While aging looks different for everyone, cognitive decline can be a common experience later in life. The American Psychological Association defines cognitive decline as the “reduction in one or more cognitive abilities, such as memory, awareness, judgment, and mental acuity, across the adult lifespan.”1APA Dictionary of Psychology. Accessed June 8, 2023. https://dictionary.apa.org/
Approximately two out of three Americans experience some level of cognitive impairment when they reach an average age of approximately 70 years.2Hale JM, Schneider DC, Mehta NK, Myrskylä M. Cognitive impairment in the U.S.: Lifetime risk, age at onset, and years impaired. SSM Popul Health. 2020;11:100577. doi:10.1016/j.ssmph.2020.100577
Yet, contrary to popular belief, cognitive decline isn’t inevitable. As naturopathic doctors (NDs) understand, various evidence-based therapeutic strategies can prevent, reduce, and effectively address cognitive decline. To learn more about the naturopathic approach to cognitive decline, we spoke to Heather Sandison, ND, Founder and Medical Director of Solcere Clinic and the Founder of Marama in California, and Moira Fitzpatrick, ND, Founder and Director of the Healing Roots Center for Transformation in California.
Establishing the Foundation for Optimal Brain Health
When Dr. Fitzpatrick first sees a patient experiencing cognitive decline, the first thing on her mind is inflammation. She first investigates potential sources of inflammation by assessing whether they are getting enough oxygen to the brain and drinking enough water. Exploring sleep patterns is a close second. “Are they getting enough sleep? How often do they get up to go to the bathroom? Do they fall back to sleep?” Fitzpatrick asks. “Sleep is one of the biggest issues as people age. You may be able to get away with less sleep as a younger person. But as you get older, it can become problematic.”
Fitzpatrick also explores their current diet (what foods are they eating? Are they getting the nutrients they need?), which leads to exploring digestive health by doing food sensitivity testing and stool testing.
She also considers their current exercise levels: how are they moving? How is their posture and balance? What is their level of flexibility?
Can environmental factors have an impact?
Fitzpatrick assesses the many environmental factors that can indeed affect brain health, including access to pure water and foods grown in soils uncontaminated by harmful chemicals. “Phthalates and parabens are a big issue. We know that mercury and aluminum are neurotoxic,” Fitzpatrick explains. “I also look at mold exposure and discuss their living environment.” Overall, she thinks about which bodily pathways impact the brain, such as the gut-brain axis, the oral-nasal pathway, and the potential effects of traumatic brain injuries.
Beliefs and a sense of purpose
But it’s not all about assessing the physical body. Fitzpatrick has found that their personal beliefs about aging, health, and illness factor in. People may believe that losing their memory is inevitable as they age, that they don’t need to exercise much, and that it doesn’t really matter what they eat. “I want to know what their consciousness is around health, to help me begin to reframe some of those beliefs,” Fitzpatrick explains. “Then, they may be more open to the fact that their memory could improve.”
A related issue that is particularly important at this stage of life is their sense of purpose. “What is meaningful to this individual? What’s the reason they get up in the morning?” she asks. “Maybe they’re on a path to self-development, doing volunteer work, or traveling the world. It doesn’t matter what it is, once it’s something that keeps them alive on this planet.”
How Specialized Residential Care Facilities Can Help Treat Cognitive Decline
In addition to her clinical practice, Dr. Sandison has founded Marama, a residential care facility for older adults that provides an immersive lifestyle experience to support cognitive health.3https://fb.me/MaramaExperience. About Us. Marama Experience. Accessed June 8, 2023. https://www.maramaexperience.com/about-us/
Spending quality time with patients
Like Fitzpatrick, Sandison also begins her therapeutic relationship with patients experiencing cognitive decline by fully exploring their foundations for optimal health. She spends about 90 minutes delving into their health history. Most of her patients are in their 60s, 70s, and 80s and have thus had a lifetime to accumulate injuries and medical diagnoses.
In addition to the questions that Fitzpatrick asks about diet, exercise, sleep, stress, and life purpose, she also inquires if they feel at home where they are and asks about their pain levels.
