Nutraceutical Support for Cognitive Functions

Individual vitality and its cognitive domain

Individual vitality and its cognitive domain are crucial for understanding the overall well-being and aging process of an individual. Vitality encompasses all physical and mental capabilities divided into five interconnected domains: cognitive, motor, psychological, sensory, and physical.

The cognitive domain includes the analysis of mental state and is defined by the ability to orient, behave appropriately, and perceive the surrounding environment and situations. It involves the ability to determine time and place, acquire new skills, solve life problems, and handle difficulties. Cognitive functions comprise components like gnosis (information perception), attention (information processing and analysis), memory (information storage and recall), praxis (goal-directed motor activity), speech (information exchange), and intellect. The neurochemical bases of cognitive function are still being studied and hold significant importance in gerontological practice.

For the elderly, it’s essential to assess the ability to independently manage finances, documents, ensure the safety and reliability of their living space, desire to acquire new knowledge, ability to learn and develop, and willingness to accept help when needed.

Besides cognitive status, individual vitality also includes the ability to move, sensory abilities (vision and hearing), vitality (energy level and balance), living environment, emotional support, and relationships with others.

Individual vitality is a dynamic construct that changes over time. Monitoring the trajectory of individual vitality components allows clinicians to identify early deviations from the norm and intervene preventively to support healthy aging and evaluate the effectiveness of interventions.

Functional ability, at the intersection of environment and individual vitality, is crucial for achieving good functionality through geriatric interventions and environmental improvements, which are the main goals of modern gerontology and geriatrics.

There are two types of aging: physiological aging, which is the natural onset and gradual development of age-related changes, and premature aging, which is the most common form of aging after the age of 40-50, characterized by any partial or overall acceleration of the aging process.

Factors contributing to the decline in the cognitive domain of individual vitality throughout the life cycle, leading to an unfavorable aging profile, include repeated head injuries, sleep disorders, transient ischemic attacks, smoking, excessive alcohol consumption, and benign age-related forgetfulness.

Geriatric syndromes reduce basic functional activity and lead to adverse health outcomes for elderly patients. Stress-related regulatory system loads, chronic non-communicable diseases, lack of dietary and physical activity strategies, alter the aging process, reduce or distort the body’s adaptive capabilities, and contribute to the development of premature aging and its associated pathological processes.

Assessing health and aging type based on the cognitive domain of individual vitality

Assessing health and aging type based on the cognitive domain of individual vitality involves questionnaires, scales, and functional methods. Traditional risk factors for cerebrovascular diseases remain relevant in old age and are associated with cognitive decline and pathological aging. Gerontology focuses on cognitive impairment (CI) as maintaining intellectual functions becomes more crucial with increasing life expectancy.

Aging is a heterogeneous process accompanied by varying degrees of cognitive deficit. Research continues to show that progressive cognitive decline negatively impacts the lifespan and functional status of the elderly.

Comprehensive neuropsychological examination is conducted for cognitive domain assessment and timely prevention of cognitive impairment.

Assessing the severity of cognitive impairments (mild, moderate, severe) is essential for prognosis and therapeutic tactics. Individual programs for elderly patients involve assessing cognitive functions and identifying resources to maintain using various cognitive rehabilitation and memory training activities.

Decreased cognitive reserve is an integral part of pathological aging. Cognitive impairment research typically involves two stages: initial screening by healthcare professionals, regardless of their specialty, to identify potential cognitive impairment, followed by detailed neuropsychological assessment by a neuropsychologist to evaluate various cognitive functions, determine the degree and qualitative characteristics of impairments, and their impact on the patient’s daily life.

Commonly used tests for cognitive function assessment include the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). MMSE assesses orientation, attention, perception, memory, and speech, while MoCA is used for quick screening of mild cognitive impairments, evaluating various cognitive functions such as attention, executive functions, memory, language, visuospatial skills, conceptual thinking, calculation, and orientation.

MMSE table

Interpretation of Test Results:

• 30-28 points: Indicates normal cognitive function.
• 27-24 points: Suggests mild cognitive impairment.
• 23-20 points: May indicate mild dementia.
• 19-11 points: Could be a sign of moderate dementia.
• 10-0 points: Likely indicates severe dementia.

