Cognitive dysfunction and chiropractic: should chiropractors address cognitive wellness with patients?
The number of Americans living with Alzheimer’s DISEASE (AD) is growing — and growing fast. More than 6 million Americans of all ages have Alzheimer’s. An estimated 6.2 million Americans aged 65 and older are living with Alzheimer’s in 2021, and by 2025, the number of people age 65 and older with AD is estimated to reach 7.1 million, about 35% more than presently. Some estimates are as high as 16 million, making cognitive dysfunction and chiropractic care an important topic of discussion.
Between 2000-19, the number of deaths from Alzheimer’s disease as recorded on death certificates has increased by 145%, while the number of deaths from the number one cause of death, heart disease, decreased by 7.3%. More and more patients are afraid of losing their memory.
Changes in the brain and dementia
The CDC states that “Subjective Cognitive Decline (SCD) is a form of cognitive impairment and one of the earliest noticeable symptoms of Alzheimer’s disease and related dementias.”1 It is defined as the self-reported experience of worsening confusion or memory loss. Signs and symptoms include:
- Memory loss, such as forgetting names, places or recent events
- Problems with organizing or planning
- Struggling with multitasking
- Difficulty with recognizing faces
- Difficulty finding words
- Misplacing items
- Problems calculating a tip or paying bills
- Slower recall
They go on to say that nearly 20 million Americans, or 1 in 9 adults, currently deal with subjective cognitive decline, and more than half of these individuals will develop more severe cognitive issues within 7-15 years.
Brain atrophy and cognitive reserve
The anatomical changes in the brain associated with cognitive decline are well-documented. At present, a growing number of neuroimaging studies have suggested that patients with Subjective Cognitive Decline show atrophy of gray matter volume, degeneration of white matter fiber structure, and reduction of spontaneous functional activity in the frontal, lateral temporal and parietal cortices.2,3 These areas of the brain are usually the first to be affected by Alzheimer’s and other dementias.
Research studies have proven that as we get older, we have a greater risk of developing impairments in areas of cognitive function. The trajectory of this cognitive decline can vary considerably from one person to the next. Despite these varying trajectories, one thing is for sure: Even cognitively normal people experience pathological changes in their brains as they age.
However, many people can function normally in the presence of significant brain damage and pathology. So why do some experience symptoms of Alzheimer’s and dementia, while others remain sharp of mind?
It comes down to something called cognitive reserve. This is a concept used to explain a person’s capacity to maintain normal cognitive function in the presence of brain pathology. To put it simply, some people have better cognitive reserve than others. Some people have better resilience to the effects of aging because they have developed a better capacity or “reserve” to cope with changes.4
Cognitive reserve is the concept that people develop a reserve of thinking abilities during their lives, and that this protects them against losses that can occur through aging and disease. Consequently, they develop resilience and have more reserve to call on in older age.
The idea that you can increase your cognitive reserve is a hot topic in research these days. It implies the possibility of preventing or compensating for cognitive decline by strengthening nerve networks and even building new ones through intellectual and social stimulation. A study by Mayo Clinic researchers found that stimulating activities such as digital computer-based brain exercises were associated with a 30-50% decrease in the chances of developing mild cognitive impairment.5
Building cognitive reserve
The good news is cognitive issues can be prevented or delayed. People can maintain cognition through activities that are designed to improve cognitive functioning.
Digital, online cognitive wellness programs have been introduced to the chiropractic profession, designed to make it easy and affordable to introduce the concept of cognitive dysfunction and chiropractic care. Programs are completely online and done from the patient’s own computer, tablet or phone. They include all the key components to optimizing cognitive performance, such as:
- Cognitive assessments to monitor cognitive function
- Brain exercises to create and strengthen neuronal pathways
- Heart rate variability training to improve meditation
- Gamma brain wave entrainment to enhance memory
- Lifestyle changes to insure optimal cognitive function as we age
In a study published in the Journal of Alzheimer’s Disease, researchers were able to prove that brain exercises increase gray matter in the brain.
