Understanding Memory Loss
Everyone forgets things once in a while. How many times have you forgotten the name of a recent acquaintance, or put your car keys in a place where you were sure you would remember them, then forgotten where you set them down? These slight lapses in memory are common and are simply part of the brain's continuous striving to sort, file, and prioritize the constant bombardment of information it receives.
Forgetfulness is a normal part of the aging process, and in general it is nothing to worry about. You may joke about having a "senior moment" every now and then, and it may take a bit longer to remember what you were looking for in the other room or the name of your neighbor's grandson.
However, when memory lapses begin to interfere with daily life, there is greater cause for concern. Unlike minor lapses in memory, forgetting things like the name of a lifelong friend or close relative, repeating the same question during the same conversation, or getting lost and confused in a familiar place can be a red flag signaling something more serious.
For many people, the realization that they are beginning to suffer from memory loss conjures up the unwelcome and ominous thought of impending Alzheimer's disease. The good news is that many cases of memory loss are not due to Alzheimer's disease, and not all age-related memory loss becomes as severe as senile dementia.
Often, what appears to be significant loss of memory is actually treatable, even reversible, and brain cell growth and learning can take place at any age. Believe it or not, maintaining healthy brain function into the later years is in large part under your own control.
Remembering is not one unique cognitive process, and memory is not confined to one certain area of the brain. For this reason, there are any number of causes of memory loss, and there are many ways to prevent, reverse, and compensate for poor recall ability.
First, though, we should look at the way the brain forms and retrieves memories. There are three unique stages to forming, storing and retrieving memories:
- Acquisition is the process of taking in new information along the nerve pathways of the brain and the neurons. During this stage, only the information you intentionally focus on takes up residence in your brain.
- Consolidation is the process of encoding new information your brain has received and storing it in long-term memory.
- Retrieval consists of recalling information along the same nerve pathways that were used to store it. The more often you use a memory, the easier it is to retrieve, provided the associated neurons remain healthy.
With the understanding that different nerve pathways and different locations of the brain are involved with the processing and storage of memory, it stands to reason that there are many different factors which can precipitate memory loss. The following list describes some of the many issues which are causes of memory loss:
- Medications. Single or multiple medications, particularly in older adults, can mimic symptoms of dementia. Even some herbal remedies and topical analgesics for arthritis can cause memory lapses when the liver fails to eliminate the chemicals quickly enough.
- Chronic use of alcohol and drugs causes a deficiency of vitamin B1, which results in memory lapses.
- Environmental toxins such as lead, mercury, carbon monoxide, and chemicals in hobby items and pesticides can lead to confusion and a reduced ability to concentrate.
- Hormone changes during menopause/perimenopause can cause temporary disconnects in the ability to recall information.
- Stress, depression and anxiety may actually lead to loss of neurons in the parts of the brain that are affected, leading to an inability to focus and memory loss.
- Head injuries such as concussion can cause a temporary lapse of memory.
- Infections, particularly those which affect the lining of the brain, can lead to memory loss.
- Impaired thyroid function leads to hormonal imbalances which can affect memory.
- Sleep deprivation from any cause can affect proper memory function.
- Nutritional deficiencies such as lack of vitamins B1 and B12 can also have an effect on memory.
- Natural aging, after all, does cause some brain function to slow down. This slowing of cognitive ability is sometimes misinterpreted as memory loss.
- Stroke, or "vascular accident," is a significant cause of memory loss.
Now for the more serious age-related memory loss causes:
* Mild Cognitive Impairment, or MCI for short. When memory loss moves beyond a few lapses into something more significant, like forgetting a weekly social event or blanking out on where you were going when you left the house, MCI may be the culprit. While frightening, and often seen as a precursor to dementia or Alzheimer's, many patients with MCI never progress to those later stages. While MCI can disrupt some day-to-day functions, many of those with mild cognitive impairment manage to live independently.
* Alzheimer's Disease, AD, is the most common type of senile dementia. It is progressive and degenerative, caused by protein deposits in the brain known as amyloid plaques and tangled nerve fibers. AD has a genetic component, and it may also be linked to a history of severe concussion. It slowly destroys a person's ability to communicate, make judgments, and engage in social activities. AD may cause significant changes in personality, and eventually loss of speech, incapacitation, and death.
