Is Cognitive Training the Answer for Dementia?

Story at-a-glance -

  • The first-ever randomized controlled trial to demonstrate an intervention effective at reducing dementia risk found a brain exercise program targeting processing speed lowered the risk of dementia by 29 percent over the course of 10 years
  • Participants who received memory training or reasoning training did not experience the same beneficial results. The benefit really appears to be limited to training that targets processing speed. The study has distinct limitations though, and needs to be replicated
  • While cognitive training may be helpful, to avoid dementia, you also need to implement more foundational prevention strategies such as diet, exercise, sun exposure and electromagnetic field (EMF) avoidance
  • Lifestyle strategies shown to promote neurogenesis include exercise, calorie restriction, nutritional ketosis, mnemonic devices and sleep. Helpful nutrients include omega-3 fats, astaxanthin, vitamin D and choline
  • Photobiomodulation offers new hope for dementia patients. It also appears to be a powerful preventive strategy. Avoiding EMF exposure is also important, as microwave radiation clearly raises your risk of Alzheimer’s

By Dr. Mercola

Could computer-based cognitive training reduce your risk for dementia? According to recent research, it might. The study, said to be the first-ever randomized controlled trial to demonstrate an intervention effective at reducing dementia risk, found a specially developed brain exercise program lowered the risk by 29 percent over the course of 10 years.1,2,3,4,5

The research was led by Dr. Michael Merzenich, professor emeritus at the University of California, who has pioneered research in brain plasticity for more than 30 years. I've included my previous interview with him, in which he discusses these principles, for your convenience. With regard to this latest study, The Guardian writes:6

"The training was designed to speed up people's visual information processing, for example by having them spot a car on a screen, and a truck on the periphery of their vision, at the same time. Those who are claimed to have benefited trained for an hour, twice a week, for five weeks, and some went on to have booster sessions at the end of the first and third years."

Too Early to Tell if Brain Training Is Effective Form of Prevention

The participants' cognitive ability was evaluated after the first six weeks, and again one, two, three, five and 10 years later. Participants who received memory training or reasoning training did not experience the same beneficial results. The benefit really appears to be limited to training that targets processing speed.

As noted by lead researcher, psychiatrist Jerri Edwards, "We need to further delineate what makes some computerized cognitive training effective, while other types are not." While the results are encouraging, the study does have its limitations. Science Alert explains:7  

"First off, the finding that speed of processing training reduced dementia risk only just scrapes by in terms of statistical standards. Scientific convention holds that a p-value of 0.05 is the threshold for statistical relevance — any higher and it's possible the same result could occur by chance. Here, the reduced risk p-value was 0.049, meaning the result would almost be considered statistically irrelevant …

Second, participants in the study self-reported their dementia, meaning they weren't clinically diagnosed as having the condition … 

'It's positive that this study compared several types of brain training and was both long term and large scale in nature,' says the director of research at the Alzheimer's Society in the U.K., Doug Brown, who wasn't involved in the research. 'However, as it relied on self-reporting of dementia in many cases rather than a robust clinical diagnosis, the results should be interpreted with caution.'"

Others, such as Rob Howard, professor of old age psychiatry at the University College London,8 have pointed out it seems rather implausible that mere hours of cognitive training could translate into cognitive benefits 10 years later. "[I]t is worth bearing in mind that the results could have occurred by chance or as a consequence of uncontrolled confounding factors," Howard says. "On the basis of this study, I won't be recommending speed of processing training to my friends or patients."

Personally, I wouldn't discourage anyone from doing cognitive training. Every little bit certainly helps, but you likely need to do it consistently, long-term. You also need to combine it with more foundational prevention strategies such as diet, exercise, sun exposure and electromagnetic field (EMF) avoidance. That said, if you want to try out some cognitive training, you can find a list of suggested programs in "Brain Health: Can These Tricks Make You Smarter?"

Your Brain Keeps Growing and Changing Throughout Life

While the results of this study clearly need to be replicated, there's ample evidence to suggest you have the capacity to improve your brain function at any age. Until recently, it was believed the human brain could not generate new neural cells once brain cells died or were damaged. This old model is no longer relevant, as it's been proven that your brain not only can generate new cells (neurogenesis), it can also create new neural pathways.