Development of an Individual Management Plan for Health Disorders and Unfavorable Aging Types in the Cognitive Domain

Selection of an Individualized Diet

One of the defining external environmental factors significantly affecting the health status and lifespan of elderly and old-aged individuals, preventing the risk of developing a number of age-associated diseases and conditions, as well as premature aging, is rational nutrition. Multimodal programs for the prevention of premature aging invariably include nutritional support in the form of resilience diets enriched with resilinators, and the prescription of bioregulating nutraceuticals – cellular chronoblockers. This allows for the achievement of protective clinical effects in cardiac, cerebral, osteodinapenic, menopausal, andropausal, metabolic, and immune variants of premature aging through differentiated prescriptions for impacting the nutritional domain of vitality. The main source of energy for the brain is glucose. Lipids are essential components of neurocyte membranes, and fats ensure normal nerve impulse conductivity, which supports cognitive abilities. Amino acids (leucine, phenylalanine, lysine, and threonine) play a key role in maintaining cognitive functions. The positive experience of using dietary supplements for cognitive dysfunction, containing amino acids and vitamins, should be noted separately. The supplement “VIRUIN® PRObrain” undoubtedly complements the individualized diet for cognitive deficits in the elderly and old age.

Currently, the primary nutritional program for patients with cognitive impairments is represented by the resilience diet, primarily aimed at maintaining age-related vitality and reducing the manifestations of asthenic syndrome. A distinctive feature of this diet is the maximum daily calorie intake – no more than 1500 kcal, combined with regular physical activity according to age characteristics. The main tenets of the diet are: 1. Protein intake should come from several sources, primarily: a. plant-based proteins (e.g., buckwheat, oat, barley cereals, legumes, nuts, etc.), b. animal-based proteins: – dairy-based products (e.g., cheeses, fermented milk products, cottage cheese, etc.), which are primary sources of calcium, – lean meat (e.g., chicken, turkey, rabbit); it is important to limit the intake of red meat – beef, – fish, predominantly marine (e.g., cod, salmon), which is a primary source of polyunsaturated fatty acids (PUFAs). 2. Carbohydrate intake should be limited; whole grain intake is recommended, less refined products: a. no more than 500g/day of “something green, yellow, red, crunchy,” the ratio of vegetables to fruits is regulated by the following indicators – 1.5:1 (e.g., 300g vegetables : 200g fruits); their intake is important in terms of fructose and fiber content; b. limiting the intake of tuberous crops (e.g., no more than 50g of potatoes per day allowed), c. consumption of dark chocolate with a cocoa content of at least 75% is allowed (e.g., 1 bar = 15-20g). 3. Fat intake should be limited by the principle “the less, the better”; the main source of fats – vegetable oils (olive, sunflower, etc.). 4. Salt intake should be limited, as it is present in minimal amounts in recommended food products. 5. Adherence to a hydration regime with fluid intake of no less than 30ml/kg body weight, which includes water, teas (e.g., green or herbal, containing ursolic acid, which participates in the prevention of sarcopenia, affecting cardiomyocytes), fruit drinks, etc.

An important aspect of the personalized nutrition program is the rhythm of eating. An incorrect eating rhythm can mediate an increased risk of chronic non-communicable diseases and cognitive impairments. The following eating schedule positively affects the cognitive domain: breakfast (6:30-9:30); lunch (12:00-13:30); afternoon snack (17:00-18:30); dinner (two – three hours before sleep).

3.3.2. Selection of an Individualized Level of Physical Activity

Regular physical activity is an effective method of prevention of cognitive impairments (CI). Moreover, physical activity is also considered the most substantiated among all available non-pharmacological methods to reduce the likelihood of developing and progressing cognitive deficits of any genesis. Key mechanisms explaining the relationship between physical activity and human cognitive functions have been identified. One of them involves increasing aerobic capacity, leading to the activation of cerebral blood flow, improved oxygen and glucose utilization in the brain, accelerated transport of cellular metabolism products, and activation of the antioxidant system. Another involves the production of myokines by muscles and the initiation of neurogenesis.

