COVER STORY CONTINUED FROM PAGE 7 controls and to patients with Down syndrome, Parkinson’s disease and Huntington’s disease (Blusztain et al., 1990). Citocholine is another treatment option. Citicoline exhibits neurore-generative effects and activates neuro-genesis, synaptogenesis, and angio-genesis and enhances neurotransmitter metabolism (Martynov & Gusev, 2015). In the IDEALE study testing for effectiveness and safety of citocho-line by Cotroneo et al. (2013), 1000mg of citocholine was administered to 349 patients with mild cognitive impair-ment. Results found that there were positive results in the treated group in comparison to the control group based on MMSE scores 9 months into the study (Cotroneo et al., 2013). DHA DHA is a component of omega-3 fatty acid which is found in fish oils and plays a role in neuron development. DHA sup-plementation significantly promotes neurite growth, synapto-genesis, and increases the levels of pre-and post-synaptic proteins involved in synaptic transmission and LTP thereby improving synaptic function (Cao et al., 2009). A double-blind, randomized controlled trial by Yurko-Mauro et al. (2010) showed that in 485 subjects, those supplemented with 900mg daily of DHA had improved learning and memory function. affected our ability to encode memory for regurgitating in exams, especially with long term memory. In a study done by Fan et al. (2019), participants with short sleep duration (de-fined as less than six hours) had decreased BDNF levels compared with the healthy controls who slept greater than six hours. There is definitely a need to work with the foundations of health including optimizing sleep to improve cognition and BDNF levels. Although these are interventions that show evidence that there are benefits to addressing cognitive decline, the primary care practitioner must first conduct a thorough assessment of the patient. Understanding which cognitive domain is affected can provide better insight on which parts of the brain are af-fected and if it truly is cognitive impairment (eg. Focus, concentration and working memory and the frontal lobe can also be misinterpreted as dementia). In addition to neurotrophic factors, there is a need to un-derstand that for any chronic condition there are two sides of the condition. In this case, fortifying synaptogenesis through trophic factors and supplementation is one approach, but only if underlying processes that impede the neuronal health have been addressed. A holistic, functional approach in addressing cognitive decline is warranted; factors that contribute to the expression of B-secretase in creating insoluble amyloid plaque needs to be addressed such as chronic inflammation, dysgly-cemia and hyperinsulinemia, toxins and heavy metals, cardi-ovascular health and anemia can impede on the proper functioning of the brain. By only primarily supplementing patients with trophic agents only depicts one part of the pic-ture; without addressing the factors that impede on brain health, we are not taking a holistic, functional approach in optimizing cognitive health. For the list of references in this story, please visit cndoctor.ca/ neurotrophic-dementia Considerations Besides relying on nutraceutical interventions, there are life-style habits that are foundational to our cognitive health. Ideally, these are considerations that need to be made along-side or prior to nutraceutical interventions. These lifestyle changes influence a major neurotrophin. One of the most extensively studied neurotrophins is Brain-derived neurotrophic factor (BDNF). In general, the functions of BDNF are related to control of development of neuronal and glial cells, as well as activity-dependent regula-tion of the synaptic structure and its maintenance, which are critical for memory and cognition (Kowianski et al., 2018). In other words, BDNF has a central role in brain plasticity (Ha-kansson et al., 2017). There are many ways to upregulate BDNF. Basic activities include physical activity and sleep. Physical activity has been shown to affect BDNF levels. A study done by Hakansson et al. (2017) found that even a single 35-minute session of physical exercise had a larger im-pact on serum BDNF than cognitive training or mindfulness practice. Physical activity is probably the biggest proponent to cognitive health and cannot be stressed enough! Sleep also has a significant contribution to BDNF. Chronic sleep deprivation has been found to be associated with down-regulation of hippocampal BDNF (Rahmani et al., 2019). In reading this, there may be some memories of those days back in studying in medical school; these nights of deprived sleep www.Cndoctor.ca Photo: © Daisy Daisy / Adobe Stock September/October 2021 Chiropractic and Naturopathic Doctor 21
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