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Protocols: Memory and Cognitive Function Improvement

Many individuals report increasing difficulties with long and short-term memory, concentration, and other cognitive abilities when under stress or as they age. We now know that such cognitive declines are not unavoidable and that the brain can actually continue to grow new neurons into the 8th decade of life. Here are some suggestions for avoiding memory problems and reducing age-associated cognitive decrements.

Using your memory to a moderate degree can help to keep these brain circuits exercised. The key is moderation since too much stress (physical, or mental) can decrease your memory capabilities. Stimulating intellectual challenges such as solving puzzles, playing chess, or learning a new skill can help to give your mind the workout it needs.
Maintaining normal blood pressure is crucial in protecting cognitive frmnctions. Research has demonstrated that high blood pressure levels (above 140 systolic or 90 diastolic) is a contributor to mini-strokes that are a common cause of dementia. Less serious insults to the small blood vessels of the brain due to high blood pressure can also gradually cause memory deterioration. Exercising, reducing salt intake, losing weight and eating potassium-rich foods can all help to relieve elevated blood pressure.
Many medications can affect memory negatively. Some of these are: antihypertensive drugs, antihistamines, anti-anxiety medications, alcohol, over-the-counter sleep aids and many others. See your physician if you believe that a drug you are taking may be affecting your memory or learning capabilities.
Physical exercise is just as important as mental exercise for maintaining cognitive functions. Research studies have consistently shown that individuals who get 30 minutes of aerobic exercise five days per week do better in tests of cognition and memory.
Getting sufficient sleep is also important for memory maintenance. Most person need 8 hours of sleep nightly to function optimally. A good test is to notice if, upon waking in the morning, you feel rested. If it is difficult to wake up without an alarm, or if your alarm leaves you feeling exhausted on rising more sleep is in order. (Our office can provide a handout with specific suggestions for improving sleep.)
The more life stress your are experiencing the more memory impairment you are likely to experience. While some stress is necessary to keep our brains alert and sharp, moderate and increasing levels of stress reduce memory capabilities dramatically. Canadian researchers found that sustained elevation of the stress hormone cortisol can actually damage brain cells in the hippocampus resulting in lowered short-term memory scores.
Practice attention to detail. Workshops and courses in memory enhancement focus largely on techniques for increasing attention. Being able to store memories to later retrieval is dependent on: (1) being motivated to notice the information, (2) deliberately storing the information (via repetition, a nemonic device, or just plain concentration) and then (3) labeling the information mentally so that it can be called up when needed. All of this takes a deliberate effort. It is also helpful to stay organized by writing things down, using planners and date books and making lists.

There are also several phytomedicinal and other supplements which have been found in research studies to improves various aspects of memory, concentration and higher cognitive function.

