Is it Possible to Extend Life With Brain Nutrients? 
Outsmarting Death
 
by Will Block

Is there a correlation between the level of one's education and longevity? This seems to be the conclusion that many studies are reporting: people with higher education enjoy better health and longer life. Is it true? Is the achievement of health merely a matter of  getting a diploma? Does spending one's time in academic groves of ivy-covered buildings ensure long life? Some recent research certainly makes it seem that way.

There are many common reasons offered for equating education with better health and longer life, such as less physical and financial stress. Indeed, for many people, more education may be the key to accessing the sort of employment that characteristically entails less strenuous work and offers a controlled indoor environment, access to health care, higher pay, and the potential for greater satisfaction and more intrinsic rewards.

Figure 1. Playing Chess with Death from Ingmar Bergman's The Seventh Seal.


Death:
Your move, Antonious Block. Have you lost interest in our game?
Knight:
Lost interest? On the contrary.

Less Education Increases Risk of Disability
In support of the hypothesis that education is beneficial, a recent Italian study has added to our understanding.1 Data was gathered from 3,460 elderly individuals 65 to 84 years old (53% men; 47% women) in order to analyze the relationship between education and physical disability and mortality. The analysis revealed a correlation between education and disability. Disability risks fell as the level of education increased in this elderly population. Or in other words, disability risks climbed as educational level declined.

According to this study, individuals (born between 1914-1933) with four to five years of total education were found to have 30% less disability than those who had less than or equal to three years of education (LTE3). Individuals with six to eight years of education had 60% less disability compared to LTE3; and finally, individuals with eight years or more of education had 79% less disability compared to LTE3. The higher the education, the greater the benefit, meaning the less disability. [See Figure 2.] So far, so good. With more education, presumably, there is less manual labor and less risk of disability due to accidents.

Figure 2.

Disability Increases Death Risk
The researchers then compared levels of education with death rates. The death rate went down for those with four or more years of education, compared to those with less education. However, more education did not translate to decreased death rates, when the impact of disability as a contributor to the cause of death was removed. In other words, the more-educated, non-disabled group did not have higher mortality rates than the less-educated, non-disabled group.

In conclusion, the authors explained that those with less education had more disability. Additionally, disabled people were more susceptible to severe diseases, many of which led to death. This was particularly true for the lowest educational levels, where those who did the most manual labor had the most hazardous jobs.  From their findings, the researchers could not support the general principle that more education lowers the death rate; but could support that contention that less education tends to increase disability and that this, in turn, results in more disease and earlier death.

But other research, as we shall see, addresses our original question - "Is there a correlation between the level of one's education and longevity?" - in a different way: Is there a correlation between using one's mind and how long one lives? The answer appears to be yes.

Depression, Cognition and Death
Despite the fact that medically ill, older adults commonly experience depression and cognitive impairment, few studies have examined depression and cognitive impairment for their predictive value for increasing mortality. However, one study did just this.

Using a battery of tests on a cohort group of 667 rehabilitation-hospital patients (60 years or older), scientists qualified 455 of them by successfully measuring cognition (Dementia Rating Scale), depression (Geriatric Depression Scale), and disabilities (Functional Independence Measure).2 Vital status was assessed one year later.

Using depression and cognitive impairment as predictors of mortality, the death risk for mild depression had the lowest odds, compared to moderate depression which had the highest odds. The increased likelihood of death for those with severe cognitive impairment fell in between mild and moderate depression. This study could not conclude that the increased death risks due to depression and cognitive impairment influenced one another. Meaning that cognitive impairment and depression didn't seem to be additive for mortality.

Depression Increases Risk of Death
However, in a review of the literature on the mortality of depression, 57 studies were found; 29 (51%) were positive, 13 (23%) negative, and 15 (26%) mixed.3 The review found only a few truly well-controlled studies to provide a sound estimate of the mortality risk associated with depression. The studies linking depression to early death were poorly controlled, but they suggest that depression substantially increases the risk of death, especially death by unnatural causes and cardiovascular disease.

The higher the education, the greater the benefit, meaning the less disability. 

Loss of Episodic Memory Increases Mortality
Scientists at the Karolinska Institute in Sweden ("home" of the Nobel Prize), investigated the relationship of memory to mortality in 178 living and 44 deceased participants in the age range of 75 to 95 years.4 Measuring cognitive performance of recall memory, visual/spacial memory and verbal task memory, the researchers found a strong relationship between high levels of word recognition and fluency (speaking) skills and reduced mortality in very old age.

