|Dr. Cynthia Libert, MD
Functional Medicine Doctor
Cognitive Decline Expert
Your brain function is vital to living a productive and fulfilling life. A healthy brain is essential so you can connect with others, experience the world around you, and even facilitate your spiritual development. But, when you think about your life as an older adult, are cognitive decline and memory loss an inevitable part of aging? Or is it possible to protect your memory and brain function even as you age?
In this interview, we spoke with Dr. Cynthia Libert, M.D., a Functional Medicine doctor who specializes in cognitive decline. Dr. Libert shared her functional medicine approach to cognitive decline, memory loss, Mild Cognitive Impairment (MCI), and Alzheimer’s disease (AD).
Disclaimer: The information in this article is for general information only and should not be considered medical advice. It is meant to educate you about the various options for cognitive decline and help you discuss the best treatment plan with your doctor.
A Q&A with Dr. Libert
How did you first become interested in cognitive decline?
My interest in helping people suffering from cognitive decline was sparked by an inquiry from a dear patient whose father was showing signs of Alzheimer’s disease.
“Can it be reversed?” was her poignant question.
As a family physician, my conventional medical training had informed me that Alzheimer’s disease was a uniformly fatal, progressive neurodegenerative disease with no real effective treatments or cure. Nevertheless, my patient’s pressing question led me to take a trip to the Buck Institute for Research on Aging in Novato, California in 2016.
It was there that I had the tremendous opportunity to learn from Dr. Dale Bredesen, M.D., a world-renowned neurologist and molecular biologist and his team of Alzheimer’s disease researchers about a promising approach to cognitive decline.
The Bredesen protocol for cognitive decline
In 2014, Dr. Bredesen published the first-ever scientific study to objectively show that memory loss can be reversed with improvements sustained, using a 36-point therapeutic personalized program. The program involves comprehensive changes in diet, brain stimulation, exercise, optimization of sleep, specific nutraceuticals, and multiple additional steps that affect brain chemistry.
I was so impressed with the positive patient outcomes that Dr. Bredesen reported, that I took the training and became a Bredesen Protocol certified practitioner. Since that time, I’ve helped hundreds of people protect their brains and optimize mood, memory, and cognitive function through Dr. Bredesen protocol and functional medicine principles.
In fact, the functional medicine approach helped to heal my own brain and body! After years of chronic stress, sleep deprivation, and overwork, I was on the verge of burnout and suffering from a myriad of health problems. Thankfully, I have healed on many levels and now enjoy vibrant health. It brings me great joy to share what I have learned with my patients and see their lives transform as well.
What is cognitive decline?
Cognitive decline simply means that the brain is not working as well as it did in the past. While a subtle decline in the speed of thinking and attentional control can be a part of the normal aging process, cognitive impairment and dementia are not. Mild cognitive impairment and dementia are broad terms that indicate that there is a decline in brain function greater than would be expected for that person’s age, education, or development.
Dementia & Alzheimer’s disease
Dementia is a general term for any disease that causes a change in memory and/or thinking skills that is severe enough to impair one’s ability to perform tasks related to daily functioning. For example, driving, shopping, balancing a checkbook, working, and communicating. All of these can be affected by dementia.
There are many different types of dementia, the most common of which is Alzheimer’s disease. Most types of dementia cause a gradual loss of function and worsening of symptoms over the years due to progressive damage to nerve cells in the brain. The damage, referred to as neurodegeneration, is caused by many underlying processes.
The symptoms of dementia vary from person to person and may include:
- Memory problems
- Mood changes
- Difficulty walking, speaking or navigating
- Difficulty with tasks once easily performed
Risk factors that can ultimately manifest as Alzheimer’s disease typically exist for decades before the first symptoms occur. While genetics plays a role, it isn’t destiny. We now know that other lifestyle factors can also increase your risk of developing Alzheimer’s disease. Some of these may include:
- Inflammation (e.g. obesity, high blood pressure, high cholesterol)
- Infections (e.g. herpes, Lyme disease, gingivitis)
- Glycotoxic (i.e. blood sugar dysregulation, prediabetes, diabetes)
- Atrophic (i.e. lack of brain growth factors such as vitamin D, thyroid hormone, sex hormones)
- Toxicity (e.g. heavy metals, pesticides, environmental chemicals, mold)
- Vascular issues (i.e. damage to the blood vessels that supply oxygen and nutrients to the brain)
- Trauma (i.e. physical or emotional trauma to the brain and body)
Preventing cognitive decline
“An ounce of prevention is worth a pound of cure.”
With chronic degenerative diseases such as Alzheimer’s, mild symptoms of cognitive decline are not an early sign of disease but normally occur later on. This disease process makes early detection even more critical.
Dr. Bredesen coined the term “cognoscopy” to describe a comprehensive medical assessment aimed to identify any risk factors for cognitive decline. It is ideal for any health-conscious individuals looking to optimize their brain health and reverse risk factors for dementia. Especially, for those with a family history of Alzheimer’s disease, APOe-4 genotype and other personal risk factors for neurodegeneration.
The primary step to prevention is to identify potential risk factors before damage takes place.
I recommend anyone who wants to protect their future cognitive function to have an annual brain health check-up after the age of 40.
