements were to be used, it is a good idea, with the doctor's approval, to begin with low dosages of a common brain enhancer for a couple of weeks and to try different ones over time to see if any are effective.