These cognitive performance abilities were significant predictors of mortality status. Having or not having these performance abilities was connected with longer or shorter life. In their words, the results of the study "indicate that episodic memory and verbal skill [editor's emphasis] may be particularly sensitive in predicting such effects [the risk of death]." Episodic memory is a form of long-term memory which involves the ability to relate a past experience kinesthetically (through recall of sights, sounds, smells, etc.). The tellers of epic tales (for example, Homer), would have this skill, as well as the length of life to carry out the task. This research paper lends itself to an "abbreviated" conclusion: Instead of  "those who do not remember the past are condemned to repeat it," we have "those who do not remember the past are condemned ..." increasingly to premature death!

Low Blood Pressure Plus Cognitive Impairment Impact Death Risk
Another study from the Karolinska Institute in Sweden investigated the relationship between abnormally low blood pressure and excess mortality in people over the age of 75 years.5 Low blood pressure has often been reported to be related to excess mortality in people over the age of 75 years. This is because low blood pressure in the very old may represent poor functional status, cardiac insufficiency and, more importantly, cognitive impairment. Are there other predictors that may account for the association, the authors asked?

Drawing on a community-based cohort of 1,810 people aged 75 years and older, the study went on for five years. There was an elevated relative risk of death for those with abnormally low systolic pressure or abnormally low diastolic pressure. Systolic blood pressure is the arterial pressure (maximum) during the heart's contraction, while diastolic blood pressure is the arterial pressure (minimum)  during the heart's relaxation phase.

The increased death risk was especially associated with any two or more of the following conditions: cardiovascular disease, limitation in activities of daily living, or cognitive impairment. The most emphatic correspondence was the combination of low diastolic pressure plus cognitive impairment for increased mortality. This led to the conclusion that cognitive impairment may contribute to the association of abnormally low blood pressure with increased mortality in the very old (meaning lower blood pressure or cognitive decline or both increased caused death risk). Cognitive impairment is the "smoking gun" that appeared to cause unacceptable reductions in both blood pressure and increased deaths. The authors concluded that cognitive impairment may be a component cause of abnormally low blood pressure. It is as though when you stop using your mind (cognitive impairment), your blood pressure goes down.

Cognitive Dysfunction May Mark the Beginning of the End
Are there cognitive markers for determining subsequent dementia and mortality? In a study attempting to locate these red flags, subjects between the ages 84 to 90 at baseline (when the study began) were re-examined three times over a six-year period using a comprehensive biobehavioral battery of tests.6

When low cognitive performance correlated to an increased death rate, the pattern of cognitive decline could also be seen in a downward progression of lower scores on prior examinations. The authors found it difficult to escape the strong suggestion that even the mildest cognitive dysfunction is an important clinical finding among the oldest of the old. It is apt to herald either the onset of dementia and/or mortality. Could this be the same for the less old?

Less education tends to increase disability, this in turn, results in more disease and earlier death. 

Cognitive Impairment Linked to Increased Mortality Due to Stroke
In a British study, scientific investigators took up the challenge of finding a relationship between cognitive function and specific mortality in people aged 65.7 After 20 years elapsed, a cohort of randomly selected elderly people living in the community was followed up. This cohort group on 921 men and women had taken part in a nutritional survey conducted in 1973-74 in eight areas throughout Britain. Among the tests given was an assessment of cognitive function. Also, data on health and diet had been recorded.

One of the principal findings linked cognitive impairment and increased mortality due to ischemic (lack of oxygen) stroke. When the subjects scored low on a mental test, the results correlated closely with an increased relative risk of dying from stroke, compared with those who gained the maximum score.

Vitamin C and Cognition
This same study of 1973-74 conducted a nutritional survey. They found that those individuals who had the lowest Vitamin C dietary intake or plasma concentration also had the worst cognitive function. This association - the relation between Vitamin C status and cognitive function - was independent of age, illness, social class, or other dietary variables. Twenty years later, the relation between cognitive function and risk of death from stroke strongly suggests that cerebrovascular health is important to help maintain cognitive function. Conversely, cerebrovascular disease is likely to be an important cause of declining cognitive function. Therefore ascorbate (Vitamin C) status, because of its effect on cerebrosclerosis, may determine whether cognitive function is maintained. High intake of Vitamin C may help protect the brain and its functions; i.e., it may protect against both cognitive impairment and cerebrovascular disease.

Other Brain Nutrients for Cognitive Health
There is good reason to believe that other brain nutrients may be able to help prevent the downward spiral toward severe age-related decline and premature death. Among the items that help to maintain proper cerebrovascular function are:

Acetyl L-carnitine: A "neural nourisher" helping to prevent ischemic damage caused by reperfusion following infarct, which can result in stroke.8,9

Antioxidant Vitamins: Includes Vitamins C, E, and various of the B Vitamins that have been established to reduce free radical damage in the cerebrovasculature and elsewhere in the brain.

Arginine: Can help to relax the cerebrovasculature thus preventing excessive stress-related dysfunction.10

CDP-Choline: Contributes positively to optimal brain functioning, prevention and improvement of age-related cognitive decline,11 memory retention,12 and enhanced awareness and coordination.13 Enhances membrane maintenance, and membrane repair.14

EDTA: Helps to chelate oxidative metal buildup which can cause plaque in arteries throughout the body and in the brain.

