As we age, a number of factors predispose us to a decline in memory capacity and the development of more severe forms of cognitive decline such as dementia and Alzheimer's disease. One of these factors is the lifetime accumulation of free-radical damage to brain cells induced by the brain's high use of oxygen.
Of importance is the fact that some studies show that individuals who supplement with antioxidants (like vitamin C and vitamin E) have a lower incidence of Alzheimer's disease as they age. Thus, it may be wise to ensure your patients get 1,000 mg of vitamin C and 400 IU of vitamin E per day from a high-potency multiple vitamin. The high-potency multiple vitamin and mineral also should contain a B-50 complex - as a number of B vitamins are required to synthesize various brain chemicals (neurotransmitters), which are essential to alertness, concentration and cognition in general. For instance, the synthesis of dopamine, serotonin, melatonin, epinephrine and norepinephrine (all important neurotransmitters) require B vitamins as co-factors for their synthesis.
A second way in which we are predisposed to memory loss as we age is the decline in synthesis of the memory chemical (neurotransmitter) acetylcholine, which really kicks in after age 54. As we age, the brain is less able to make this important memory chemical, setting us up for memory loss and many of the manifestations of dementia and Alzheimer's disease. There appears to be a decline in the production of the enzyme that combines acetyl coenzyme A with choline, known as acetyl transferase. As such, the brain makes less acetylcholine and memory fails. In some cases, it is thought that the brain has trouble getting its hands on sufficient amounts of choline in order to make acetylcholine.
In any case, the good news is there are several natural agents that have been shown in clinical studies to help the aging brain boost its production of acetylcholine, thereby helping to combat age-related decline in memory. The most important natural agents include CDP-choline (cytidine 5-diphosphocholine or citidinediphosphocholine or citicholine), phosphatidylserine, Bocopa monnieri and huperzine A
CDP-cholineis a normal component of the nerve cell membrane, which is important for transmission of nerve impulses from one nerve to the next. It also is vital to the formation of the memory chemical acetylcholine. Unfortunately, the aging brain is less able to synthesize the CDP-choline it requires. However, studies have shown supplementation with CDP-choline can reconstitute brain levels of CDP-choline, boosting levels of several important brain neurotransmitters and improving nerve conduction ability. These results translate into enhanced mental acuity and improvement in a number of disorders involving memory loss and cognitive decline.
Note that supplementing with most other forms of choline has not been shown to be effective. Therefore, you cannot substitute lecithin or other forms of phosphatidylcholine in place of CDP-choline, as these forms don't appear to cross the blood-brain barrier as readily, and in clinical trials have not shown benefit.
Phosphatidylserine,like CDP-choline, is a natural component of the nerve cell membrane and it, too, is a victim of age-related decline in synthesis. Studies show supplementation with phosphatidylserine also can elevate brain levels of acetylcholine, and has been shown to improve memory and cognition in clinical trials with afflicted individuals.
Bacopa monnieri, the leaf of Bacopa or water hyssop, has been used in the Indian medical system of ayurveda since the 6th century A.D. to help improve mental performance. Its active ingredients (bacosides A and B) have been shown to enhance nerve transmission and are potent antioxidants that have been shown to protect brain cells from free radicals and other toxic substances. Human studies indicate Bacopa monnieri can preserve memory function and can be used in the treatment of various conditions involving memory loss.
Huperzine Ais a natural substance, initially discovered within a club moss that grows in Asia, that has been used traditionally to aid memory loss. Since being isolated, huperzine A is now synthesized for use in natural health products and has shown a remarkable ability to support brain levels of acetylcholine (the memory chemical). It does so by partially inhibiting the enzyme that breaks down acetylcholine (acetylcholinesterase), which results in higher acetylcholine brain levels. Its positive effects on memory and brain function have been shown in a number of human clinical trials.
