"Brain Boosters" - Do They Help Mild Cognitive Impairment and Dementia?

Brain Boosters. They are an ever-growing field of medications and supplements known as Nootropics - cognitive enhancers and smart drugs - that continue to gain traction in the United States Nootropics is a compound word that was created in 1972 by two Greek words ‘nous’ which means mind, and ‘tropos’ which means to bend or turn. For this blog, we will focus on the over the counter supplements, targeting older adults and those experiencing cognitive difficulties.

We’ve all seen them in stores and heard them advertised on television, promising increased cognitive abilities and the ability to boost memory. The ads all tout the same thing, that their product “keeps your mind sharp and memory strong with an ingredient that’s clinically proven to improve memory and recall in healthy adults. It’s powered by the #1 clinically studied ingredient for memory among leading brain health supplements.”

Let’s look at the last sentence in this ad – “powered by the #1 clinically studied ingredient for memory among leading brain health supplements.” Notice it doesn’t say the #1 “proven” supplement, it says #1 clinically studied ingredient. But read it fast and it looks impressive. And then comes this disclaimer at the bottom of each advertisement, "These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease and results may vary. Testimonial results are not typical. Customers may have received a gift certificate after submitting their testimonial."

Maybe not as good as the ad makes it sound. But with the greying of America and an ongoing focus on Alzheimer's and other types of dementia, why would those selling these supplements waste time with the truth when there is cash to be made? So are these OTC nootropics effective and are older adults really buying into this craze?

According to a 2019 survey conducted by the American Association of Retired Persons (AARP), nearly one in four adults over the age of 50 are taking brain supplements for health reasons making them a multi-billion dollar industry that continues to grow at a rapid pace, with a quarter of our seniors spending hundreds if not thousands of dollars annually in an attempt to ward off cognitive decline as they age. There are several dangers in this, most importantly, putting off a visit to the doctor when such symptoms present in favor of these modern-day snake oil products when medical treatment, at an early stage of cognitive decline, could offer some help.

According to multiple medical journals, a review of studies to date have found no good evidence that such products can prevent or even delay the onset of memory lapses, mild cognitive impairment (MCI), or dementia in older adults.

Some of the most widely touted supplements or ingredients contained in these supplements have been studied for their effectiveness. These include fish oils (omega-3 fatty acids), B vitamins such as folate, B6 and B12, Ginkgo Biloba extract, made from the leaves of the gingko tree, ginseng and more. And what were the findings?

For Gingko Biloba, a study of nearly 3000 adults, as cited in Lancet Neurology, who presented with memory complaints were given a dose of Ginkgo Biloba twice a day for five years. The findings? Those who took this extract had no fewer cases of Alzheimer's than those who took the placebo (a pill with no active or study ingredients).

What about the fish oils? There have been some studies that found that diets high in Omega 3s may lower the risk of developing dementia, but a review of those studies found that thousands of older adults found that those who took omega-3 fatty acid supplements had no fewer dementia diagnoses or better scores on tests of short-term memory than those who took a placebo.

B vitamins also appeared to offer little in the way of protection. A 2015 review of studies found that supplementation with B6, B12, and/or folic acid failed to slow or reduce the risk of cognitive decline in healthy older adults and did not improve brain function in those with cognitive decline or dementia.

Then came a recent study of a large number of supplements for the actual amounts of B vitamins, omega-3 fatty acids, vitamin D, caffeine, coenzyme Q10, and Ginkgo Biloba actually contained in the product. What came about in the study, however, was a finding that some of the products contained a drug called piracetam which is not permitted in to be in supplements in the United States due to harmful side effects.

Piracetam is approved for prescription use in Europe, where the typical daily dose for someone with dementia is 2,400 to 4,800 milligrams (mg), however, it has been associated with adverse psychological and psychiatric effects including depression, anxiety, insomnia, and weight gain. Because they require a prescription, such side effects can be monitored and managed by providers, but when included in unregulated OTC supplements without any medical oversight, problems occur.

There are a lot of unknowns for these supplements, particularly when they’re being used at potentially higher doses than have been studied and, as we wrote earlier, without the supervision of a physician.

