By Dr. Chinta Sidharthan Mar 14 2023 Reviewed by Danielle Ellis, B.Sc.
In a recent article published in the journal Cureus, researchers at Loma Linda University Medical Center and the University of California Irvine reviewed the impact of applying the six pillars of lifestyle medicine — stress management, plant-based nutrition, avoidance of risky substances, physical activity, social connections, and restorative sleep — on neurocognitive decline and dementia.
Review: The Impact of the Six Pillars of Lifestyle Medicine on Brain Health. Image Credit: Black Salmon / Shutterstock
Background
Alzheimer’s disease and other neurocognitive disorders have become highly prevalent among older adults across the world and are a growing economic burden on healthcare systems. Furthermore, available treatment methods only slow the disease progression in some cases and cannot reverse the cognitive impairment or memory loss.
Lifestyle medicine, which is being explored by many healthcare professionals and patients, recommends lifestyle changes to manage or treat chronic neurocognitive diseases and helps patients and their families practice healthy behaviors to improve their quality of life. The six pillars of lifestyle medicine are stress management, plant-based nutrition, avoidance of risky substances, physical activity, social connections restorative sleep, which target the major known neurocognitive risk factors, including depression, hypertension, type 2 diabetes mellitus, insulin resistance, smoking, obesity, and hypercholesteremia.
Plant-based nutrition
Studies have reported that increased incorporation of whole foods in the diet positively impacts cognition. Lifestyle medicine recommends the Dietary Approach to Systolic Hypertension (DASH), Mediterranean, and Mediterranean DASH diet Intervention for Neurodegenerative Delay (MIND).
The Mediterranean diet is abundant in nuts, fruits, legumes, vegetables, cereals, and olive oil, with moderate portions of dairy and alcohol and significantly reduced consumption of processed and red meats, sweets, and saturated fats. The included food groups are believed to provide fibers and micronutrients required for neurocognitive health.
The DASH diet, which was developed to address hypertension, also emphasizes the inclusion of plant-based foods and limits the intake of sweets, cholesterol, sodium, short fatty acids, and total fat. Studies have found that the DASH diet resulted in verbal memory improvements, although no improvements were seen in visual memory. However, participants who have consistently followed the DASH diet have reported improvements in semantic and episodic memory and global cognition over time.
The MIND diet combines the DASH and Mediterranean diets and was designed to address neurocognitive degeneration and dementia. A longitudinal study from Australia reported that strict observance of the MIND diet resulted in a 53% reduction in the risk of Alzheimer’s disease.
Mobility and physical activity have been observed to delay the progression of Alzheimer’s disease and other neurocognitive disorders. Apart from reducing the neurocognitive impairment risk factors such as hyperlipidemia, cardiovascular diseases, type 2 diabetes, and metabolic syndrome, physical activity is also thought to increase Irisin and fibronectin type III domain-containing protein 5 (FNDC5) in the hippocampus. Irisin is involved in increasing glucose tolerance and improving energy expenditure, while FNDC5 plays an important role in neuronal function. Together, these two proteins may improve memory, neuronal cell survival, and synaptic integrity by stimulating brain-derived neurotrophic factor expression in the hippocampus.
Stress management
Research shows high perceived stress is associated with all-cause dementia and mild cognitive impairments, especially late-onset Alzheimer’s disease. However, studies have found that one traumatic or stressful event alone is not correlated with dementia, but successive events and psychosocial stress have been linked to an increased risk of severe dementia later in life. Psychosocial stressors include losing a loved one or a support system, inadequate food or housing, lack of social connections, and mental illness in relatives.
Avoidance of risky substances
The three significant risky substances that lifestyle medicine recommends avoiding are alcohol, nicotine, and benzodiazepines. While conflicting results have linked alcohol consumption and cognitive impairment, a longitudinal study linked alcohol use disorder to an increased risk of early-onset dementia. Although contrasting studies state that moderate alcohol consumption is associated with a lower risk of dementia, the definition of moderate or light alcohol consumption remains controversial.
Additionally, studies show that current and ever smokers (who have been former smokers and continue to smoke) are at a significantly higher risk of neurocognitive impairment. Benzodiazepines, especially the short half-life classes, have also been linked to an increased risk of dementia, especially among women. This is especially important since benzodiazepine medications are commonly used by older adults.
Restorative sleep
Insomnia, obstructive sleep apnea, movement disorders, and overall poor sleep quality are associated with type 2 diabetes, obesity, cardiovascular diseases, depression, and increased cognitive impairment. Reduced sleep has also been linked to the build-up of amyloid-β in Alzheimer’s disease and increased oxidative stress in patients with vascular dementia. The authors believe that the diagnosis and treatment of sleep disorders could lower the risk of cognitive decline.
Social connections
Studies using magnetic resonance imaging have shown that increased weekly social interactions significantly increase brain volume and improve performance in neuropsychology tests. Patients who had extensive social groups also had larger amygdala volumes. Additionally, cohort studies among older women showed that lower social support was linked to a two-fold increase in all-cause dementia incidence.
Conclusions
Overall, the review indicated that daily interventions encompassing the six pillars of lifestyle medicine could not only delay or slow the progression of neurocognitive impairments but also improve cognitive function. The authors recommended that primary care physicians provide resources and educate patients who are at risk of neurocognitive impairments about the benefits of lifestyle medicine.
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