Prevention and Management of Age-Related Cognitive Decline
Thanks to your wholesome remedies, O God,
May I attain the span of a hundred winters!
Drive far away from us all hatreds and troubles
Scatter to the four winds every sort of sickness.1
All of us have a desire for longevity, yet we wish to see old age with a sound body and mind. Age related cognitive decline, also known as mild cognitive impairment (MCI) or age associated memory impairment (AAMI) is a prevalent condition (recent estimates vary from 18% to 85%) that robs the ‘golden years’ of their glory.2
Beginning at around age fifty, or, for women, at menopause, our elder years usher in the vata time of life, with accompanying neurological impairments that can range from mild memory loss to full-blown Alzheimer’s or Parkinson’s Disease. Memory loss in general can arise from vata, pitta, kapha or toxic causes, even though the end result is vitiation of prana vayu in the central nervous system.
Vata causes of memory loss include trauma, stress, head injury, sleep deprivation, B vitamin deficiency and aging. Pitta causes include depression and infectious diseases such as HIV, TB, syphilis and herpes. Among kapha causes are hypothyroidism, obesity, diabetes and metabolic syndrome. Toxic causes include alcoholism, illicit drug use and some medications, such as statins, anti-depressants, sleeping pills, anti-histamines, tranquillizers, anti-psychotics and opiates. While some of these causes, such as head injury, depression, infections, and hypothyroidism are specific conditions in their own right, others combine to make up the degenerative pattern of MCI. Age related cognitive decline or MCI is a multi-factorial condition that appears to be related to stress, excess blood lipids, sedentary lifestyle, poor nutrition, overweight and metabolic syndrome. As such, MCI is extremely susceptible to the holistic approach of Ayurveda. Ayurvedic geriatrics, also known as Rasayana Tantra, consists not in the study of how to manage senile elders in nursing homes, but rather in the science of rejuvenation leading to a healthy old age.
“From promotive treatment one attains longevity, memory, intelligence, freedom from disorders, youthful age, excellence of luster, complexion and voice…Rasayana means the way for attaining excellent rasa etc.”3
Diagnosing Memory Loss
Many clients over forty-five are concerned about their memory deteriorating, particularly if they have a parent with Alzheimer's Disease (AD). Hence it is important for the practitioner to be able to distinguish clinically significant memory loss, and to reassure the client if this does not appear to be present. According to the FDA website, a typical line of questioning could include:
- “What kinds of things are you forgetting?” It is quite normal to forget the name of a person you met recently and briefly or to forget some parts of a conversation, as opposed to forgetting the conversation ever occurred or forgetting the name of someone you know well.
- “How often do your memory lapses happen?” Any of us might miss an appointment once in a while or occasionally forget where we parked. It’s a different matter if this is a common occurrence.
- “Does memory loss disrupt daily living?” If memory loss is interfering with normal daily activities that we could previously perform, it is clinically significant memory loss.
- “Is your memory progressively deteriorating?” Progressive memory loss should always be evaluated.
If there is no evidence of clinically significant memory loss, it is most likely a simple case of vata provocation. If clinical memory loss appears to be present, consider all potential causes including previous head injury, recent trauma, medications, possible undiagnosed diabetes and undiagnosed hypothyroidism. Progressive memory loss could indicate a serious pathology such as a brain tumor, myxodema or severe untreated diabetes, and requires medical evaluation. As an example, a seventy-five year old Episcopalian lay reader began repeating herself in sermons and forgetting the order of service. Convinced she was ‘becoming demented,’ she resigned her post. Her symptoms later turned out to be due to undiagnosed diabetes. Once she was medicated for diabetes, her memory and cognitive functions returned. Only if other significant causes are absent should a diagnosis of MCI be made. In that event, it is best to implement a balanced Ayurvedic program to address the condition.
