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The 7 Risk Factors for Cognitive Decline

Cognitive decline, or dementia, is a hot topic these days as the baby boomer generation—almost 80 million people born between 1946 and 1964—approaches the magic age of 65, when dementia symptoms most commonly develop. Dementia is an economic burden that already costs our nation more than $275 billion annually. But most important, dementia is a devastating physical, mental and emotional burden for sufferers and their families.

Identifying the Root Causes of Dementia

Alzheimer’s disease, the most common form of dementia, currently affects almost 6 million people and is projected to double over the course of the next few decades. Alzheimer’s is formally ranked as the sixth leading cause of death in the United States, but more recent estimates indicate that it may actually rank third, just behind heart disease and cancer.

But perhaps the most disturbing news is that unlike heart disease and cancer, scientists have not yet developed a clear understanding of Alzheimer’s. There is no treatment to prevent it or to cure it. In fact, out of 244 drugs tested from 2000 through 2010, only one was approved, and it only minimally slows decline and in fact can prolong the confusion, frustration and terror that accompanies dementias of all forms.

Why no pill? It’s something that scientists refer to as the amyloid-beta paradox. For years, scientists believed that the cause of cognitive decline is the accumulation of plaques in the brain made from a protein called amyloid-beta. Their hypothesis was that if they could develop a treatment that would stop the advance of plaque or destroy it altogether, cognitive decline could be prevented or even reversed.

However, when drug companies tested compounds created to attack plaque, the drugs worked as promised, but patients did not get better and in some cases actually got worse.

Some scientists now even suspect that the formation of the amyloid-beta plaques is actually the body’s way of protecting the brain from the root cause contributors to the disease.

So what are those root causes of Dementia?

  • Genetic Predisposition or Family History of Dementia. Five million to seven million years ago, our species went through a number of genetic mutations resulting in certain genes now associated with inflammation. And inflammation often leads to cardiovascular disease, arthritis and in some cases cognitive decline.

The most notorious gene with respect to cognitive decline is called ApoE. We all carry two copies of ApoE, one inherited from our mother and one inherited from our father. There are three “types” of this allele: ApoE2, ApoE3 and ApoE4. What we now know through advanced genetic testing is that most people carry two copies of ApoE3, which carries a genetic risk of Alzheimer’s of about 9 percent. Twenty-five percent of Americans (about 75 million people) carry a single copy of ApoE4, raising their risk to about 30 percent. And approximately 7 million Americans carry two copies of the ApoE4 allele, pushing their risk to well above 50 percent. The positive news is that we can test for this and determine risk. Though all of us should strive to nurture our bodies and brains all the time, those with ApoE4 should be the most conscious when it comes to taking proactive measures to protect themselves.

  • Inflammation is your body’s natural defense mechanism; it serves as our internal army ready to battle infection and stressors. We are constantly exposed to potential invaders—things like viruses, bacteria, fungi and parasites—all of which activate the immune system to fight back. This is great if that threat is an acute one; our body fights it off and we are good to go. The problem is when threats are chronic in nature and the inflammatory response becomes continuous. When that happens, chronic inflammation can impact the brain by causing the body to produce the amyloid-beta plaques I mentioned earlier.

Amyloid is a potent pathogen fighter but one that eventually goes overboard, harming the brain rather than protecting and preserving. Therefore, to prevent and reverse cognitive decline, we MUST deal with inflammation. This means testing for and eradicating potential infections and triggers—stress, certain foods, toxins, etc.—which will help boost our immune system to fend off and fight pathogens and heal any damage that has been done to the gastrointestinal tract (Leaky Gut or Metabolic Endotoxemia).

How do we test for inflammation? There are specific biomarkers that we can look at, including C-reactive protein. We look at gut health via a GI-MAP. And we test ApoE status. We also test metabolic markers such as blood glucose, A1C and insulin, as these can be major contributing factors to inflammation.

  • Diabetes and Prediabetes. Type 2 diabetes is a disease that results from a constant and chronic state of stress as your body struggles to regulate blood sugar and the necessary insulin to drive glucose into cells to produce energy, which is your body’s fundamental fuel.