Ginkgo Biloba: One of the oldest living deciduous tree species on earth. Individual trees can live for more than a thousand years. Used for medicinal purposes extensively in Europe and has a minor role in traditional Chinese medicine. Method of Action: Composed of several tlavmoids, terpenoids (e.g. ginkgolides), and organic acids believed to synergistically act as free radico scavengers. Since excessive peroxidation and cell damage have been observed in Alzheimer disease Ginkgo has been found effective. Systematically Ginkgo improves vascular profusion by modulating vessel wall tone and can decrease thrombosis through antagonism of platelet activating factor. Indications and Usage: Mild to Severe Memory Impairment (esp. Short Term); Poor Concentration; Diminished Intellectual Performance; Confusion; Mild to Moderate Depression (especially in elderly); Sexual Side-Effects of Serotonergic Drugs; Alzheimer's Disease; Multi-Infarct Dementia; Fatigue; Isehemic-ReperfusionProtective Effect; Tinnitus, Vertigo Balance Problems and Inner Ear Disturbances; Macular Degeneration; Headache; Hearing Loss; Poor Circulation; Impotence; also an Antioxidant. Dosage and Administration: Standardized commercial preparations should contain the active constituents flavone glycosides (24%) and terpenoids (6%) Standard dosage is 40 to 60mg three times daily. Contraindications: Ginkgo may alter bleeding time. Caution should be exercised when ginkgo is taken in conjunction with anticoagulant treatment (including aspirin) or where there is a risk of bleeding (e.g., peptic ulcer disease, subdural hematoma) and for individuals with a sensitivity to ginkgo. Safety in pregnancy and lactation has not been established. Concomitant use with aspirin, NSAIDs, and anticoagulants such as warfarin is ill advised. Use 40 mg or less for patients taking aspirin, or anticoagulant medications. Some amount of Ginkgo toxin is found in Ginkgo Bioba preparations. Avoid use in known epileptic patients because Ginkgo Biloba may diminish the effectiveness of administered anticonvulsants (e.g. carbamazepine, phenvtonin, phenoberbital). Do not use concomitantly with medications known to decrease seizure threshold such as tricydic antidepressants. Clinical Effect In: Four to twelve weeks. No controlled studies of efficacy or safety over 3 months. Adverse Reactions: Relatively safe with few documented adverse reactions. Mild transient stomach upset, headache, allergic skin reactions have occurred. All side effects are rare and avoidable by gradually titrating to the required dose. Spontaneous bilateral subdural hematomas have occurred secondary to Ginkgo ingestion attributable to ginkgolide B (a potent inhibitor of platelet-activating factor needed to induce arachidonate-independent platelet aggregation. Concomitant use with aspirin, NSAIJDs, and anticoagulants such as warfarin is ill advised. Some amount of Ginkgo toxin is found in Ginkgo Biloba preparations. Avoid use in known epileptic patients because Ginkgo Bioba may diminish the effectiveness of administered anticonvulsants (e.g. carbamazepine, phenvtonin, phenoberbital). Do not use concomitantly with medications known to decrease seizure threshold such as tricycic antidepressants. Known Interactive Effects: Can be taken to enhance standard, herbal or hormonal antidepressant, or antianxiety treatment.
Phosphatidylserine: A pharmacologically active phospholipid which, in over 18 double-blind studies has been found to enhance activity of membrane-bound enzymes involved in neurotransmitter release and signal transduction in the central nervous system. PS stimulates catecholinergic neurotransmission and acetylcholine release and synthesis in the cerebral cortex in animal studies. Also prevents age-induced loss of dendritic spines in hippocampal pyramidal neurons and atrophy of cholinergic cells in the basal forebrain. Indications and Usage: Treatment with PS increases learning and memory functions and improves the age-associated decay in spatial behavior. In addition PS in vitro reduces cell death induced by xanthine oxidase. Especially helpful in treating age-related declines in memory (learning, storage and retrieval during verbal learning) and other higher cognitive functions. Also, significant improvements in attention, motivation, initiative, interest in the environment and socialization were noted in clinical trials with elderly patients. Some of these attentional changes may contribute to the improvements in memory noted. Contraindications: Do not use this product if you are pregnant or lactating without first seeking advice from your physician. Dosage and Administration: 300 mg daily for first one to two months followed by 100-200 mg per day thereafter. Clinical Effect In: Two to six months. Adverse Reactions: Laboratory tests to assess possible modifications in blood chemistry, cell counts, liver and kidney function and various other metabolic parameter did not show any significant change attributed to PS administration in treatment groups. Known Interactive Effects: The administration of PS along with other drugs failed to show and pharmacological interactions in several multicenter studies.
Acetyl-l-carnitine: Structurally related to acetylcholine, acetyl-l-carnitine appears to act upon neural transmission and, or metabolism. Increases activity of various enzymes together with increased choline uptake in the cerebral cortex and hippocampus. In electrophysiological studies and increased amplitude in the 4 to 8 Hz frequency band and incrementation of the B band with increased amplitude of the visual evoked potential have been noted. Indications and Usage: Improvements in short-term memory (backward digit span test) visual spatial temporal memory and orientation, immediate visual memory, long-term visual memory and constructing ability, judgment, abstraction, co-operative behavior and reduced levels of depression. Contraindications: Do not use this product if you are pregnant or lactating without first seeking advice from your physician. Dosage and Administration: One gram taken twice daily with meals (to reduce gastrointestinal side-effects). Clinical Effect In: Twelve to twenty-four weeks. Adverse Reactions: Gastrointestinal upset (28%) including nausea and vomiting). Laboratory tests to assess possible modifications in blood chemistry, cell counts, liver and kidney function and various other metabolic parameter did not show any significant change attributed to administration in treatment groups. Infrequent reports in some studies of insomnia agitation and, or aggression. Discontinue if insomnia, agitation and, or aggression outweigh treatment benefits. Known Interactive Effects: None known.
Omega-3 Fatty Acids: Found in oily cold-water fish (e.g. free-range salmon), ground golden flax seeds and other food and supplement sources Omega-3 fatty acids are necessary for general health. Unfortunately, most diets are highiy deficient in crucial fatty acids, and particularly DHA (Docosahaxaenoic Acid) and EPA (Eicosapentaenoic Acid). Taking a flax or fish-oil supplement containing 240 mg of DHA and 360 mg of EPA is well advised for most persons.
Antioxidants: The brain consumes more oxygen than any other organ and thus is exposed to a high number of free radicals. A University of Pennsylvania study found that the brains of people with Alzheimer's Disease had twice as much free-radical activity. Our office recommends that all persons in our society follow an antioxidant plan to reduce free radical damage from environmental pollutants, life stress, dietary and other lifestyle factors. An antioxidant plan begins with adherence to a high fruit, fiber and vegetable diet. It is also important to drink at least 8-10 glasses of filtered water daily. Our office further recommend dietary inclusion of between 40 and 75 milligrams per day of high potency flavonoids (flavonols and flavones) from food sources such as green leafy vegetables, carrots, yellow and orange vegetables, onions, artichokes, citrus fruits. and golden flax seeds. We also recommend taking supplemental antioxidants in the form of two to four of the items *ed below. If you suffer from a specific disease or condition you should consult a professional regarding antioxidant supplements as some are helpful for certain conditions and can be harmful in others.

