Mental Decline

Nowadays, as people live longer, we notice a rising incidence of diseases that come together with longevity such as cardiovascular disease, cancer, and an array of brain conditions that produce cognitive decline and dementia.

Advances in the understanding of the human genome led to the discovery of the APOE4 gene which increases the risk in those who carry it of late-onset Alzheimer disease.

A large prospective study, published online February 28 in Neurology showed that signs of damage in the microvasculature of the eye are linked to subsequent cognitive decline. The study used fundus photography, which takes images of the interior surface of the eye, including the retina. The study found that retinal disease was associated with faster cognitive decline over a 20 year period versus no retinal disease. One of the reasons might be that changes in the very small blood vessels in the eye probably mirror the very small blood vessel changes that are going on in the brain. The advantage is that the fundal examination is routine, noninvasive and easy to administer, and is already used to screen for eye diseases, and the adverse effects of other conditions, including diabetes and hypertension. It is a bit early, though, to say that we can predict cognitive decline with this test.

More research is necessary, and newer techniques, such as optical coherence tomography may prove more sensitive for predicting cognitive decline based on microvascular changes in the future. An important point to stress is that the finding of increased risk of cognitive decline does not mean a sentence of doom.

The FINGER study (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability), published in 2015 showed that after 2 years of multimodal lifestyle intervention, including nutrition changes, exercise on a regular basis, regular care by a treating clinician every 3-6 months, and cognitive engagement, patients who adhered to the intervention actually had better cognitive outcomes.

In a new study from the Karolinska Institutet in Sweden, published in JAMA Neurology last month showed that both people who had a copy of the APOE4 gene, and people who did not have that gene responded as well in a cognitive way to multimodal lifestyle interventions. That means it may be possible to win the tug of war against your genes. This is a very important finding for, as yet there is no blockbuster drug to treat Alzheimer’s and other forms of cognitive decline. So any patient who wants to reduce their risk and protect cognitive health over time may benefit from lifestyle interventions. 

Eating a brain-healthy (Mediterranean style) diet, regular physical exercise, mixing cardiovascular as well as some weight training, staying cognitively engaged in life, an a regular follow-up with a clinician are absolutely important.

Minding one’s risk factors, as well as keeping one’s blood pressure, cholesterol, and blood sugars in check is a great way to slow down the pathologic processes of Alzheimer’s disease. Seven to eight hours a night of sleep, keeping the brain engaged, socializing, learning something new, be it a language or a musical instrument, all of these are non-pharmacologic approaches to protect cognitive health over time.


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