According to the WHO Global Recommendations on Physical Activity (2010), the recommended physical workload for healthy adults aged 18-64 includes: moderate-intensity activities for at least 150 minutes per week or high-intensity gymnastic exercises for at least 75 minutes per week, or an equivalent volume of moderate and high-intensity physical activities. For additional benefits, adult patients should increase the duration of moderate-intensity gymnastic exercises to 300 minutes per week or perform high-intensity gymnastics for up to 150 minutes per week, or an equivalent volume of moderate and high-intensity activities; 2. gymnastic exercises should be performed in several series of at least 10 minutes each; 3. strength exercises should involve the main muscle groups on 2 or more days per week. The recommended physical workload for healthy adults over 65 includes: 1. moderate-intensity activities for at least 150 minutes per week or high-intensity gymnastic exercises for at least 75 minutes per week, or an equivalent volume of moderate and high-intensity activities. For additional benefits, older adults can increase the time spent on moderate-intensity gymnastic exercises to 300 minutes per week or perform high-intensity gymnastics for up to 150 minutes per week, or an equivalent volume of moderate and high-intensity activities; 2. gymnastic exercises are performed in several series of at least 10 minutes each; 36 3. strength exercises are performed involving the main muscle groups two or more days per week; 4. balance exercises – 3 or more days per week. Recommendations regarding physical activity for patients with existing cognitive impairments differ somewhat. For older adults with mild cognitive impairments, low-intensity resistance exercises, strength exercises, and multimodal training are recommended. According to research, aerobic exercises have demonstrated greater efficiency in older patients with moderate cognitive impairments due to increased oxygen consumption by tissues and muscle mass growth. It has been established that aerobic loads of various intensities in old and elderly age improve the executive functions of the brain. Undoubtedly, an individual approach to each patient is appropriate, taking into account existing experience with physical activity, age characteristics, and multimorbidity.

Information on the Logistics of Receiving Medical Care

Individual projects to assist patients in older age groups are being developed in each region, and our priority task is to inform citizens about them. The availability and continuity of care for the elderly patient are important. The organization of medical care for the elderly should include: geriatric clinics in adult polyclinics, geriatric departments/beds in multi-specialty medical organizations, and care provided in Federal scientific centers. There is now a need not only to define the directions of state policy concerning the provision of assistance to citizens of the older generation, their families, and social institutions interacting with this category of citizens but also to actively involve citizens of the older generation in social life. Mechanisms for implementing the direction related to ensuring older citizens’ access to informational and educational resources include: improving programs for teaching computer literacy to older citizens; developing an information system about the educational services provided for older citizens; organizing professional training, additional professional education for older citizens; personalized funding for additional educational programs aimed at developing various types of functional literacy for older citizens (computer, financial, legal, language, environmental, and others). Mechanisms for implementing the direction related to the development of modern forms of social services, the social services market, include: improving mechanisms for determining the need of older citizens for social services; improving the activities of social service organizations in providing social services in a semi-residential form for older citizens; ensuring an individual approach in providing social services; developing and spreading the practice of placing orders for social services; ensuring information for citizens about the social services provided in the Russian Federation subject and social service providers; forming the “foster family” institute for older citizens, providing care for such citizens, including legislative consolidation of this institute; stimulating the creation of standard projects and the construction of standard facilities for social service organizations.