Diet and Lifestyle Adjustments for MCI
When I leave the rarefied atmosphere of Boulder to do Ayurvedic consultations in localities such as Iowa, Nebraska or Minnesota, I realize that the majority of Americans live on sugary cold cereal, hamburgers, French fries, subway sandwiches, M&Ms and ice cream, with the occasional ‘healthy’ meal of meat and potatoes. Such a diet, high in sugars, refined flour, salt and saturated fat, is depleted of major nutrients such as B vitamins and is almost calculated to create MCI, diabetes and obesity in susceptible subjects. The first step is to introduce the basic healthy diet, including a protein breakfast, a main meal with whole grains, vegetables and either fish or vegetable proteins, some fresh fruits and some nuts and seeds for snacks and a lighter dinner such as a soup.
Once your client learns to eat items you would recognize as food, you can introduce more advanced concepts such as a vata soothing diet to support memory. At this point you can also provide some recipes for dals and kitcheri such as those in Ayurvedic Cooking for Self Healing by Vasant Lad. It is essential to get as much organic high quality turmeric into the diet as possible. “Curcumin as an antioxidant, anti-inflammatory and lipophilic action improves the cognitive functions”4 in patients with MCI or AD. Caffeinated beverages can be replaced by herbal tea prepared from tulsi, which plays a vital role in improving memory and cognitive functioning,5 and should be consumed on a daily basis by anyone who has memory loss issues.
Regular self-massage with sesame Oil, Vata Massage Oil or the appropriate massage oil for prakruti will help balance vata and thus support memory. Exercise should include new and challenging forms of movement, so starting a yoga practice is highly recommended. It is never too late to take up yoga. When I resided at Christa Prema Seva Ashram in 1980 I practiced Iyengar yoga every day with an octogenarian nun who had recently taken to asana practice. Toxins contributing to memory loss, such as alcohol consumption or drug use should be gradually eliminated via lifestyle counseling procedures
At a recent consultation, a patient with memory loss issues was equipped with a notebook, calendar and pen carefully rubber banded together and kept in a prominent place in her purse. Another client who had MCI had a list displayed inside his front door,
- Stove burners off?
- Back door locked?
- Got keys?
These individuals present examples of good rehabilitation. The AmericanAcademy of Family Physicians recommends making lists, keeping a detailed calendar, putting important items in consistent places, repeating names when meeting new people and making associations as a memory aid. Retirement may be a significant cause of MCI. While stress at work can certainly contribute to memory loss, lack of challenge and stimulation can also lead to accelerated decline. Encourage retirees to take classes, get involved in causes as a volunteer, and to do activities to exercise the mind. One stroke victim who struggled with speech and writing found Sudoku number placement puzzles to be a helpful rehabilitative tool. From retirement to the empty nest to death of elders who formerly needed their care, elders in their vata time of life are faced with multiple losses of purpose. Through meditation, retreat, or active imagination and journal exercises, elders can discover a new purpose to energize the latter part of their life. From an astrological standpoint, the second Saturn Return at age fifty eight is an ideal time for such exploration.
Current studies relate MCI to a variety of neurodegenerative processes including reduced levels of acetyl choline in the brain,6 reduced dopamine,7 disorders of the hypothalamic-pituitary-adrenal axis and consequent lowered DHEA levels8. Many of these processes may be related to oxidative stress9 and an inflammatory situation in the brain.10
The ancient science of Rasayana Tantra offers many herbs which have now been found to act on these degenerative processes. Thus rather than taking supplemental DHEA or levodopa, clients can take Ayurvedic herbs which actually restore the body’s inherent ability to manufacture these compounds endogenously. Ashwagandha is a pre-eminent anti-aging and memory supporting herb which supports normal hypothalamic-pituitary-adrenal axis (HPA) function and hence raises production of DHEA, produced by the adrenals.11 In addition, "recent research suggests that ashwagandha enhances cholinergic activity in the brain."12 Tulsi, likewise, enhances cholinergic activity. (5) Kapi Kacchu can "restore the endogenous levodopa, dopamine, norepinephrine and serotonin content in the substantia nigra" of the brain,13 having effective action particularly on the cognitive and motor aspects of Parkinson’s Disease, but also affecting the disease process in MCI. Brahmi has been shown to be effective in combating oxidative stress14, while Bacopa reduces brain inflammation.15 Other herbs traditionally used in Ayurveda to improve memory include vidari, shankhapushpi and licorice. Containing many of these memory-enhancing herbs, Mental Clarity can be used to support clients with MCI, while Stress Ease might be preferred where excess stress is seen to be a significant factor. Chyavanprash is scientifically formulated according to Rasayana Tantra to alleviate issues of advancing age, including memory loss, and is a palatable way to get daily doses of nervine herbs such as ashwagandha and vidari. “By using this rasayana the extremely old Chyavana regained youthful age….even the old attain intellect, memory, and luster.”16 Chyavanprash is most effective when used following pancha karma.16
As we have seen, it is important to diagnose memory loss carefully. MCI can be diagnosed when other conditions causing memory loss are excluded, and is extremely susceptible to a holistic approach combining diet and lifestyle modifications, rehabilitative measures, appropriate pancha karma therapies and herbal therapies. The herbs discussed in Rasayana Tantra have been found to address the root causes of memory loss within the brain and hypothalamic-pituitary-adrenal axis.