Most Potent Known Antioxidants

Flavonol and Flavone Group

There are a great number of flavonoids found in plants that are consumed by humans. Many of these have strong antioxidant properties. Others have proxidant properties which may suggest they should be avoided as isolated supplements. Quercitin, morn, kampferol, fisetin, myricetin, quercitrin, rhamnetin, wogonin and rutin are among the mutagenic fiavonoids. The following are flavonols and flavones which have undergone research and do not appear to have mutagenic effects: Myricetin, luteolin, chrysin, hesperetin, hesperidin, isorhamnetin, apigenin, taxifolin, and catechin. These flavonoids are recommended as antioxidants.

Highest Potency Antioxidants

Grape Seed Extract (60 mg)
Green Tea Extract (100 mg)
Pine Bark Extract or "Pycnogenol" (100 mg)
Ginko Biloba Extract (60 mg daily)
Vitamin C as magnesium ascorbate a (250-500 mg twice daily)
Vitamin E (200-400 IU per day)
Beta-carotine (15,000 IU per day) Can be mutagenic.
Golden flax seeds (1/4 to 1/2 cup ground daily)

Other Recommended Antioxidants

Marmitech Phyto-Aloe Formula
Reshi Mushroom Extract (900 mg daily)
Cordyceps Sinensis (615 mg daily)
Maitake Mushroom Extract (150 mg twice daily)
Coenzyme QIO
Tomato Caratenoids (include. Lycopene) (15,000 IU daily)
Melatonin (1 mg daily)
Astragalus
7-KETO-DHEA
Selenium (100-200 micrograms daily)

B-Vitamins: These vitamins are vital for cognitive functioning. A Tufts University study found a link between higher blood level of vitamin B-6 and better scores on memory tests, while low levels of B-12 and folate were associated with weaker spatial skills. We advise taking a B-i 00 supplement (including 400 of folic acid) unless this is already included in your multivitamin regimen.
Estrogen Replacement Therapy (ERT): Researched believe that estrogen supplementation may actually enhance memory. Women taking estrogen replacement scored significantly higher than nonusers in tests of memory, language and abstract reasoning and their verbal memory actually improved slightly. This is good new for postmenopausal women who choose ERT for hormone replacement, however, ERT is can increase risk of estrogen-dependent breast cancer.

Warnings: The information above is provided for educational purposes and may not be construed as a medical prescription or as a substitute for the advice of your physician. Do not use these products without first consulting your physician especially if you are pregnant or lactating. Be advised that some herbs and dietary supplements can cause severe allergic reactions in some individuals and may also have an adverse result in conjunction with other medications, or treatments.

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