Bio Health Center

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Memory Loss-Cognitive Dysfunction appears to be clinically affecting greater numbers of patients during the past few years. Currently, following Fatigue and Cardiovascular problems, "Memory problems," "brain fog," "mental dullness" and/or unexpected-inappropriate "mental performance decline" is the third most common complaint Dr Edwards hears from patients in his daily practice.

The answer to this interesting and vitally important question actually depends on who you ask. For example, I am sure that most individuals will answer that their "Mind" is priceless... it is the very essence of who they are... the sum total of experience, memory, personality, persona, emotion, etc. that makes up a biologically unique individual. But if you ask the strange bureaucracy that is euphemistically called "scientific medicine" what "a mind is worth" you will get a set of different answers, depending on how one parses the question. For example, a patient with "a little" memory loss is reassured that "all is well and nothing should be done." But a patient with "a lot" of memory loss is worth prescribing symptomatic drugs to slow (not cure) the process. However, another "member of the modern scientific health care team," the insurance company or government entitlement agency (Medicare, Medicaid, Veterans Affairs, etc.), has their own way of "providing for" (approving or denying payment for "treatments" of) diseases of the mind. Their usual pattern is to pay for warehousing those with serious problems and underwriting some symptomatic drug therapies for those denied "covered" supportive care. In any case, the obvious lesson here is to understand that a lot less "value" seems to be placed on the importance of maintaining a healthy and peak functioning "Mind" when it doesn't involve one's own!

The mysterious biological process of "Memory" is required for a multitude of essential, life-sustaining physiological processes. Well recognized examples include nuclear DNA remembering your genetic information, immune system cells (B-lymphocytes, T-lymphocytes, etc.) required to remember important immune information essential for survival, and the Autonomic Nervous System (Sympathetic/Para-sympathetic or "Reptilian" nervous system) remembering to keep your heart beating, lungs breathing (even during sleep and coma states) and not allowing one to commit suicide by holding their breath. If any of these essential Memory functions fails disease and death are the result. Thus, the physiologic and regulatory process of biological Memory is essential to sustaining Life itself. Interestingly, each of the previously mentioned examples of "memory" occurs below the level of our conscious awareness... or "consciousness". For this reason, the "clinical" definition of "Memory" has been "academically" limited to what has come to be called "cognitive" or "noetic" Memory function.
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There are a number of defined clinical "syndromes" that involve memory loss and/or cognitive impairment. Some of these are clearly treatable with proper diagnosis and therapy. Others are currently not treatable and only palliative measures can be applied at present. Clinically, there appears to be no difference between these "organic" brain disorders and other types of "age-related" memory impairment other than subjective degree. Whether this clinical lack of difference is real and important has yet to be determined by laboratory ("academic or evidence-based") medical science.

In addition to Alzheimer Disease (AD), clinical medicine currently recognizes the following non-curable syndromes of memory loss, cognitive dysfunction or dementia: Age-Related Cognitive Decline, Mild Cognitive Impairment, Senile Dementia of the Alzheimer Type (SDAT), Pick's Disease, Diffuse Lewy Body Disease, Progressive Supranuclear Palsy (Steele-Richardson Syndrome), Huntington's Disease and others.1 In some cases the specific syndrome is associated only with progressive dementia (AD, SDAT, Pick's), while others may have additional associated neurologic abnormalities that give them their unique clinical picture. These syndromes are not currently curable, but commonly referred to as "medically manageable". The true occurrence Alzheimer Disease is uncommon. What most media and non-medical people mean when they refer to "Alzheimer Disease" is actually Senile Dementia of the Alzheimer Type (SDAT). Statistically speaking, SDAT is much more common than true Alzheimer Disease.

At Bio Health Center, rather than focusing on "academic" diagnostic "labels" (i.e Alzheimer, SDAT, Lewey Body Disease, Mixed Dementia, Multi-Infarct Dementia, etc.), for which there really are no definitive or specific treatments, we have developed a staging process for memory loss, cognitive impairment and/or some dementia patients. Based on the individual patient's clinical presentation, they will be classified into one of four levels of symptomatic expression of memory loss-cognitive dysfunction or actual dementia.

The staging system currently used at Bio Health Center for memory impairment, cognitive dysfunction and dementia consists of the following four clinical stages:

Stage II: Mild to moderate memory or intellectual problems significant enough to mention them to others, including family members or a health care practitioner.

Stage III: Moderate memory loss or disturbed executive brain function problems that clearly and regularly interfere with activities of daily living (bathing, dressing, food preparation, shopping, paying bills, etc.) and require assistance regularly, but not full time. Lab, cardiovascular and/or radiographic testing demonstrating abnormalities are consistent clinical with symptoms.

