Introduction: Why Cognitive Decline Matters
Concerns about memory and brain health are increasingly common, both in clinical practice and in everyday life. Clients often want to know whether their forgetfulness or mental “slowness” is part of normal aging or a sign of something more serious. Families may also raise concerns when they notice changes in a loved one’s thinking, problem-solving, or communication.
As clinicians and caregivers, we also have questions and understanding where to begin—what is typical, what is concerning, and what to look for—is an important first step.
Common Signs of Cognitive Changes and How to Respond
Clients bring concerns to us about memory loss or changes in cognitive function, including processing speed, thinking, and problem-solving. Many complain of short-term memory loss. How should we respond, and what are the basics to begin with? Sometimes individuals dismiss their own symptoms, while family members or friends may be the first to notice changes. Or, individuals may be concerned, and family and friends may dismiss or minimize their concerns.
Some memory decline is a regular part of aging, but in some cases, it may be an early sign of mild cognitive decline that leads to any number of types of dementia. Medical, emotional, or lifestyle factors can also play a role, and some causes are reversible. Depression affects memory, as does anxiety, PTSD, and chronic complex trauma. Gentle screening and referrals to medical or neurological care can be part of your approach to care.
A simple screening test for cognitive decline is the MoCA Test. I encourage the clinician to do this with the client to assess results in real time and allay any fears that may arise.
Depression, Trauma, and Memory Loss
Depression and chronic trauma can significantly affect memory and cognitive function, sometimes mimicking dementia symptoms. Research shows that depression in midlife or later increases the risk of developing dementia, possibly due to stress-related changes in brain structure and function (JAMA Neurology, 2023).
Post-traumatic stress disorder (PTSD) and complex trauma are also linked to cognitive decline. Individuals with severe PTSD symptoms may experience worse memory, attention, and processing speed, and PTSD has been associated with a higher long-term risk of dementia (Nature Communications, 2023).
Recommended Screening Tools
To assess depressive and stress-related symptoms, the following screening tools are recommended:
- CES-D (Center for Epidemiologic Studies Depression Scale): A 20-item scale designed to measure the frequency of depressive symptoms in the general population.
- Perceived Stress Scale (PSS): A tool that measures perceived stress and how individuals cope with challenging situations.
These tools help identify individuals at risk and guide early interventions.
Clinical Pearl: Improving sleep can enhance both cognitive function and mood. Adequate, restorative sleep helps the brain consolidate memories, supports attention and problem-solving, and reduces the negative impact of stress and depression on cognitive health.
The Role of Sleep in Cognitive Function
Poor quality sleep, failure to get into enough REM and deep restorative sleep, along with sleep apnea, are common yet often undiagnosed in older adults. They can impair memory and attention, leading to daytime sleepiness and even accidents if people fall asleep while driving. Symptoms include more than just cessation of breath and snoring while asleep and can also include sleeping with the mouth open.
While the in-patient sleep study is considered the gold standard, some people find it difficult to sleep with wires covering them and fail to achieve a deep enough sleep to obtain an accurate reading. Home units, by contrast, are cost-effective and may increase adherence to testing opportunities.
In addition to CPAP (Continuous Positive Airway Pressure), which many people resist, there are mouth exercises to strengthen the muscles of the mouth and tongue, as well as a new product called Excite OSA for mild obstructive sleep apnea (OSA).
Alzheimer’s and Other Types of Dementia
- Alzheimer’s disease is the most common type of dementia, gradually affecting memory and reasoning, sometimes starting in middle age.
- Vascular dementia results from reduced blood flow or strokes and may progress gradually or suddenly, especially in people with cardiovascular risks.
- Lewy body dementia impacts memory, movement, and alertness, often causing vivid hallucinations.
- Frontotemporal dementia more often affects personality, judgment, and language than memory; typically begins before the age of 65.
- Mild cognitive impairment (MCI) involves noticeable changes that may be situational, remain stable, or progress to dementia, making regular monitoring essential.
For perspective, about 15% per year of people diagnosed with MCI progress to Alzheimer’s disease. Within 5 years, 30–50% may progress to dementia, and over 10 years, studies suggest 50–70%. The takeaway is that MCI should not be ignored. There really is no such thing as “normal” memory loss.
Nutritional Deficits, Health and Cognitive Health
- Vitamin B12 deficiency, more common in vegans, vegetarians, and those with limited food access, can cause confusion and mood changes, but often improves with supplements.