Consider Recommending a Brain Support Supplement to Patients 55 and Older
Alzheimer's disease affects 6 percent to 8 percent of the population over 64 years of age and 47 percent of people who live to be 85 or older. Part of maintaining one's quality of life requires putting nutrition and lifestyle practices in place that maintain a highly functional body and "mind." Many wellness-striving individuals focus on preserving their bodies and don't realize their brain also is responsive to wellness interventions. Due to the fact the aging process is associated with decreased synthesis of the memory chemical acetylcholine, as well as important phospholipids (CDP-choline, phosphatidylserine), which are required for optimal nerve impulse transmission, I suggest patients begin ingesting a supplement at age 55 that can help combat memory loss and other related problems. Key ingredients in a memory support supplement include CDP-choline, phosphatidylserine, Bacopa monnieri and huperzine A. All of these have been shown to be safe and effective natural ingredients when taken at appropriate dosages, and unlike Ginkgo biloba and vinpocetine, do not increase risk for bleeding disorders. The only caveat is that these supplements cannot be used in conjunction with drugs commonly used to treat Alzheimer's disease.
One final note: Brain support nutrients of this type are best used in conjunction with an antioxidant/B-vitamin-enriched multiple vitamin and mineral supplement, as well as an essential fatty acid supplement containing borage seed, flaxseed and fish oil. Nutrients from these supplements also have been shown to support brain function and discourage the development of age-related cognitive decline problems, including Alzheimer's disease.
- Agnoli A, et al. New strategies in the management of Parkinson's disease: a biological approach using a phospholipid precursor (CDP-Choline) Neuropsycholbiology, 1982;8(6):289-96.
- Canty DJ, et al. Lecithin and chloine in human health and disease. Nutr Reviews, 1994;52:327-39.
- Citicoline, Alzheimer's disease and cognitive performance. Life Extension, 2000:6(9):69,2(Alt Health Watch database).
- Encyclopedia of Nutritional Supplements. Prima Publishing 1996;Murray M:137-41.
- Foiravanti M, Yanagi M. Cytidinediphosphocholine (CDP-Choline) for cognitive and behavioral disturbances associated with chronic cerebral disorders in the elderly. Cochrane Syst Rev, 2002;(2):000269 In: The Cochrane Library, 1,2002. Oxford: Update Software.
- Present Knowledge in Nutrition (5th ed). The Nutrition Foundation, Inc, 1984;Choline:383-99.
- Secades JJ, et al. CDP-Choline: pharmacological and clinical review. Methods Find Exp Clin Pharmacol, 1995;17(Suppl B):1-54.
- Zeisel SH, et al. Choline, an essential nutrient for humans. FASEB J 1991;5:20093-2098.
- Cenacchi T, Bertoldin T, Farina C, et al. Cognitive decline in the elderly: a double-blind, placebo-controlled multicenter study on efficacy of phosphatidylserine administration. Aging, 1993;5:123-33.
- Crook T, Petrie W, Wells C, Massari DC. Effects of phosphatidylserine in Alzheimer's disease. Psychopharmacol Bulletin, 1992;28:61-6.
- Crook TH, Tinklenberg J, Yesavage J, Petrie W, Nunzi MG, Massari DC. Effect of phosphatidylserine in age-associated memory impairment. Neurology, 1991;41:644-9.
- Engel RR, Satzger W, Gunther W, Kathmann N, Bove D, Gerke S, et al. Double-blind cross-over study of phosphatidylserine vs. placebo in subjects with early cognitive deterioration of the Alzheimer type. Eur Neuropsychopharmacol, 1992;2:149-55.
- Funfgeld EW, Baggen M, Nedwidek P, Richstein B, Mistlberger G. Double-blind study with phosphatidylserine (PS) in parkinsonian patients with senile dementia of Alzheimer's type (SKAT). Prog Clin Biol Res, 1989;317:1235-46.
- Maggioni M, Picotti GB, Bondiolotti GP, Panerai A, Cenacchi T, Nobil P, et al. Effects of phosphatidylserine therapy in geriatric patients with depressive disorders. Acta Psychiatr Scand, 1990;81:265-70.