* Other types of dementia - there are a number of other types of dementia, with varying causes but similar results. In most cases, the patient's ability to function deteriorates, leading to inappropriate social behavior, loss of independence, emotional disturbance, loss of language skills, and eventually incapacitation and death. These forms of dementia include vascular dementia (caused by blockages in the arteries), Parkinson's disease, and Huntington's disease.
Fortunately, many types of memory loss can be prevented or reversed. With an eye to your long-term health and quality of life, there are several preemptive steps you can take to improve and enhance your memory.
Methods to Improve Memory
A body detoxification program can be employed to eliminate heavy metals such as lead and mercury, as well as other environmental toxins. A liver detox is especially helpful in removing any harmful chemicals resulting from alcohol use or chemicals from medications that have remained in the body due to poor liver function.
* Memory exercises such as crossword puzzles, reading, games, and even gardening are an excellent way to keep the neural pathways open and the memory sharp.
* Memory supplements can help to compensate for the loss of vital nutrients from poor diet, alcohol and drug use, improper thyroid function, and menopause or perimenopause. Many supplements have also been shown to reduce the affects of Alzheimer's and other forms of dementia.
Some effective memory supplements include:
- Gingko biloba;
- Omega-3 fatty acids (found in fish oils);
- Huperzine A (Chinese club moss);
- Acetyl-L-carnitine (an amino acid);
- Vinpocetine, an alkaloid extract of the periwinkle plant which acts like dopamine;
- Vitamin E;
- Phosphatyl choline, a phospholipid found in egg yolks and soybeans;
- Piracetam, a synthesized nootropic drug which enhances cognitive ability.
* Physical exercise improves blood flow to the brain and may reduce the risk of memory loss. It also reduces stress and enhances the body's own abilities to regenerate itself.
* Consuming an organic diet of fresh fruits and vegetables, whole grains and lean proteins allows you to eat nutrient-rich fresh foods while avoiding harmful toxins such as pesticides and chemical fertilizers which can impair memory function.
* Practicing stress management is tremendously helpful in staving off memory loss. By keeping down your stress levels, you can avoid the stress- and anxiety-induced hormones that promote memory loss.
* Maintaining social interactions is an important part of maintaining a healthy mind. While loneliness has been shown to be a factor in Alzheimer's disease, keeping healthy social interactions can reduce stress levels and promote cognition and memory.
By adapting a healthy and active lifestyle now, you are giving yourself every chance at a long, healthy, independent and fulfilling life.
The New View of Early Memory Loss
Early memory loss is associated with loss of brain cells (neurons). At some point this loss crosses over from everyday annoying forgetfulness to clinically significant symptoms. In the past, scientists and we clinicians believed, in contrast, that normal aging is associated with similar loss of neurons, just at a slower rate. Results of more recent research, however, strongly suggest that there may be very little nerve cell loss with normal aging.
Think about the far reaching ramifications of this new data. Two in particular stand out:
- It is more important than ever to identify and aggressively address signs and symptoms of early memory loss, and
- In addition to screening for early memory loss, we must proactively promote the health of nerve cells and optimize neurotransmitter and hormonal balance before you begin to experience memory and other cognitive decline.
The Link Between Dementia and Homocysteine
To this end, we have been developing better ways of assessing your risk for the most aggressive form of memory loss: Alzheimer’s disease (AD). One of the best predictors of your future risk for this dreaded form of dementia is whether or not you have elevated levels of homocyteine in your blood.
For example, the Framingham Study, one of the most well-known and informative of studies on the prevalence of diseases (epidemiology), demonstrated that plasma homocysteine level is a strong predictor of future Alzheimer’s disease. In fact, for every 5 units increase in homocysteine, the risk of AD was increased by 40%. Moreover, plasma homocysteine concentrations > 14 μmol/L nearly doubled the risk of AD.
Their finding led investigators in this study to conclude that plasma homocysteine is a strong, independent risk factor the development of dementia in general or specifically AD. Not only that, in persons who already have Alzheimer’s, increased Hcy levels in the brain may accelerate the progression of the disease.
The Folate Connection
Another set of studies has found that these elevations of homocysteine are associated with low levels of folate in the central nervous system. As such, early intervention with a certain type of folate supplementation will prevent the age-related increase in homocysteine.