This ability of your brain to change and adapt in response to experience is known as neuroplasticity.9 You can think of these neurological changes as your brain's way of tuning itself to meet your needs, which change over time. One example of this is when you're learning a new skill. The more you focus and practice, the better you become, and this is a result of new neural pathways that form in response to your learning efforts.

At the same time, your brain is undergoing "synaptic pruning" — elimination of the pathways you no longer need. This phenomenon applies to emotional states as well. For example, if you have a history of anxiety, your neural pathways become wired for anxiety. If you develop tools to feel calm and peaceful more of the time, those anxiety pathways are pruned away from lack of activity. "Use it or lose it" really does apply here.

Besides life experiences and/or mental training, your brain's plasticity is also controlled by your diet and lifestyle choices such as exercise. Despite what the media tells you, your brain is not "programmed" to shrink and fail as you age. The foods you eat, exercise, your emotional states, sleep patterns, your level of stress and exposure to EMF are all factors that influence your brain from one moment to the next.

All of these factors also influence your genetic expression. It's important to realize that any given gene is not in a static "on" or "off" position. You may be a carrier of a disease-activating gene that never gets expressed, simply because you never supply the required environment to turn it on. As previously explained by neurologist David Perlmutter:

"We interact with our genome every moment of our lives, and we can do so very, very positively. Keeping your blood sugar low is very positive in terms of allowing the genes to express reduced inflammation, which increase the production of life-giving antioxidants.

So that's rule No. 1: You can change your genetic destiny. Rule No. 2: You can change your genetic destiny to grow new brain cells ...You are constantly growing new brain cells … throughout your lifetime, through the process of neurogenesis."

How to Protect Your Brain With Wise Lifestyle Choices

A number of simple lifestyle strategies have proven to promote neurogenesis, which will help protect against memory loss and dementia. This includes but is not limited to:10

Exercise, especially high-intensity interval training.

Calorie restriction (intermittent fasting and/or multiple-day water fasting appears to have many of the same benefits while being easier to comply with).

Cyclical nutritional ketosis, i.e., a ketogenic diet high in healthy fats (including and especially animal-based omega-3 fats), low in net carbohydrates (non-vegetable carbs, especially grains and sugars) with a moderate amount of high-quality protein. According to Perlmutter, who wrote the book "Grain Brain," a low-carb, high-fat diet is a key component of Alzheimer's prevention. Gluten appears to be particularly problematic for brain health.

Sleep. Research11 shows sleeping well helps you retain information by growing dendritic spines, connections between brain cells that make it easier for information to pass across the synapses. Deep sleep is also essential for brain detoxification and waste removal.

This includes the removal of amyloid-beta, proteins that form the plaque found in the brains of Alzheimer's patients. If you do not sleep well or long enough, your brain will not be able to perform these basic cleanout processes.

Mnemonic devices — memory tools to help you remember words, information or concepts by organizing information into an easier-to-remember format.

Examples include the use of acronyms (such as PUG for "pick up grapes"); visualizations (such as imagining a tooth to remember your dentist's appointment); rhymes (if you need to remember a name, for instance, think "Shirley's hair is curly); and chunking, which is breaking up information into smaller "chunks" (such as organizing numbers into the format of a phone number).

Are You Getting Enough of These Important Brain Nutrients?

Certain nutrients are also really important for optimal brain health. In addition to animal-based omega-3s, these include:

Vitamin D. Researchers have located metabolic pathways for vitamin D in the brain's hippocampus and cerebellum; areas that are involved in planning, information processing and memory formation. In older adults, research has shown that low vitamin D levels are associated with poorer brain function. Patients with vitamin D levels below 20 ng/mL (50 nmol/L) were more likely to suffer cognitive impairment and slower reaction times.

Studies have also confirmed vitamin D can help improve dementia, including its most severe form, Alzheimer's disease.12 Keep in mind that if you take a vitamin D supplement, you may also need to increase your magnesium, calcium and/or vitamin K2, as all of these work in tandem.