Focusing on the four pillars of foundational health
At Marama, they focus on four pillars of foundational health. First, Sandison uses an organic, ketogenic diet, as both the research and her clinical experiences show that this dietary approach best supports brain health and cognition. A 2023 review explored three diets shown to slow cognitive decline: the Mediterranean diet, the ketogenic diet, and the MIND diet. While all three diets did demonstrate the ability to slow cognitive decline, the ketogenic diet, in particular, had a beneficial effect on patients with diabetes mellitus and improved verbal recognition.4Devranis P, Vassilopoulou Ε, Tsironis V, et al. Mediterranean Diet, Ketogenic Diet or MIND Diet for Aging Populations with Cognitive Decline: A Systematic Review. Life (Basel). 2023;13(1):173. doi:10.3390/life13010173
The second pillar is creating a non-toxic environment. “This means creating an environment that supports brain health by reducing toxicity but also sets people up for success. For example, we keep the TV in a cabinet and have brain games and puzzles out in the open so that they are easier to access,” Sandison explains. “Then, also setting it up for social engagement. The environment is designed to optimize brain health from a very foundational level.” Brain games can also help prevent cognitive decline in healthy aging – even in the virtual environment. Research shows that computerized cognitive games in healthy adults over 60 can significantly improve processing time, working memory, executive function, and verbal memory.5Bonnechère B, Langley C, Sahakian BJ. The use of commercial computerized cognitive games in older adults: a meta-analysis. Sci Rep. 2020;10(1):15276. doi:10.1038/s41598-020-72281-3
The third pillar has to do with activities. “Everything that residents do from the beginning to the end of the day is designed to support their cognition. This means brain games, creative activities, and physical activity, which is especially important for brain health,” says Sandison. “We also provide stress management through meditation and prayer practices, as appropriate for that individual. Research shows that meditation can improve memory, slow cognitive decline, and reduce mild cognitive impairment among older adults.6Tsai FJ, Shen SW. Concepts of dementia prevention in the health promotion among older adults: A narrative review. Medicine (Baltimore). 2022;101(50):e32172. doi:10.1097/MD.0000000000032172
The fourth pillar deals with community and care. “This could be the relationships around you. It’s how we communicate and how we’re understood. And then, what is expected of us?” Sandison asks. “Are we expected to get better or worse? Often, we will go in the direction of the expectations of the people around us.”
Lab Testing and Stimulating Self-Healing Mechanisms
After a thorough assessment, naturopathic doctors explore how to support the body’s natural healing abilities.
Hyperbaric oxygen therapy
Fitzpatrick points to oxygen as “an essential nutrient” and uses hyperbaric oxygen therapy to increase oxygenate tissues. “There are studies showing the effect of hyperbaric oxygen on attention, memory, and concentration. Their processing speed increases and there is increased blood flow to the brain,” she explains. “In addition to the importance of exercise in getting blood flow to the brain, hyperbaric oxygen therapy really helps.” Fitzpatrick recalls a 75-year-old patient who came in saying that his wife and friends were concerned about his worsening memory. What happened after 28 hyperbaric oxygen sessions? “The feedback from his family and friends was, “You’re back!”. He was processing again, and his memory was better. That wasn’t the only thing I did, but it was really significant in terms of oxygenating the brain,” she recalls. Although the brain comprises only 2% of the body’s weight, it uses 20% of the total oxygen.7Fu Q, Duan R, Sun Y, Li Q. Hyperbaric oxygen therapy for healthy aging: From mechanisms to therapeutics. Redox Biol. 2022;53:102352. doi:10.1016/j.redox.2022.102352
Research confirms that regular hyperbaric oxygen therapy sessions can significantly increase blood flow to the brain, improving attention, information processing speed, and executive functions.8Fu Q, Duan R, Sun Y, Li Q. Hyperbaric oxygen therapy for healthy aging: From mechanisms to therapeutics. Redox Biol. 2022;53:102352. doi:10.1016/j.redox.2022.102352
Ensuring a healthy gut microbiome
Fitzpatrick deepens her health explorations at this stage by performing targeted lab tests, starting with the gut. “With practically every patient, I do food sensitivity testing and a stool test to evaluate the function of the gut barrier because of the strong association through the gut-brain axis. If the gut is off, then the brain is probably off,” she notes. Research confirms that a healthy community of gut microbiota keeps the brain healthy and can protect against different types of neurological disorders.9Alsegiani AS, Shah ZA. The influence of gut microbiota alteration on age-related neuroinflammation and cognitive decline. Neural Regen Res. 2022;17(11):2407-2412. doi:10.4103/1673-5374.335837
