Why Drugs Are Mostly Ineffective At Restoring Thinking And Cognition
Has someone in your family had more and more senior moments, including difficulty remembering names or managing complex tasks at work? Maybe you have a parent or grandparent with dementia. Do you have one or two copies of one of the genes that increase the risk for dementia or Parkinson’s?
Drugs are mostly ineffective at restoring thinking and cognition.
The number of studies examining the impact of lifestyle interventions on cognitive function is growing.
This paper (PMID: 36806378) was a systematic review of randomized controlled trials that utilized interventions of diet, exercise, stress management, or emotional well-being. The authors found 65 papers. Exercise was the most effective intervention, and was more effective in mild cognitive impairment than it was for dementia. Neither stress management nor emotional well-being programs demonstrated a significant benefit for mild cognitive impairment, and there was not enough evidence in the setting of dementia to draw conclusions. Due to the lack of randomized dietary intervention trials for cognitive impairment of dementia, the effect of diet was unable to be assessed.
Doing a systematic review of the literature to find eligible studies to include in a meta-analysis generates the strongest evidence for whether an intervention is helpful (or harmful) for addressing a specific condition. I was very pleased to see the authors noted that observational studies have linked diet and lifestyle factors to the risk of cognitive impairment.
The integrative and functional medicine approach for addressing cognitive impairment and dementia has a few key principles. First, work to prevent cognitive impairment and dementia through exercise and movement. I talk to my patients about the benefits of including strength training and balance training in their exercise routine. Other lifestyle physical activities such as shopping, gardening, doing laundry, and cleaning are beneficial. Walking, biking, yoga, tai chi, and dancing are also helpful. The goal is at least 30 minutes a day of moderate activity (such as brisk walking). What physical activities do you enjoy?
In addition to exercise, I want my patients to track their metabolic health. That is because insulin resistance, metabolic syndrome, pre-diabetes, and diabetes markedly increase the risk for developing mild cognitive impairment and dementia. While it is easy to identify patients that are overweight or obese, poor metabolic health (insulin resistance, metabolic syndrome, pre-diabetes, and diabetes) has no physical symptoms. Unless someone is tested for blood sugar, hemoglobin a1c, or insulin levels, they would never know if they are developing problems with their metabolic health.
Poor metabolic health worsens many health outcomes, increasing the risk of cognitive impairment and dementia. Those with multiple sclerosis have much higher rates of obesity and poor metabolic health, conditions that lead to more aggressive disease, earlier job loss, earlier walking and cognitive impairment, earlier frailty, and earlier nursing home care.
All of us should ask our medical team to monitor our metabolic health and take action to keep our metabolic health in excellent shape. It is one of the best things we can do to live longer and preserve our cognitive function.
I check blood sugar, hemoglobin a1c, and insulin on my patients so I can assess their metabolic health. While being overweight or obese increases the risk of developing metabolic syndrome, thin people can develop insulin resistance. Having a hemoglobin a1c of <5.2% is ideal, as those people have the lowest risk of early cognitive decline. If the hemoglobin a1c is 5.6% or higher (or the insulin is 8 or more), I suggest the patient adopt a lower carbohydrate diet and follow the hemoglobin a1c. We may also discuss the merits of a continuous glucose meter and the benefits of monitoring how food choices and exercise impact blood sugar. I wear a continuous glucose monitor and use Levels to get feedback on the impact of diet and exercise on my blood sugar. It has been very helpful for me and my patients.
Sometimes I have patients add a supplement that supports blood sugar metabolism to improve their metabolic health. Nearly always the combination of exercise, dietary changes to reduce carbohydrates and increase healthy fats, and targeted supplements gets my patients back to excellent metabolic health. And these choices help protect the brain and dramatically reduce the risk of developing cognitive impairment or dementia. They also reduced the risk of early job loss, early walking impairment, and early need for assisted living and nursing home care.
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