One quick cautionary note. You may be fortunate enough to have a savvy primary care clinician who is familiar with this data. He or she may even have been proactive enough to measure folate levels in your blood. If so, and your level came back normal, be aware that brain levels of folate do not correlate to serum folate levels. In fact in a study by Serot, et al, that people with AD often have normal serum folate levels despite very low CNS (central nervous system) folate levels. So if your homocysteine levels are high, even if your serum folate levels are normal, you still need treatment with folate supplementation.
In addition, several other studies linking low folate levels to high homocysteine levels concluded the following:
- High total folate intake is associated with reduced risk of AD (Corrada M, Kawas C. et al. Reduced Risk of Alzheimer's Disease with High Folate Intake: The Baltimore Longitudinal Study of Aging. Alzheimer's & Dementia. 2005 July 1.); and
- High total folate intake may protect against AD (Luchsinger JA, Tang MX, Miller J, Green R, Mayeux R. Relation of higher folate intake to lower risk of Alzheimer disease in the elderly. Arch Neurol. 2007 Jan;64(1):86-92.).
Yet another study found that folate supplementation for 3 years significantly improved 5 domains of cognitive function (memory, sensorimotor speed, information processing, complex speed, global cognitive function – some by as much as performance of an individual 7 years younger) that tend to decline with age.
What About The Other B Vitamins?
Good question. It turns out that elevated plasma homocysteine is also an important bio-marker for low vitamin B12 levels. The story on B12 is particularly interesting. For example, studies have shown that there is a direct relationship between serum B12 and serum folate such that optimum levels of both vitamins are necessary to protect you from cognitive decline. More specifically, low B12 and normal or even high folate levels do not protect against memory loss. Hence the need to ensure normal B12 levels when supplementing with folate. It is for this reason that in our best-selling memory supplement – FolaNAC – we have combined both of these crucial vitamins.
It has historically been believed that vitamin B12 had to be given via shots. The more recent data, however, is very reassuring: oral cobalamin is as effective and possibly superior to parenteral (IV or IM) therapy.
The net effect of this dynamic duo is to ensure that you are able to continue to making that neurotransmitter most closely aligned with memory and cognition: acetylcholine.
As you might suspect, in the earliest stages of memory loss, you have an imbalance in your acetylcholine activity that results in increased need for new synthesis of this all important brain chemical. New acetylcholine is formed through a series of chemical reactions first initiated by L-methyfolate (the type of folate that your brain can utilize) along with methyl-B12 and in the process reduces your elevated homocysteine levels.
Slowing Brain Degeneration
A logical question arises: how exactly does elevated homocysteine cause memory loss and brain deterioration? The answer to this question is obviously complex but several possible mechanisms have been identified:
- Homocysteine activates a specific brain receptor – NMDA – that has been implicated in many different brain disorders including depression, dementia, Parkinson’s, migraines, epilepsy, and Lou Gehrig’s disease. Some believe that homocysteine is at least as neurotoxic as excess glutamate.
- Activation of the NMDA receptor ultimately leads to nerve cell death.
- Homocysteine causes oxidative stress that accelerates the rate at which you burn through your acetycholine.
- Homocysteine at the same time slows down the rate at which you make acetylcholine.
Because of the havoc elevated homocyteine levels can wreak, in addition to combining L-methylfolate and B12, we have added a powerful anti-oxidant and NMDA receptor stabilizer, namely, n-acetyl-cysteine (NAC), to FolaNAC. NAC is one of the most widely studied and used supplements in the field of integrative psychiatry because of its potential effectiveness and its proven safety and tolerability.
In addition to its potent antioxidant properties, NAC lowers homocysteine and prevents nerve cell death.
One Last Point
Not all folate is created equal. There is a good chance, particularly if you already have early memory loss (or depression for that matter), that the dietary folate you get from green leafy vegetables (you have to eat them first) and the synthetic folic acid that pollutes your multi-vitamin or your B complex, cannot get from your gut/blood past your blood-brain-barrier and into your brain. If it can’t, it won’t reduce your brain homocysteine levels and won’t protect you from cognitive decline.
It is imperative that you take folate in the L-methylfolate form that readily crosses from your systemic circulation into your brain.
I find it ironic how powerfully the organ cartels – heart, lung, endo, kidney, etc. – preach the good word on end-organ protection. For my money, however, the most precious organ (ok second most precious among men) is the brain. Protect it at all cost. For when it is gone, you and I are gone. So you guessed it. Although I don’t always buy my own hustle, I take my FolaNAC. Everyday.