This study examined 19 patients suffering with Subjective Cognitive Decline. They measured the volume of gray matter of different areas of the brain using magnetic resonance imaging. Then, those 19 patients did brain training exercises specifically for episodic memory for two months. At the end of two months, researchers measured the gray matter again and found significant increases of gray matter volume in the brain regions responsible for episodic memory (hippocampus).
Since gray matter is composed of synaptic connections, this increase in gray matter volume represents neuroanatomical evidence that brain training exercises can result in neuroplastic changes in the brain.6
The FINGER study was multi-year and examined 1,260 adults at risk for cognitive decline.
Researchers found that people who engaged in cognitive training and lifestyle changes demonstrated improved cognitive performance. At the end of the study there was a 25% improvement in overall cognition, a 40% improvement in memory function, an 83% improvement in processing speed and a 25% improvement in executive function.7
In 2021 a study was conducted of five patients between the age of 45-59 who were at moderate or high risk of Subjective Cognitive Decline. Each patient was given a full cognitive assessment that included nine individual assessments designed to measure different aspects of cognitive function. For the next 30 days, each patient used brain exercises and a coherence training tool three to five times per week for 15 minutes each time. Then, each patient took the cognitive assessment again and the scores were compared. There was an overall improvement in cognitive assessment scores of 16.2%.8
Cognitive dysfunction and chiropractic: Implementing a wellness program
No one is immune to cognitive decline, but there are things we can do to maintain our cognitive health as we get older in regard to cognitive dysfunction and chiropractic care. It’s important to note that it is never too early to begin paying attention to cognitive health.
In a study carried out by the Alzheimer’s Society, 62% of those surveyed were most afraid of losing their memory.9 Most of those surveyed feel there is nothing they can do to prevent this from happening. They have no idea there are proven tools they can use now to prevent memory loss later.
As chiropractors we preach the concept of wellness to our patients and we recognize things like receiving chiropractic adjustments, exercising, eating healthy and sleep hygiene are all important parts of a wellness program. However, most of us are not addressing cognitive health and this is truly unfortunate. Utilizing an online cognitive wellness program for cognitive dysfunction and chiropractic care is an easy and affordable way to introduce cognitive wellness into an overall wellness program with our patients.
GUY ANNUNZIATA, DC, is the founder and developer of the CerebroCore Cognitive Wellness Program designed specifically for chiropractors to use with their patients. To learn more about implementing this program in your office, please email email@example.com or call 843-338-1838.
- Fan LY, Lai YM, Chen TF, Hsu YC, Chen PY, Huang KZ, Cheng TW, Tseng WI, Hua MS, Chen YF, Chiu MJ. Diminution of context association memory structure in subjects with subjective cognitive decline. Hum Brain Mapp. 2018 Jun;39(6):2549-2562. doi: 10.1002/hbm.24022. Epub 2018 Mar 8. PMID: 29516634; PMCID: PMC6866359.
- Liang L, Zhao L, Wei Y, Mai W, Duan G, Su J, Nong X, Yu B, Li C, Mo X, Wilson G, Deng D, Kong J. Structural and Functional Hippocampal Changes in Subjective Cognitive Decline From the Community. Front Aging Neurosci. 2020 Mar 17;12:64. doi: 10.3389/fnagi.2020.00064. PMID: 32256336; PMCID: PMC7090024.
- Yaakov Stern, Daniel Barulli, in Handbook of Clinical Neurology, 2019
- Engvig A, Fjell AM, Westlye LT, Skaane NV, Dale AM, Holland D, Due-Tønnessen P, Sundseth O, Walhovd KB. Effects of cognitive training on gray matter volumes in memory clinic patients with subjective memory impairment. J Alzheimers Dis. 2014;41(3):779-91. doi: 10.3233/JAD-131889. PMID: 24685630.
- Ngandu T, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015 Jun 6;385(9984):2255-63. doi: 10.1016/S0140-6736(15)60461-5.