5-HTP: Because depression may be a causal factor in diabetes, cancer or stroke.15

Folate and Vitamin B6: Help reduce homocysteine buildup and concomitant cerebrosclerosis.16

Ginkgo biloba: Improves cerebral metabolism and reduces risk of hypoxic damage to the brain.17,18,19

Green Tea: Epidemiologic evidence finds less stroke associated.20

Lipoic Acid: Can significantly increase survival in rats that have suffered a stroke, if given before the stroke occurs.21

Melatonin: Antioxidant properties help provide neuroprotective functional benefits.22

Niacin: Helps prevent disruption of oxygen and the reuptake of blood flow back into the brain.23

Vinpocetine: Increases oxygen availability and glucose to brain; operates as neuroprotector.24 Helps prevent the initiation of intracellular molecular cascades that may result in the  irreversible damaging of neurons.

Impaired Cognition: Predictor of Dementia and Mortality
At the Albert Einstein College of Medicine in Bronx, NY, clinical studies done on cognitive impairment among the elderly have been linked to mortality.25 Cognitive impairment and other social and health factors were assessed in 1,855 elderly community residents, with periodic follow-ups to assess changes in health and survival.

At the beginning of the study, 33% of the elderly were diagnosed with mild cognitive impairment and 8% with severe cognitive impairment. After four years the survival probability spread for the following groups was: 15% of the unimpaired had died, 31% of the mildly impaired had died, and 49% of the severely impaired subjects had died. After allowances were made for the effects of other health and social covariants, the most cognitively impaired were 70% more likely to die than the unimpaired. There was substantially increased risk as well for those only mildly impaired. They were about 1/3 more likely to die.

In yet another study, neuropsychological function was assessed in 2,123 Framingham Heart Study participants and was found to be related to mortality in a study spanning 8 to 10 years.26 The Framingham Study is one of the longest continuous research projects in the U.S. During the 8 to 10 years, about 1/4 of the subjects died. The authors' analysis found a solid connection between poor cognitive function and an increased risk of death. The relative risk of dying was substantial for poor cognitive performance results when compared to high performance.

This finding is consistent with the finding of other researchers that cognitive impairment is a significant predictor of dementia and mortality. To say the least, extended survival can result from early detection of impaired cognition if attention is given to improving overall health and especially that of the brain.

Studies suggest that depression substantially increases the risk of death, especially death by unnatural causes and cardiovascular disease. 

Low-Cognitive Performance Among the Non-Demented Increases Mortality
A French study investigated the issue of whether low-cognitive performance can independently predict mortality even in non-demented elderly individuals.27 More than 2,100 65-year old individuals were selected because they had no major physical or cognitive disabilities at entry in the study. However, within three years, 179 (8.3%) had died, with mortality rates accelerating with age.

Extensive cognitive tests proved predictive of increased patterns of mortality which accelerated as the test scores decreased. Subjects scoring in the lowest quartiles had the highest mortality rates. Compared to the highest performers, subjects who scored lowest in their overall cognitive performance had an increased death rate that was more than triple.

Cognition and Pneumonia
The National Institute on Aging, part of the National Institutes of Health in Bethesda, MD, examined the causality of pneumonia-related mortality by looking at the role of functional and cognitive limitations in the risk of mortality in older adults.28 Pneumonia is frequently listed as the cause of demise on death certificates. Three widely spread communities contributed  more than 10,000 subjects (61% women and 39% men) ages 65 or older. Subjects were given baseline interviews between 1981 and 1983. They were followed for as many as six years.

When women were no longer fit enough to walk a half-mile, climb stairs, or perform heavy housework, pneumonia mortality significantly increased. If their body-mass index was above the median, both men and women reported significantly lower risk of pneumonia mortality, unlike those whose body-mass index was significantly below the median. In other words, being too thin was a problem for whatever reason.

Pneumonia was examined as an underlying, immediate, or contributing cause of death with a total of 243 men and 160 women dying from it. There was a significantly increased risk of pneumonia mortality associated with limitations in daily living activities and cognitive impairment. This was true for both men and women.

Take Your Brain Supplements
Undoubtedly, there is enough intelligent evidence supporting the desirability of maintaining a bountiful brain. There can be little doubt that the studies with the elderly will give us further insight when considering our health strategies and supplement insurance policies. Science has a long way to go before finding the magic bullet that entirely prevents or eradicates degenerative disease and aging. That doesn't mean that you can't or shouldn't do anything now to slow the ravages of aging and keep yourself mentally fit. When the breakthroughs arrive, won't you be glad to still have your cognitive "cake" and thus be able to serve yourself another slice of life too? 

References

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