Preventing memory loss - recognising early symptoms is the key
Editorial by Patrick Holford, CEO, Food for the Brain and Dr Emer MacSweeney, CEO, Re:Cognition Health and consultant neuroradiologist
In the past few weeks, there will have been many thousands more people who will have seen what dementia can do to even the strongest of personalities and for a few of its audience the new film, The Iron Lady, may also have highlighted some very personal concerns.
Dementia is now more feared than cancer . If the film makes those worried about their own, even mild, memory impairment act quickly and do something about it, then The Iron Lady will save a great deal of unnecessary anxiety.
There are two key reasons why anyone with early signs of cognitive impairment must get a thorough diagnosis, as soon as possible. Firstly, symptoms linked with dementia may equally be a sign of something quite different and treatable. Secondly, with early treatment, the progress of some forms of dementia can be, at least, delayed and potentially arrested.
We may be aware of a memory problem ourselves or it may be recognised only by someone else. Furthermore, because there are several different causes of memory loss and other symptoms of mild cognitive impairment which may progress to more severe symptoms of dementia, it is easy for these conditions to be misdiagnosed by hard-pressed GPs.
We are pleased to announce that the Brain Bio Centre is collaborating with Re:Cognition Health, a specialist medical clinic in London, to bring together clinical experts on the comprehensive assessment, diagnosis and management of cognitive impairment with the experts on nutritional approaches to for mental health. Re:Cognition Health for the first time has brought together a team of 20 clinical experts including nationally recognised leaders on cognitive impairment, from mild memory loss to its more severe forms. Together, we now have all the right resources to take the patient through a carefully designed consultant-led assessment programme within a week - or even as little as a single day.
The Re:Cognition process starts with a clinical assessment that includes memory tests and a physical examination. Further investigation includes neuropsychological assessments such as testing of the patient’s thinking, problem solving, memory, attention, concentration and language abilities.
Specialist neuroimaging of the brain has become increasingly important in the diagnosis of memory and other cognitive problems. The most advanced imaging with 3T MRI, which is performed at Re:Cognition, includes the very latest methods for automated measurements of brain volume. Further imaging to analyse patterns of brain activity is also performed. Lumbar puncture, when appropriate, provides samples of the patient’s spinal fluid to test for unusual levels of specific proteins that are indicators of Alzheimer’s disease, together with blood tests including homocysteine.
The ability to diagnose early the cause of memory loss and other symptoms of cognitive decline is essential in order to initiate appropriate management, as soon as possible. This may be to treat reversible causes of dementia, or to delay progression of symptoms and to ensure all measures to protect the brain are instigated. The discovery in the past year, through neuroimaging, that the disease process in Alzheimer’s Disease starts 10-15 years before significant symptoms may become apparent  is hugely important in ensuring we undertake all possible measures to protect our brain health in exactly the same way as we are conscious to maintain good physical health through exercise, an optimal diet, appropriate supplementation and other preventative measures, many years before we may experience any symptoms of ill health. The risk factors for general physical health as we age are increasingly recognised to also affect our brain health .
Food and the Shrinking Brain
Nutrients, cognitive function and MRI measures of brain ageing.
In this ground-breaking study, 104 healthy elderly people (with an average age of 87) had blood levels of 30 different nutrients measured. These were compared with results of a battery of cognitive tests assessing functions such as memory, attention and decision-making, and MRI scan results. MRIs were used to assess brain volume, which declines with normal ageing, and a greater decline is seen with dementia. The aim of the study was to investigate whether there is a relationship between nutrient levels, cognitive function and brain volume.
For the analysis, the nutrients were grouped into ‘nutrient biomarker patterns’ or NBPs. Two of the NBPs were associated with better cognitive function and better MRI results – one of which was the NBP that was high in the B vitamins (B1, B2, B6, folate and B12) and vitamins C, D and E; the second of which was high in omega-3 fats. A third NBP was associated with worse cognitive function and worse MRI results (less brain volume) – this NBP was characterised by high levels of trans fats. Trans fats are the damaged fats found in fried and processed foods and in many baked goods with a long shelf life.