Astaxanthin, a carotenoid that's very good for reducing free radical-mediated damage to fat (which is what most of your brain is made of). Astaxanthin has also been found to reduce the accumulation of phospholipid hydroperoxidases, better known as PLOOH — compounds known to accumulate in the red blood cells of people who suffer from dementia13 — and some scientists believe astaxanthin could help prevent dementia, including Alzheimer's.

The human diet does not contain very high amounts of astaxanthin, unless you eat loads of microalgae and sea creatures that consume the algae (such as salmon, shellfish, red trout and krill). The typical dose of astaxanthin when taken in supplement form is 2 to 4 milligrams (mg), but emerging evidence suggests you may need a lot more, depending on your health status.

Dr. Robert Corish, author of "A Guide to Men's Health: Easy Tips for a Long and Healthy Life," believes 12 mg may be an optimal dose for brain and heart health.

Choline, an essential nutrient your body makes in small amounts. To get enough, you need to get it through your diet. In adults, choline helps keep your cell membranes functioning properly, plays a role in nerve communications and reduces chronic inflammation. Eggs and meat are two of the best dietary sources. If you do not consume animal foods, you may be at risk of a deficiency and want to consider supplementation.

Last but not least, the state of your gut can also have a significant influence on your brain function. Your gut is quite literally your "second brain." Just as you have neurons in your brain, you also have neurons in your gut, and gut bacteria transmit information from your GI tract to your brain via your vagus nerve. In addition to avoiding sugar, one of the best ways to support gut health is to consume fermented vegetables, which are loaded with beneficial bacteria.

Mitochondrial Dysfunction Is at the Heart of Alzheimer's

I recently interviewed Dr. Dale Bredesen, director of neurodegenerative disease research at the UCLA School of Medicine and author of "The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline." If you missed it, I highly recommend viewing it now (for the full interview, see the original article, linked above).

Bredesen has identified more than four dozen variables that can have a significant influence on Alzheimer's, but at the heart of it all is mitochondrial dysfunction. This makes logical sense when you consider that your mitochondria are instrumental in producing the energy currency in your body, and without energy, nothing will work properly.

Your mitochondria are also where a majority of free radicals are generated, so when your lifestyle choices produce higher amounts of free radicals, dysfunctions in mitochondria are to be expected. The accumulation of mutations in mitochondrial DNA are also a primary driver of age-related decline.

Importantly, Bredesen's work sheds light on why amyloid is created in the first place. Amyloid production is actually a protective response to different types of insults, each of which is related to a specific subtype of Alzheimer's. Bredesen explains:

"If you've got inflammation going on, you are making amyloid because … it is a very effective endogenous antimicrobial. [I]n that case, it's not really a disease … [It's] a falling apart of the system. You're making amyloid because you're fighting microbes, because you're … inflamed, because you are decreased in your trophic support (insulin resistance, and so on) or because [you're toxic].

Guess what amyloid does beautifully? It binds toxins like metals, mercury and copper. It's very clear you're making [amyloid] to protect yourself. It's all well and good if you want to remove it, but make sure to remove the inducer of it before you remove it. Otherwise, you're putting yourself at risk."

The program Bredesen developed is a comprehensive approach that addresses the many variables of Alzheimer's at their roots. Interestingly, if you have the ApoE4 gene, which increases your risk for Alzheimer's, you would be wise to implement intermittent fasting or do longer fasts every now and then.

In fact, this gene appears to be a strong clinical indication that you need to fast on a regular basis to avoid Alzheimer's. The reason for this is because the ApoE4 gene helps your body survive famine. Unfortunately, it also promotes inflammation. Fasting appears to help cancel out this inflammatory proclivity.

Alzheimer's Screening Tests

Bredesen also recommends a number of screening tests to help tailor a personalized treatment protocol. For example, if you have insulin resistance, you want to improve your insulin sensitivity. If you have inflammation, then you'll work on removing the source of the proinflammatory effect. If your iron is elevated, you'll want to donate blood to lower it, and so on.