Gut bacteria make some neurotransmitters and other substances that influence brain function, including dopamine.10Alsegiani AS, Shah ZA. The influence of gut microbiota alteration on age-related neuroinflammation and cognitive decline. Neural Regen Res. 2022;17(11):2407-2412. doi:10.4103/1673-5374.335837
Testing for environmental toxins
She also looks into if the person is producing enough brain growth factors. Chemicals are a big focus in testing, where she looks specifically for environmental toxins such as aluminum, mercury, and phthalates. “Aluminum is processed in the kidneys. If a person has chronic kidney disease, then we need to support the kidney as well as help them avoid sources of aluminum.” Research confirms that mercury exposure contributes to cognitive decline,11Geier DA, Kern JK, Homme KG, Geier MR. A Cross-Sectional Study of Blood Ethylmercury Levels and Cognitive Decline Among Older Adults and the Elderly in the United States. J Alzheimers Dis. 2019;72(3):901-910. doi:10.3233/JAD-190894 while a study of people living in an aluminum mining zone demonstrated a significant association between aluminum exposure and lower cognitive function.12Zhang T, He F, Lin S, et al. Does aluminum exposure affect cognitive function? A comparative cross-sectional study. PLoS One. 2021;16(2):e0246560. doi:10.1371/journal.pone.0246560
The Alzheimer’s LINX test and the blood-brain barrier
Her favorite test for patients complaining of memory imbalance is the Alzheimer’s LINX test, which provides a wealth of information, including potential causes of inflammation (often an underlying root cause of cognitive decline). This test also tells her if there is a breach in the blood-brain barrier, which likely indicates a breach in the gut barrier. The test measures immune reactivity to Amyloid-beta through IgG antibodies. “There’s a lot that we can look at that directs the course of the treatment. But we always have to deal with the gut.” Research demonstrates that both people who have mild cognitive decline and people with Alzheimer’s Disease have high levels of IgG antibodies against phosphorylated tau.13Ossenkoppele R, Pichet Binette A, Groot C, et al. Amyloid and tau PET-positive cognitively unimpaired individuals are at high risk for future cognitive decline. Nat Med. 2022;28(11):2381-2387. doi:10.1038/s41591-022-02049-x
Other comprehensive testing options
Sandison also does a very comprehensive set of lab testing. “It’s what your typical provider would do, but on steroids,” she explains. Instead of looking at one or two thyroid metrics, she looks at eight to ten. Instead of basic cholesterol testing, she does advanced cardiometabolic testing. “We also do a stool panel for everyone. We run three different toxin labs for chemical toxins, mycotoxins, and heavy metals,” she notes. “We also do nutrient and infectious disease testing and run sleep studies on anyone with cognitive decline.” Sandison also points to the fact that some infections (including herpes, gingivitis, COVID, and Lyme disease) substantially impact brain inflammation.
Over time, she has learned that the best approach to testing is proactive. She recalls past patients whom she didn’t initially test for mold, as they said they were not exposed. Then months later, when they were not progressing as expected, she would ask what they may have missed. Often, that missing piece was a mold test. “It’s better to do what my mentor Dr. Dale Bredesen calls a ‘Cognoscopy’: looking at everything we know of that might be impacting cognitive health and assessing if there is impact, even if we don’t think it’s likely,” she explains. “It’s much easier to rule it out than to wait and not make any progress because we didn’t look for that thing that could have a causal impact on cognitive decline.”
Amplifying the body’s natural detox processes
Essentially, Sandison is looking for imbalances in any areas that may cause negative impacts on the health of neurons in the brain. Like Fitzpatrick, she explores heavy metals, mycotoxins, and chemical toxins. “Our goal is to get them out through detox support. We stimulate the body’s self-healing mechanism by amplifying our natural detox processes,” she explains. “That involves the organs of elimination, including the skin, bowel, liver, kidneys, and lungs.” Looking for nutrient imbalances and healing the gut is also a strong focus to ensure that we can “digest, absorb, assimilate, and eliminate what doesn’t serve us,” as Sandison describes.
Stress and cognitive decline
We’re all familiar with the consequences of too much stress. But Sandison finds that the opposite can also present problems. When people retire, she often sees patients with the attitude that they’ve “done the work” and plan to enjoy retirement by not pushing themselves too hard. “There is such a thing as too little stress and not having a purpose,” she explains. “The more physically active and engaged you are in a community and doing purposeful work, the better your cognition, mood, sleep, and quality of life in general.”