This study suggests that having better levels of vitamins (think fruits, vegetables, and whole grains) and omega-3 fats (primarily from fish oil, and to a lesser extent nuts and seeds) and lower levels of trans fats (by avoiding fried and processed foods), you could expect to have better cognitive function and brain volume in old age, both of which are associated with a much reduced risk of dementia.
Bowman GL, Silbert LC, Howieson D, Dodge HH, Traber MG, Frei B, Kaye JA, Shannon J, Quinn JF (2011) Nutrient biomarker patterns, cognitive function, and MRI measures of brain aging. Neurology Dec 28. [Epub ahead of print]
Click here for abstract.
Egg it Up
Dietary choline, cognitive performance and brain volume.
Dietary intake of choline was assessed for 1,391 healthy elderly people and compared with cognitive function and MRI results to assess brain volume and white-matter hyperintensity (WMH). Choline is the precursor to the key memory neurotransmitter acetylcholine. Loss of brain volume (brain atrophy) and increased white-matter hyperintensity (WMH) are associated with a decline in cognitive function and Alzheimer’s disease. The researchers found that current choline intake was associated with better cognitive function, and remote (or previous) choline intake was associated with less WHM.
Comment: The best sources of dietary choline are eggs (not fried) and organ meat (especially liver), soya lecithin, wheat germ and kidney beans. Other meats, dairy products and bread are also significant dietary sources for most people.
Poly C, Massaro JM, Seshadri S, Wolf PA, Cho E, Krall E, Jacques PF, Au R. (2011) The relation of dietary choline to cognitive performance and white-matter hyperintensity in the Framingham Offspring Cohort. Am J Clin Nutr. 94(6):1584-91.
Click here for abstract.
Fish consumption associated with better brain volume and memory.
In this study, 260 healthy people were assessed for their level of fish consumption, their cognitive function and also underwent an MRI to assess their brain volume twice with a 10-year interval. It was found that those who ate baked or grilled fish on a weekly basis have better cognitive function and better levels of gray matter in their brain.
This study adds to the body of evidence that suggests that regular consumption of fish (at least once per week) may keep your brain healthier for longer. Fried fish didn’t show the same benefits.
Raji C, Ericson K, Lopez O, Kuller L,. Michael GH, Thompson P, Riverol M, Becker J (2011) Regular Fish Consumption Is Associated with Larger Gray Matter Volumes and Reduced Risk for Cognitive Decline in the Cardiovascular Health Study Presented to meeting of Radiological Society of North America, 2 December 2011
Click here for abstract.
In decline from 45?
Cognitive decline begins earlier than previously thought.
It had previously been thought that age-related cognitive decline began for most people in their 60s. However, this study, which tested the cognitive functions of 7,390 UK civil servants aged 45 to 70 over a 10 year period, found that people started to see a reduction in their memory, vocabulary and comprehension skills from their 40s.
Comment: While this might seem like a ‘bad news’ story, it’s important to remember that you can start taking action to preserve your cognitive function at any age, and this study should serve as a gentle nudge to start sooner rather than later.
Singh-Manoux A, Kivimaki M, Glymour MM, Elbaz A, Berr C, Ebmeier KP, Ferrie JE, Dugravot A. (2012) Timing of onset of cognitive decline: results from Whitehall II prospective cohort study.BMJ Jan 5;344:d7622. doi: 10.1136/bmj.d7622.
Click here for abstract.
 BUPA (2009) Dementia worry bigger than cancer. Available at: www.bupa.co.uk/individuals/care-homes/care-homes-news-2009/september-2009/ch-170909-dementia-worry.
 Kantarci et al., (2011) Magnetic resonance spectroscopy, β-amyloid load, and cognition in a population-based sample of cognitively normal older adults. Neurology, 77(10):951-8. Epub 2011 Aug 24. Available at: www.ncbi.nih.gov/pubmed/21865577.
 Society for Neuroscience (2011) Healthy Aging. Available at: www.sfn.org/index.aspx?pagename=brainbriefings_11_healthyaging.