Alzheimer's Screening Tests

Test Recommended range

Ferritin

40 to 60 ng/mL

GGT

Less than 16 U/L for men and less than 9 U/L for women

25-hydroxy vitamin D

40 to 60 ng/mL

You can get the test here

High-sensitivity CRP

Less than 0.9 mg/L (the lower the better)

Fasting Insulin

Less than 4.5 mg/dL (the lower the better)

Omega-3 index and omega 6:3 ratio

Omega-3 index should be above 8 percent and your omega 6-to-3 ratio between 0.5 and 3.0

You can get the omega-3 index test here

TNF alpha

Less than 6.0

TSH

Less than 2.0 microunits/mL

Free T3

3.2-4.2 pg/mL

Reverse T3

Less than 20 ng/mL

Free T4

1.3-1.8 ng/mL

Serum copper and zinc ratio

0.8-1.2

Serum selenium

110-150 ng/mL

Glutathione

5.0-5.5 μm

Vitamin E (alpha tocopherol)

12-20 mcg/mL

Body mass index (which you can calculate yourself)

18-25

ApoE4 (DNA test)

See how many alleles you have: 0, 1 or 2

Vitamin B12

500-1,500

Hemoglobin A1c

Less than 5.5 (the lower the better)

Homocysteine

4.4-10.8 mcmol/L

Photobiomodulation for Brain Health

I also want to touch on the topic of photobiomodulation which, if preliminary findings are any indication, offer tremendous hope for dementia and Alzheimer's patients. It also appears to be a powerful preventive strategy. Earlier this year, I interviewed Dr. Lew Lim about the use of near-infrared therapy to treat Alzheimer's disease, and how you can use light therapy to radically reduce your risk.

Recent animal research has shown that introducing gamma frequencies into the brain significantly reduces the amyloid plaques associated with Alzheimer's.14 Lim hopes that by targeting the hippocampus and other memory consolidation areas of the brain with gamma frequency, he may be able to achieve better outcomes in people with more advanced Alzheimer's — people for whom there is currently no hope whatsoever.

Near-infrared light is thought to work by interacting with cytochrome c oxidase (COO) — one of the proteins in the inner mitochondrial membrane and a member of the electron transport chain. COO is a chromophore, a molecule that attracts and feeds on light. When you eat food, the nutrients nourish your cells and provide fuel for biological functions. But food is not your body's sole source of fuel. Sunlight is also a source (about 40 percent of the energy in sunlight is near-infrared).

Unfortunately, few clinicians have any idea that light is a powerful fuel for your body. In my view, this ignorance is one of the reasons why Alzheimer's disease is skyrocketing in prevalence, as so many are routinely avoiding sensible sun exposure. The same can be said for the last topic I want to address, namely EMF exposure.

EMFs — A Wildly Underestimated Contributor to Alzheimer's

Last year, Martin Pall, Ph.D., published a review15 in the Journal of Neuroanatomy showing how microwave radiation from cell phones, Wi-Fi routers and computers and tablets (when not in airplane mode) is clearly associated with many neuropsychiatric disorders, including Alzheimer's.

The way microwaves emitted from devices such as these end up harming your health in general, and brain specifically, is by increasing intracellular calcium through the voltage gated calcium channels (VGCCs) in your cells. The tissues with the highest density of VGCCs are your brain, the pacemaker in your heart, and male testes.

Once VGCCs are stimulated, they trigger the release of neurotransmitters, neuroendocrine hormones and highly damaging reactive oxygen species, significantly raising your risk of anxiety, depression and neurodegenerative diseases like Alzheimer's.

Based on this mechanism, it seems clear that chronic exposure to EMFs can play a significant role in dementia, and that as a society we need to take this very seriously. On a personal level, be sure to limit your exposure to wireless technology. Simple measures include turning your Wi-Fi off at night, not carrying your cellphone on your body and not keeping portable phones, cellphones and other electric devices in your bedroom.

I also strongly recommend turning off the electricity to your bedroom at the circuit breaker every night. This typically works for most bedrooms unless you have an adjacent room, in which case you might need to shut that off too. This will radically lower electric and magnetic fields while you sleep.

This will help you get better, more sound sleep, allowing your brain to detoxify and cleanse itself out each night. As you can see, there are a number of things you can do to prevent dementia and Alzheimer's, but it does require you to be proactive.

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