Natural and Synthetic Treatment Options
Part of Fitzpatrick’s testing includes a complete evaluation of metabolic genomics. She explores their genetic predispositions by looking at specific genetic mutations (including MTHFR, COMT, CBS, NOS, and VDR). This testing also provides insight into their liver function, which helps her decide on the best course of action. “If they’re on a lot of medications, I may support their liver. But I’ll support their liver even more if they have certain mutations like CBS or PEMT. I utilize B vitamins as indicated by testing.”
Anti-Inflammatories, High-DHA fish oil, and vitamins
She regularly uses a product with anti-inflammatories for the brain, high-DHA fish oil, and ensures they have optimal vitamin D. Research demonstrates promising beneficial effects on improving brain health by using Omega 3 fatty acids,14Naureen Z, Dhuli K, Medori MC, et al. Dietary supplements in neurological diseases and brain aging. J Prev Med Hyg. 2022;63(2 Suppl 3):E174-E188. doi:10.15167/2421-4248/jpmh2022.63.2S3.2759 and vitamin B12.15Vinueza Veloz AF, Carpio Arias TV, Vargas Mejía JS, et al. Cognitive function and vitamin B12 and D among community-dwelling elders: A cross-sectional study. Clin Nutr ESPEN. 2022;50:270-276. doi:10.1016/j.clnesp.2022.05.004
The importance of a healthy diet
Fitzpatrick ensures patients are limiting sugar and processed foods and typically uses supplements or prescribes Metformin (according to patient preference) to control blood sugar. Some of her patients are on a multivitamin protein powder with a full scope of amino acids. “I’m a firm believer that you can’t just keep adding supplements. As the gut heals, we back off the GI supplements and focus more on other things that they need.”
Addressing physical alignment
Regarding physical alignment, Sandison doesn’t just think of structure as ‘the hip bone is connected to the leg bone.’ “I also think about the genetic structure, that molecular structure. We need to think about blood flow in and out of the brain so that we can get nutrients in and toxins out – oxygen in particular.”
Fitzpatrick often sees patients in their late 60s through 80s who want to stay young and vibrant. To support this goal, she works closely with a personal trainer to help her patients with balance, posture, strength, and aerobic exercise, which supports their physical structure. “The personal trainer is well versed in neurology, so he’s tuned in to the best ways to slowly strengthen the body,” she explains. “I’m over 65, and I see this personal trainer too. I’m probably stronger than I’ve ever been in my life!”
The benefits and risks of sleep medications
If nutrients to support healthy sleep aren’t working, she may consider medications like Trazodone or Mirtazapine to improve sleep and reduce anxiety. An advocate for trying natural options first, she recalls a situation where she had to advocate for a patient to stop taking a particular medication. Her patient went to a Primary Care Physician (PCP) complaining of worsening short-term memory. “The first thing that his PCP did was put him on the medication Aricept. He had such a horrific reaction!” she exclaims. “He had nightmares, and we had a lot of work to do. I evaluated him, worked on his gut, got him off Aricept, and now he’s progressing.”
Nutrients and supplements to support cognitive health
Sandison utilizes a long list of nutrients and supplements based on what is best for each patient. For detox, she commonly uses binders and glutathione to get toxins out of the body. She also typically prescribes nootropics (nutrients that improve memory and cognition), fish oils, and vitamin D. Sandison uses hormone replacement therapy as appropriate, which can have a significant signaling impact on the brain.
“Typically, we find that people can get off of or reduce medications for diabetes, high blood pressure, mood stabilizers, and antidepressants. That’s a really satisfying part of the work.”
Surgery and other high-force interventions
“In terms of surgeries, people may have knee or hip replacements. I recommend PRP (platelet-rich plasma) or stem cell therapy,” says Fitzpatrick. “Sometimes knee and hip are important for quality of life.”
Looking at the Big Picture with Cognitive Decline
For Sandison, it’s important to consider the larger societal impacts and costs of cognitive decline. “Over time, it can look like a complete loss of independence and dignity. It could involve a costly move into assisted living. Not only is it costly for the individual, but also their family members,” Sandison notes. “There are millions of people who provide unpaid care for those who are suffering from dementia. We see regularly that if we reverse it, we get improvements in cognition. But even if we simply delay that decline, we can save hundreds of thousands by doing this work ahead of time.”