3.3.4. Nutraceutical Support VIRUIN_PRObrain

3.3.4.1. Composition of the Nutraceutical and the Action Mechanism of Components

Nutraceutical support is a key component of cognitive impairment prevention. It is necessary as an additional source of vitamins, microelements, and amino acids. The dietary supplement VIRUIN_PRObrain allows for the quick resolution of nutritional status issues in patients with a limited cognitive domain. This is related to the special role of amino acids in nervous tissue: participation in the synthesis of neuropeptides and proteins, realization of interneuronal connections, functioning as neurotransmitters and neuromodulators, and energy provision for nerve cells. The supplement consists of essential amino acids, the peptide complex IPH GAA, pyridoxine hydrochloride, and nervonic acid. Pyridoxine is considered one of the neurotropic vitamins, its molecular-biological effects spectrum is broad and includes influence on amino acid metabolism, synthesis of neurotransmitters, biosynthesis of vitamins. Pyridoxine activates metabolic processes, especially under hypoxic conditions, participates in the synthesis of neurotransmitters, GABA, glycine, serotonin. Pyridoxine, through the activation of pyridoxine-dependent and magnesium-dependent proteins, potentiates anti-inflammatory, antioxidant, anticonvulsant, and neuroprotective effects. Nervonic acid is an omega-9 replaceable acid with a very long chain. It is part of the cell membrane structure, especially in the myelin sheath. It ensures the functions of neuron membranes, prevents demyelination. The peptide complex in VIRUIN_PRObrain has a cytoprotective effect and positively affects the cognitive functioning of older age group patients. Currently, it does not require proof that the functional activity of the brain depends on the peculiarities of the biochemical organization of neurons and neuroglia, in particular, on the qualitative composition and properties of proteins. L-glutamic acid is an important neurotransmitter amino acid and plays a significant role in energy metabolism. A comprehensive histochemical study has found high brain tissue content of proteins rich in arginine and lysine. They are part of nucleoprotein complexes and constitute 35% of the mass of ribosomes, which, as is known, provide RNA synthesis in nerve cells tens of times more intensively compared to other tissues. It turned out that neurons predominantly contain proteins rich in lysine, while neuroglia contain proteins rich in arginine. L-arginine and L-lysine have neuroprotective and antihypoxic effects, as confirmed in several studies. Thus, nutraceutical support for older age group patients VIRUIN_PRObrain provides additional preventive advantages for the overall health status and positively affects the cognitive status.

Dosage, Application Features, Indications, and Contraindications

The dietary supplement “VIRUIN PRObrain / VIRUIN PRObrain.”

The ingredient composition of the supplement: food industry raw material “AMINO PEPTIDE COMPLEX IPN BRAIN MEM” (L-arginine, L-ornithine, L-theanine, L-glutamic acid, L-leucine, L-lysine hydrochloride, peptide complex IPH GAA), capsule (hydroxypropyl methylcellulose), nervonic acid, vitamin B6 (pyridoxine hydrochloride), maltodextrin. The form of release of the supplement: capsules weighing 0.60 g; 30-180 capsules per consumer package. Application area: this supplement is necessary for the population as a dietary supplement – a source of L-arginine, L-ornithine, L-theanine, L-glutamic acid, L-leucine, L-lysine, peptide IPH GAA, nervonic acid, vitamin B6. Indications for the use of the supplement: memory reduction, attention concentration, thinking productivity, stress conditions. Contraindications for the use of the supplement: individual intolerance to the components of the dietary supplement, pregnancy, breastfeeding. It is necessary to consult a doctor before using the dietary supplement. Special application features of the supplement: adults should take 1 capsule 3 times a day with meals for 1 month. If necessary, the intake of the dietary supplement can be repeated. The included ingredients improve memory, increase attention concentration, enhance thinking productivity, and have a powerful protective effect, causing CNS relaxation in stress conditions. Storage conditions of the supplement: the dietary supplement should be stored in a dry place, protected from direct sunlight and out of reach of children. The recommended storage temperature of the dietary supplement is no higher than +25°C. The shelf life of the dietary supplement is 3 years from the date of manufacture.

Conclusion

Preventive gerontological counseling for elderly and old-aged individuals is aimed at minimizing unfavorable aging. For patients with reduced cognitive reserve, personalized premature aging programs should be developed. These programs must consider all components of the individual health condition (IHC) and the severity of cognitive impairments.

It is essential to guide the patient not only towards somatic status but also towards healthy aging and longevity, and an active lifestyle overall.

The individual plan should include: an individualized diet, an individualized level of physical activity, information on the logistics of receiving medical care, and nutraceutical support.

For nutritional status support in elderly patients with cognitive impairments, the use of nutraceuticals is recommended. One of the universal supplements is VIRUIN_PRObrain. The components of the supplement improve metabolism in the brain structures and enhance cognitive function.