What are the signs of cognitive impairment?
If you answer yes to one or more of the following questions, you may be experiencing some warning signs of cognitive impairment.
- Think your memory is worse than it was 10 years ago, or worse than that of other people your age?
- Have difficulty doing tasks such as following a recipe or running errands?
- Become lost on freeways or near your home or need a GPS when driving familiar routes?
- Have trouble concentrating or remembering when reading or learning new things?
- Avoid friends, family, or socializing due to your memory or cognitive problems?
- Feel uncharacteristically angry, suspicious, anxious, irritable, confused, or depressed?
- Have difficulty paying bills or managing money?
- Have difficulty remembering recent conversations, appointments, current events, names, or recognizing faces?
- Lose objects or forget where you placed them more often than previously?
- Feel overwhelmed due to memory decline even when doing routine tasks at home or work?
Keep in mind, while these are possible symptoms of cognitive impairment, there may be other more subtle warning signs as well. It is therefore important to speak with a qualified health professional about your experience if you have any concerns about your memory or brain health.
Cognitive decline diagnosis & treatment
The diagnosis and treatment of cognitive decline are not an overnight task. It’s a journey, a multi-layered process, that must be customized to fit the individual state of health and needs of each patient.
To give you an idea of what to expect, below is an overview of the functional medicine approach for cognitive decline I developed in my practice. The plan is very comprehensive and aims to identify and target the 50-plus known causes of cognitive decline.
My approach to cognitive decline diagnosis and treatment includes:
- Various medical tests such as metabolic, genetic testing, and diagnostic imaging
- Intensive lifestyle interventions such as diet, exercise, and sleep optimization
- Targeted nutritional supplementation
- Brain training
- Other therapies such as photobiomodulation (PBMT) light therapy, and assisted detoxification when needed.
All these elements can play a role and help optimize brain function, reverse mild memory loss, improve the symptoms of early Alzheimer’s disease, and reduce the risk of developing dementia.
Here are the five basic steps I use to help patients heal their brain and body
- Assess the patient’s individual current state of health.
We look at a person’s entire life timeline with attention to modifiable lifestyle, mental, emotional, spiritual and other factors that play a role in cognitive decline. I always start with listening to a person’s unique story, as it is vitally important. Many of the root causes of dysfunction can be linked to individual life experiences dating back to childhood. From there, we collect information based on physical exam, health questionnaires, and comprehensive medical tests.
- Uncover the root causes of brain & body dysfunction.
Identify individual root causes and risk factors for cognitive decline, based on the information collected on step 1.
- Connect the dots and deal with the data.
Review potential lifestyle changes that may help address the root causes and risk factors captured in the previous step.
Personal lifestyle patterns such as diet, sleep, stress, exercise, beliefs, and others can all affect the way we feel and may play an important role in the body’s ability to heal.
- Personalize action plan for each patient.
Including collaboration with a certified Functional Medicine health coach to help patients implement the recommended lifestyle changes.
- Continue with a realistic plan to cultivate daily self-care measures.
Maintaining good cognitive health requires a lifelong commitment and readiness to change. So, it is important to make sure you have the appropriate professional support when needed, to help you address any areas you find challenging.
Can cognitive decline be reversed?
Of course, the best way to reverse cognitive decline is to address the root cause(s) before it appears! But I can unequivocally report from my clinical experience that cognitive decline can, in many cases, be reversed with a Functional Medicine approach.
Starting an evaluation and treatment program as soon as memory concerns become apparent favors a successful outcome. The more advanced the disease, the longer the reversal of symptoms would be expected to take. There are a few reports of patients with advanced Alzheimer’s type dementia experiencing some symptomatic improvement, but there is most likely a point of no return, beyond which reversal is not possible. For this reason, I limit my clinical practice to only those with early disease and those desiring prevention and health optimization.
At the very least, patients can expect to improve their overall health and quality of life by engaging in a comprehensive lifestyle medicine plan to address risk factors for cognitive decline. While conventional drug therapies for Alzheimer’s disease can cause unpleasant side effects like diarrhea, nightmares, urinary incontinence, and sedation, a Functional Medicine approach typically has mostly positive effects including better sleep, energy, relaxation, peace, and joy!
When can I expect to feel better?
The benefits from the treatment can vary from one patient to another. Some patients may notice improvements within two weeks while others don’t notice improvements until nine months or beyond. With that said, in my experience, patients or family members/caretakers often become aware of improvements around the completion of the third month of the program.
The first sign of improvement is typically the slowing of decline. This can be subtle and is usually followed by the absence of further decline. Additionally, many patients experience mild improvements that progress over time to major improvements. These may initially be noticed by the patient or only by family, friends, or co-workers.
For optimal results, follow the program as closely as possible and continue the protocol throughout life. Keep in mind, as with any medical treatment program, results cannot be guaranteed.
If you or a loved one are showing signs of cognitive decline, know that it is possible to protect memory and brain function and improve symptoms. With functional medicine, we have plenty of tools that can help you identify the possible causes for the cognitive decline and provide you with the treatment options you need.
- The Functional Medicine Approach to Cognitive Decline - June 29, 2020