New research supporting lifestyle interventions for improved cognitive health
Sandison was recently published in the Journal of Alzheimer’s Disease with a study that follows a clinical trial held in her office with 23 patients. The study shows multiple measures of cognitive function improving after six months of interventions that included lifestyle changes such as diet, movement, stress management, nutraceuticals, and medications.16Sandison H, Callan NGL, Rao RV, Phipps J, Bradley R. Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline. Jour of Alz Dis. 2023;Preprint(Preprint):1-12. doi:10.3233/JAD-230004 The study concludes that there are enough positive results to warrant further research. “We’re really looking forward to getting the information out there regarding how using precision medicine with a naturopathic approach has measurable, positive outcomes on sleep and quality of life in cognitive decline,” Sandison says.
Fitzpatrick wants people to know that naturopathic medicine has much to offer people as they age and experience cognitive decline. “It doesn’t have to keep going downhill. There’s a lot we can do.”
- 1APA Dictionary of Psychology. Accessed June 8, 2023. https://dictionary.apa.org/
- 2Hale JM, Schneider DC, Mehta NK, Myrskylä M. Cognitive impairment in the U.S.: Lifetime risk, age at onset, and years impaired. SSM Popul Health. 2020;11:100577. doi:10.1016/j.ssmph.2020.100577
- 3https://fb.me/MaramaExperience. About Us. Marama Experience. Accessed June 8, 2023. https://www.maramaexperience.com/about-us/
- 4Devranis P, Vassilopoulou Ε, Tsironis V, et al. Mediterranean Diet, Ketogenic Diet or MIND Diet for Aging Populations with Cognitive Decline: A Systematic Review. Life (Basel). 2023;13(1):173. doi:10.3390/life13010173
- 5Bonnechère B, Langley C, Sahakian BJ. The use of commercial computerized cognitive games in older adults: a meta-analysis. Sci Rep. 2020;10(1):15276. doi:10.1038/s41598-020-72281-3
- 6Tsai FJ, Shen SW. Concepts of dementia prevention in the health promotion among older adults: A narrative review. Medicine (Baltimore). 2022;101(50):e32172. doi:10.1097/MD.0000000000032172
- 7Fu Q, Duan R, Sun Y, Li Q. Hyperbaric oxygen therapy for healthy aging: From mechanisms to therapeutics. Redox Biol. 2022;53:102352. doi:10.1016/j.redox.2022.102352
- 8Fu Q, Duan R, Sun Y, Li Q. Hyperbaric oxygen therapy for healthy aging: From mechanisms to therapeutics. Redox Biol. 2022;53:102352. doi:10.1016/j.redox.2022.102352
- 9Alsegiani AS, Shah ZA. The influence of gut microbiota alteration on age-related neuroinflammation and cognitive decline. Neural Regen Res. 2022;17(11):2407-2412. doi:10.4103/1673-5374.335837
- 10Alsegiani AS, Shah ZA. The influence of gut microbiota alteration on age-related neuroinflammation and cognitive decline. Neural Regen Res. 2022;17(11):2407-2412. doi:10.4103/1673-5374.335837
- 11Geier DA, Kern JK, Homme KG, Geier MR. A Cross-Sectional Study of Blood Ethylmercury Levels and Cognitive Decline Among Older Adults and the Elderly in the United States. J Alzheimers Dis. 2019;72(3):901-910. doi:10.3233/JAD-190894
- 12Zhang T, He F, Lin S, et al. Does aluminum exposure affect cognitive function? A comparative cross-sectional study. PLoS One. 2021;16(2):e0246560. doi:10.1371/journal.pone.0246560
- 13Ossenkoppele R, Pichet Binette A, Groot C, et al. Amyloid and tau PET-positive cognitively unimpaired individuals are at high risk for future cognitive decline. Nat Med. 2022;28(11):2381-2387. doi:10.1038/s41591-022-02049-x
- 14Naureen Z, Dhuli K, Medori MC, et al. Dietary supplements in neurological diseases and brain aging. J Prev Med Hyg. 2022;63(2 Suppl 3):E174-E188. doi:10.15167/2421-4248/jpmh2022.63.2S3.2759
- 15Vinueza Veloz AF, Carpio Arias TV, Vargas Mejía JS, et al. Cognitive function and vitamin B12 and D among community-dwelling elders: A cross-sectional study. Clin Nutr ESPEN. 2022;50:270-276. doi:10.1016/j.clnesp.2022.05.004
- 16Sandison H, Callan NGL, Rao RV, Phipps J, Bradley R. Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline. Jour of Alz Dis. 2023;Preprint(Preprint):1-12. doi:10.3233/JAD-230004