Large doses of some vitamins, minerals and even some herbs can cause side effects, such as nausea, diarrhea, constipation, fainting, headaches, seizures, heart attack, or stroke, and even lead to liver or kidney damage. Products that contain melatonin can offer its own dangers as it is not recommended for those with dementia due to the “risk of increased falls or other adverse events.”

Perhaps most important when it comes to senior health is to be aware that the use of dietary supplements may have harmful interactions with prescription medications and could prevent them from working as they should. Let's take a look at some of them:

  • BLACK COHOSH - Black cohosh has been shown to reduce the effectiveness of such drugs like amiodarone, fexofenadine (Allegra), glyburide, and many statin medications.

  • CURCUMIN - A single study showed that curcumin could cause decreased levels of many antidepressant and antipsychotic medications and has also been shown to increase sulfasalazine (Azulfidine) levels.

  • GARLIC - Garlic extract has been shown in human studies to decrease concentrations of colchicine, digoxin, doxorubicin (Adriamycin), quinidine, rosuvastatin (Crestor), tacrolimus (Prograf), and verapamil should not be combined with garlic supplements.

  • GINKGO - Ginkgo is known to inhibit platelet aggregation, which could theoretically increase bleeding risk, especially in combination with antiplatelet or anticoagulant drugs such as warfarin.

  • GOLDENSEAL- Goldenseal has been shown to inhibit two major metabolic enzymes which are responsible for the metabolism of more than one-half of currently used pharmaceutical agents (Goldenseal, by the way, has been a favorite of those abusing certain drugs as a way to "pass" a urine test, although the effectiveness is in doubt).

  • GREEN TEA EXTRACT - Green tea extract has been investigated for the ability to increase simvastatin (Zocor) concentrations and inhibit the transport of many medications, including statins, fluoroquinolones, some beta-blockers, and antiretrovirals.

  • KAVA KAVA - Kava kava has been shown to inhibit the metabolizing of many nonsteroidal anti-inflammatory drugs, angiotensin receptor blockers, glipizide (Glucotrol), glyburide, rosiglitazone (Avandia), valproic acid (Depakene), warfarin, proton pump inhibitors, phenytoin (Dilantin), and clopidogrel (Plavix). Caution should also be exercised in patients using central nervous system depressants, such as benzodiazepines or alcohol, because of the increased risk of drowsiness and motor reflex depression.

  • ST. JOHN'S WORT - St. John's Wort has been shown in multiple human studies to reduce concentrations of cyclosporine (Sandimmune), tacrolimus, warfarin, protease inhibitors, irinotecan (Camptosar), theophylline, digoxin, venlafaxine, and oral contraceptives.

  • GINSENG - Caution advised about concomitant use with phenelzine (Nardil), warfarin (Coumadin), oral hypoglycemics, insulin, or caffeine, and about use in patients with hypertension or bleeding.

As for the Food and Drug Administration (FDA), they do not treat supplements like prescription medication and therefore manufacturers are not held to the rigorous clinical trials that are required to prove the claims they make. Many supplements are not tested for accuracy of the ingredients that are stated on the bottle nor do they have the need to prove through legitimate scientific methods that their products work period.

Dr. John Stoukides, Alzheimer's researcher and Director of Geriatrics at Roger Williams Medical Center.

On a recent Connelly Law's Southcoast Seniors Radio Show on WPRV am790, our guest was Dr. John Stoukides, a renowned Alzheimer’s disease researcher and the Director of Geriatrics at Roger Williams Medical Center in Providence, RI and the medical director and lead researcher at Rhode Island Mood & Memory Research Institute. When he was asked about these products, he was quite clear, “Save your money,” he said. Instead, Dr. Stoukides stated that those with MCI do better by “adopting healthier lifestyles, including exercise and eating a more nutritious diet.”

Here's the bottom line, to date, scientific evidence does not support the use of any supplement to prevent, slow, reverse, or stop MCI or dementia or other related neurological diseases. Many of these unproven and costly "remedies" pass quickly through the kidneys and into the toilet, prompting many medical providers in other parts of the globe to say, "Americans have the most expensive urine in the world."

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