- Hypothyroidism can lead to fatigue and slowed thinking, but usually improves with thyroid treatment.
Medications and Medical Conditions That Affect Memory
- Polypharmacy, especially sedatives, antihistamines, or antidepressants, may impair cognition and should be reviewed regularly.
- Alcohol-related brain changes can sometimes improve with sobriety and proper nutrition.
- Traumatic brain injuries, especially from falls, raise dementia risk and require prevention strategies.
- Delirium, a sudden and severe form of confusion often caused by illness or medication, is a medical emergency.
- Normal Pressure Hydrocephalus can mimic dementia or Parkinson’s disease but may be treatable if identified early. Symptoms include gait disturbance, urinary incontinence, and cognitive decline.
Hearing Loss and Cognitive Decline
Hearing loss places extra strain on the brain as it works harder to interpret incomplete sounds. This can reduce attention and memory capacity, leading to fatigue and confusion. It also accelerates brain changes in areas responsible for memory and language.
Hearing difficulties may cause social withdrawal, depression, and isolation—factors strongly linked to cognitive decline. Untreated hearing loss may also reflect broader neurological changes and could serve as an early sign of dementia.
A systematic review found a significant relationship between hearing loss and cognitive decline in the elderly, suggesting that addressing hearing loss could help improve cognitive function. The study also noted that moderate or severe hearing loss had a strong relationship with cognitive impairment, even after adjusting for various factors.
A Whole-Health Intervention Checklist for Prevention and Care
To assess, prevent, maintain, or reverse cognitive decline, consider the following areas:
- Medical and neurological evaluation following a positive MoCA score
- Mood and trauma history
- Sleep quality
- Nutrition and thyroid health
- Medication and substance use
- Injury and fall prevention
- Hearing and sensory health
- Social connection and emotional well-being
Learn a Comprehensive Approach to Protecting Brain Health Using Integrative Strategies for Cognitive Decline
Cognitive decline is influenced by many factors—memory changes, depression, trauma, sleep, nutrition, and medical conditions all play a role. While small changes are part of normal aging (as well as depression and ADHD), others may signal early cognitive impairment that deserves attention.
In my certification course, Nutrition & Integrative Medicine for Diabetes, Cognitive Decline, and Alzheimer’s, I guide healthcare professionals through evidence-based, integrative strategies to support brain health, address cognitive decline, and understand the connection with Type 2 diabetes. Learn practical approaches you can apply in your practice to help patients maintain memory, mood, and overall cognitive wellness.
In the course, you will find physical exercises, special right-left brain stimulation, the use of energy medicine, delicious recipes for food and herbs, and specific protocols that guide your use of supplements. I also have a detailed pharmaceutical guide (reviewed by my favorite pharmacist! that helps you make choices and especially defines drug-nutrient-herb interactions.
References
Conceição Santos de Oliveira, D., Gomes-Filho, I. S., Araújo, E. M., Xavier Ramos, M. S., Freitas Coelho, J. M., Marques, A. A., Hintz, A. M., Firmino Rabelo, D., Figueiredo, A. C. M. G., & da Cruz, S. S. (2023). Association between hearing loss and cognitive decline in the elderly: A systematic review with meta-analysis study. PLoS ONE, 18(11), e0288099. https://doi.org/10.1371/journal.pone.0288099
Elser, H., Horváth-Puhó, E., Gradus, J. L., et al. (2023). Association of early-, middle-, and late-life depression with incident dementia in a Danish cohort. JAMA Neurology, 80(9), 949–958. https://doi.org/10.1001/jamaneurol.2023.2309
Fischer, P., Jungwirth, S., Zehetmayer, S., Weissgram, S., Hoenigschnabl, S., Gelpi, E., Krampla, W., & Tragl, K. H. (2007). Conversion from subtypes of mild cognitive impairment to Alzheimer’s dementia. Neurology, 68(4), 288–291. https://doi.org/10.1212/01.wnl.0000252358.03285.9d
Prieto, S., Nolan, K. E., Moody, J. N., et al. (2023). Posttraumatic stress symptom severity predicts cognitive decline beyond the effect of Alzheimer’s disease biomarkers in veterans. Translational Psychiatry, 13, 102. https://doi.org/10.1038/s41398-023-02354-0
She served as a Fulbright scholar on traditional medicine, a Clinical Fellow at Harvard Medical School, and a National Institutes of Health-funded research scientist in mind/body medicine.
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