What is the best treatment for long-term cognitive function?

From the Guidelines

For optimal long-term cognitive health, adopt a comprehensive approach that includes regular physical exercise, a Mediterranean-style diet, quality sleep, and ongoing mental stimulation. This approach is supported by the most recent and highest quality study, which emphasizes the importance of a multifaceted strategy for maintaining cognitive function 1. Key components of this approach include:

• Regular physical exercise, aiming for 150 minutes of moderate activity weekly, to help preserve cognitive function and reduce the risk of vascular-related cognitive decline later 1
• A Mediterranean-style diet rich in vegetables, fruits, whole grains, fish, and olive oil to promote neuroplasticity and reduce inflammation
• Quality sleep, aiming for 7-9 hours nightly, to support the growth of new neural connections and reduce cortisol levels that damage brain cells over time
• Ongoing mental stimulation through learning new skills or solving puzzles to challenge the brain and build cognitive reserve Additionally, social engagement, stress management techniques like meditation or mindfulness practice, and maintaining healthy blood pressure, cholesterol, and blood sugar levels through regular medical check-ups are also crucial for supporting cognitive health 1. It is essential to note that no single medication has been proven to enhance cognition in healthy individuals long-term, though addressing underlying conditions like vitamin deficiencies or sleep apnea can significantly improve cognitive function if present 1. By prioritizing this comprehensive approach, individuals can take proactive steps to support their long-term cognitive health and reduce the risk of cognitive decline.

From the FDA Drug Label

The effectiveness of memantine hydrochloride as a treatment for patients with moderate to severe Alzheimer’s disease was demonstrated in 2 randomized, double-blind, placebo- controlled clinical studies (Studies 1 and 2) conducted in the United States that assessed both cognitive function and day to day function The ability of memantine hydrochloride to improve cognitive performance was assessed in both studies with the Severe Impairment Battery (SIB), a multi-item instrument that has been validated for the evaluation of cognitive function in patients with moderate to severe dementia The SIB examines selected aspects of cognitive performance, including elements of attention, orientation, language, memory, visuospatial ability, construction, praxis, and social interaction.

Cognitive Function: Memantine hydrochloride has been shown to improve cognitive performance in patients with moderate to severe Alzheimer's disease, as measured by the Severe Impairment Battery (SIB) in two clinical studies 2.

• The SIB assesses various aspects of cognitive function, including attention, language, and memory.
• However, the long-term effects of memantine on cognition are not explicitly stated in the provided drug label. Therefore, no conclusion can be drawn about the long-term effects of memantine on cognition.

From the Research

Dietary Patterns for Cognition

• A Mediterranean diet, rich in plant-based foods, poly- and mono-unsaturated fatty acids, and low in processed foods, has been consistently shown to have a positive effect on cognitive health in older adults 3, 4, 5, 6.
• Other dietary patterns, such as the DASH, MIND, and Anti-inflammatory diets, have also shown promising results, particularly for those at risk of cardiovascular disease 5, 6.
• A "whole diet" approach, focusing on macro- and micro-nutrient intake levels that have protective effects against cardiovascular diseases, is likely to be effective against neurodegenerative disorders as well 5.

Specific Nutrients for Cognition

• Omega-3 fatty acids, particularly EPA and DHA, have been linked to healthy aging and cognitive function throughout life 4, 7.
• Polyphenols and flavonoids from plant-based foods have antioxidant and anti-inflammatory properties that may benefit cognitive health 4.
• B group vitamins, iron, and other micronutrients play a crucial role in cognitive health, and low-fat diets may be protective against cognitive decline 5.

Lifestyle Factors for Cognition

• A life course approach to cognitive health highlights the importance of modifiable lifestyle factors, including diet, physical activity, cognitive and social engagement, smoking, and alcohol consumption 5.
• Young adulthood and middle age are crucial periods for determining cognitive health in old age, and preventive approaches may be necessary for target populations in their 40s and 50s 5.