Stage IV: Clinical dementia requiring a majority or full time supervisory care for all or most activities of daily living (bathing, dressing, food preparation, shopping, paying bills, etc.). Clear evidence of laboratory, vascular testing and/or CT/MRI/PET scan abnormalities.

Prior to clinical staging, each patient should undergo a thorough clinical, laboratory, cardiovascular and radiological evaluation looking for confirmatory diagnostic evidence, and also to rule out potentially reversible causes of memory loss, cognitive dysfunction or dementia.

The actual "cause" of most forms of chronic memory loss, cognitive dysfunction and dementia syndromes is essentially unknown. There are scientific "theories", but they are just that... theories. No expert really knows what is causing the clinical problem in a majority of cases. There are, however, various categories of causative mechanisms that can be investigated in order to identify potentially treatable and, hopefully, reversible mechanisms of memory loss, cognitive dysfunction and/or dementia. Included among these categories are:

The current clinical evidence for Micro-Vascular disease as a potential cause for has grown convincingly strong. The association of cognitive decline and dementia with diabetes, metabolic syndrome, inflammation and abnormal protein glycation(Advanced Glycosylation End-Products or AGE products) appears to be very strong statistically. These conditions are also all known to be clinically associated with the toxic biological effects of sugar on the structural and regulatory function of the neuro-endocrine-immune system and/or brain Micro-Circulation.

Despite the clinical fact(s) that someone may be experiencing or manifesting obvious memory loss, cognitive dysfunction and/or dementia, there is no definitive clinical, radiographic or laboratory test that is specific for Alzheimer Disease, Senile Dementia of an Alzheimer's Type (SDAT) or any other form of chronic, progressive mental/mind dysfunction. Thus, the "diagnosis" of memory loss, cognitive dysfunction or dementia syndrome is almost exclusively a "clinical" or "bedside" diagnosis made by the physician, not the laboratory or radiology department. However, there are number excellent clinical tools to help the clinician more closely evaluate an individual patient suspected of memory loss or cognitive dysfunction.

In order to optimize functional performance the clinical interpretation of the results of testing will vary depending on the physician's perspective... the clinical problem of "normal" versus "optimal". Normal is based on statistical data.

Preventive measures may help maintain or even improve mental performance and may also help to minimize and slow the clinical development of memory loss, cognitive dysfunction or dementia. Regular physical exercise has been shown to delay the onset of AD. The regular use of intellectual powers, such as doing crossword puzzles, other games of mental skill and engaging cognitive function on a regular and challenging basis has also been reported to delay the onset of memory loss-cognitive dysfunction. Depending on which "causative" theory one uses, diet may also be used as a preventive measure, but the scientific evidence is still too early to know for sure. Unfortunately, there are currently no other "evidenced-based" scientific methods for prevention available. So all that remains to be done from an evidenced-based, scientific medicine perspective is to wait for symptoms to develop and then try and decide if those symptoms are statistically normal aging or the presence of an early memory loss syndrome (AD, SDAT, etc.). Since the current recommendations of experts writing in the scientific literature is also to start treatment as early as possible, a difficult task confronts the patient and physician... how does one know when and who to treat? The "evidence-based" scientific "experts" do not seem to address this question adequately.

In addition, there is no currently known specific curative treatment for academically named memory loss, cognitive dysfunction or dementia syndromes. The current methods that are being employed for treatment can be divided into two major categories: (1) Evidence Based ("statistically significant" scientific) therapies and (2) Clinically Based (Heuristic, Anecdotal) therapies.

The first group of FDA approved pharmaceuticals increases neural network content of Acetylcholine by decreasing the activity of the enzyme Acetyl-Cholinesterase. These carbamate anti-cholinesterase neurotransmitter-enhancing drugs are actually based on the concept of pesticides! The second group of drugs, which only has one member, acts by selectively blocking the neurotoxic effects of abnormal glutamate transmission. All pharmaceuticals currently approved by the FDA to treat AD, Cognitive Decline and/o Memory loss are expensive, potentially toxic, have significant side-effects and only treat symptoms... they do not "cure" the condition.

Since the "cause" of most clinical memory loss-cognitive dysfunction syndromes may be "multi-factorial" (meaning more than one causative mechanism or contributing factor), simple logic would dictate that any potential treatment protocol should also be directed at "multi-factorial" factors.

Integrative Medicine utilizes the following modalities in individualized prevention or treatment protocols to integrate lifestyle-altering, biochemical, structural and regulatory methods of therapy:

1. Beal MF, Richardson EP Jr, Martin J. Alzheimer's Disease and Other Dementias. In [eds: Isselbacher AB, Braunwald E, Wilson JD, et al] Harrison's Principles of Internal Medicine. 1994;1:2269-2272.