- Rudra, Rig Veda II 33, from Raimondo Pannikar, The Vedic Experience, Motilal Barnasidass 1977 p 285
- Hänninen, Tuomo Age-associated memory impairment. A neuropsychological and epidemiological study. Series of Reports, No 39, Department of Neurology, University of Kuopio. 1996. 86 p. + appendix
- Charaka Samhita, Chikitsansthanam Ch 1 v7-8 trP.v. Sharma, Chaukambha Orientalia, Varanasi 1994
- Shrikant Mishra, Kalpana Palanivelu The effect of curcumin (turmeric) on Alzheimer's disease: An overview Annals of Indian Academy of Neurology 2008 Vol 11, 1, 13-19
- H Joshi, M Parle Cholinergic basis of memory improving effect of Ocimum tenuiflorum linn Ind. J Pharmaceutical sci. 2006 Vol. 68, 3, 364-365
- Alvin V. Terry, Jr. 1* Jerry J. Buccafusco The Cholinergic Hypothesis of Age and Alzheimer's Disease Related Cognitive Deficits Journal of Pharmacology And Experimental Therapeutics June 12, 2003; DOI10.1124/jpet.102.041616
- Nora D. Volkow, M.D., Ruben C. Gur, et al, Association Between Decline in Brain Dopamine Activity With Age and Cognitive and Motor Impairment in Healthy Individuals Am J Psychiatry155:344-349, March 1998
- Ettore Ferrari, Daniela Casarotti, et al, Age-related changes of the adrenal secretory pattern: possible role in pathological brain aging Brain Research Reviews Volume 37, Issues 1-3, November 2001, Pages 294-300
- William R. Markesbery Oxidative Stress Hypothesis in Alzheimer's Disease, Free Radical Biology and Medicine Volume 23, Issue 1, 1997, Pages 134-147
- E Tarkowski1, N Andreasen, et al, Intrathecal inflammation precedes development of Alzheimer’s disease Journal of Neurology Neurosurgery and Psychiatry 2003;74:1200-1205
- James Rouse, N.D. Herbal Support for Adrenal FunctionCNI609 6/98 Clinical Nutrition Insights
- Sudhir S, et al. Pharmacological studies on leaves of Withania somnifera. Planta Med 1986:61-63.
- Manyam, B. V., Dhanasekaran, M., Hare, T. A. Neuroprotective effects of the antiparkinson drug Mucuna pruriens Phytotherapy Research, 2004 (Vol. 18) (No. 9) 706-712
- MH Veerendra Kumar and YK Gupta Effect of Centella asiatica on cognition and oxidative stress Clinical and Experimental Pharmacology and Physiology Volume 30 Issue 5-6, Pages 336-342
- Russo A, Izzo A, Borrelli F, et al. Free radical scavenging capacity and protective effect of Bacopa L. on DNA damage monniera Phytotherapy Res 2003;17:870-875 16. Charaka Samhita, Chikitsansthanam Ch 1 v74 trP.v. Sharma, Chaukambha Orientalia, Varanasi 1994