A major component of diabetes is insulin resistance, which means that cells resist insulin, which tells them to take up glucose. In particular, brain cells are highly dependent on glucose. When the cells can’t take up glucose properly, they become starved of their main energy source. The combination of effects of diabetes, inflammation and impaired glucose metabolism due to insulin resistance has been termed “type 3 diabetes” by some researchers. So it is critical that those at increased risk for dementia aggressively address the three leading contributors to diabetes: nutrition, exercise and stress management. Eat well. Move your body, and do your best to mitigate and manage stress.

  • Nutritional and Hormonal Factors. To function optimally, our brains need neuron- and synapse-supporting factors such as hormones, nutrients and trophic factors. One particularly important compound is called brain-derived neurotrophic factor (BDNF). This compound is basically Miracle-Gro for the brain, fertilizing brain cells to keep them functioning and growing. BDNF can be increased through exercise as well as hormones like estradiol and testosterone and nutrients such as vitamin D and folate. So make sure you are nutritionally complete. Get tested for optimal nutrition. One important test is called the DUTCH test, which stands for Dried Urine Test for Comprehensive Hormones. This test tells us not only levels of hormones but how your body is using them and, just as importantly, detoxifying them.
  • For some of us, toxins are the main contributing factor to cognitive decline. The challenge with "toxic dementia" is that it develops differently from other types of dementia and often becomes apparent in the late forties to early sixties and can begin after a traumatic experience or significant amount of stress.

In addition, the symptoms are often sporadic and come with no predisposition of family history or genetics. So what can we do to minimize our exposure? First, develop healthier habits by switching to toxin-free cleaning products (even switching from store-bought products to homemade and using natural cleaners like white vinegar and essential oils). Review hygiene products, including contents of shampoos, toothpaste, soaps, deodorants, conditioners, lip balm, sunscreen, body lotions, shaving creams and makeup. Avoid products containing parabens, fragrances and harmful chemicals. Finally, consult sites like for guidance and insight on products that are brain friendly.

  • Head Trauma. Moderate or severe head injury—even just once—can increase risk of cognitive decline. The most common causes of head injury are falls and motor vehicle accidents. For seniors, falls often begin a vicious downward spiral that can lead to cognitive decline, loss of independent function and premature death.

 Whatever your age, take precautions to prevent head injury. Choose to wear a helmet to protect your head if your activity suggests or requires it. Because falls are a leading cause of head injuries, take measures to prevent them. Work to maintain balance. Do resistance exercises to maintain your leg strength. Do yoga and tai chi. Consider standing on one leg while brushing your teeth, making it a doubly beneficial activity. Have fun with it!

  • Vascular Disease. The vascular risk factors for cognitive decline are familiar to many of us because they are the same risk factors we hear of for heart disease. To name a few: smoking, diabetes, high blood pressure, obesity, sedentary living and atherogenic cholesterol (a form of cholesterol damaging to blood vessels).

Studies have shown that vascular risk factors at midlife increase the risk of cognitive decline and dementia at the following rates:

39 percent for those with high blood pressure.

  • 41 percent for those who smoke.
  • 77 percent for those with diabetes or with the ApoE4 gene.

What can you do? Stop smoking. Control your blood pressure, have an in-depth lipid panel done, increase your physical activity, and improve your blood sugar and insulin sensitivity.

Our essential message: You have a choice every single day in terms of how you nurture and care for your health that allows you a level of control to sustain your brain and prevent cognitive decline.

And if the above information doesn’t convince you, how about some numbers: The national cost of Alzheimer’s and other dementia is $277 BILLION (and estimated to reach $1.1 TRILLION by 2050). The average annual cost of Alzheimer’s care in an assisted-living facility in New Jersey is $82,500. And the approximate lifetime cost of care for an individual living with dementia in 2018: a whopping $341,840.

In contrast, living a life that is long, vital and cognitively clear: PRICELESS.

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The information on this website is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.  Princeton Integrative Health advises that you use this information in consultation with your functional medicine doctor or other healthcare professional.