- Nunzi MG, Milan F, Guidolin D, et al. Effects of phosphatidylserine administration on age-related structural changes in the rat hippocampus and septal complex. Pharmacopsychiat, 1989;22:125-8.
- Valzelli L, Kozak W, Zanotti A, Toffano G. Activity of phosphatidylserine on memory retrieval and on exploration in mice. Meth Find Extl Clin Pharmacol, 1987;9:657-60.
- Vannucchi MG, Casamenti F, Pepeu G. Decrease of acetylcholine release from cortical slices in aged rats: Investigations into its reversal by phosphatidylserine. J Neurochem, 1990;55:819-25.
- Dar A, Channa S. Calcium antagonistic activity of Bacopa monniera on vascular intestinal smooth muscles of rabbit and ginea-pig. J Ethnopharmacol, 1999;66(2):167-74.
- Dietary Supplement Information Bureau. www.content.intramedicine.com: Bacopa Monnieri.
- Kidd PM. A review of nutrients and botanicals in the integrative management of cognitive dysfunction. Altern Med Rev, 1999 Jun;4(3):144-61.
- Mukherjee GD et al. Clinical trial on brahmi. I. J Exp Med Sci, 1966;10(1):5-11.
- Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T, et al. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl), 2001 Aug;156(4):481-4.
- Tripathi YB, et al. Bacopa monniera linn. as an antioxidant: mechanism of action. Indian J Exp Biol, 1996 Jun;34(6):523-6.
- Vohora D, Pal SN, Pillai KK. Protection from phenbytoin-induced cognitive deficit by Bacopa monniera, a reputed Indian nootropic plant. J Ethnopharmacol, 2000 Aug;71(3):383-90.
- Ashani Y, Peggins JO, Doctor BP. Mechanism of inhibition of cholinesterases by huperzine A. Biochem Biophys Res Commun, 1992:184:719-26.
- Bai DL, et al. Huperzine A, a potential therapeutic agent for treatment of Alzheimer's disease. Curr Med Chem, 2000 Mar;7(3):355-74.
- Cheng DH, Ren H, Tang XC. Huperzine A, a novel promising acetylcholinesterase inhibitor. Neuroreport, 1996;8:97-101.
- Cheng DH, Tang XC. Comparative studies of huperzine A, E2020, and tacrine on behavior and cholinesterase activites. Pharmacol Biochem Behav, 1998;60:377-86.
- Dworkin N. "Restoring Memory." Psychology Today, 2000 Jul/Aug;32(4):28.
- McCaleb R. "Huperzia Looks Promising for Improving Memory. HerbalGram, Oct. 31, 1995;35:14.
- Pirisi, Angela. "Plant Wisdom: Memory Moss." Yoga Journal, Aug. 31, 1999;147:95.
- Sun QQ, Xu SS, Pan JL, et al. Huperzine-A capsules enhance memory and learning performance in 34 pairs of matched adolescent students. Acta Pharmacol Sin, 1999;20:601-3.
- Tang XC. Huperzine A (shuangyiping): A promising drug for Alzheimer's disease. Chung Kuo Yao Li Hsueh Pao, 1996 Nov;17(6):481-4.
- Wang Z, Ren G, Zhao Y et al. A Double-Blind Study of Huperzine A and Piracetam in Patients With Age-Associated Memory Impairment and Dementia. In: Kanba S, Richelson E (eds.) Herbal Medicines for Nonpsychiatric Diseases. Tokyo: Seiwa Choten Publishers, 1999:39-50.
- Xu SS, Gao, ZX, Weng Z et al. Efficacy of tablet huperzine-A on memory, cognition, and behavior in Alzheimer's disease. Chung Kuo Yao Li Hsueh Pao, 1995;16:391-5.
Click here for more information about James P. Meschino, DC, MS.