Initial presentation
The client, a 68-year-old female retired schoolteacher, presents with brain fog, short-term memory lapses (forgetting names & misplacing items) and slower mental processing over the past year. She is otherwise physically healthy. Her mother had Alzheimer’s disease (AD).
Her sleep is fragmented, waking 1-2 times per night. She reports mild anxiousness about her cognitive decline.
Moderate intake of dietary fibre, low protein intake, tends to skip breakfast. She typically has a sandwich for lunch of white bread with ham, tomato, lettuce and cheese, and a piece of fruit. Sedentary lifestyle; walks occasionally. She lives with her husband but has limited social engagement since retirement.
Naturopathic assessment
68-year-old female presents with brain fog, short-term memory lapses, delayed mental processing and fragmented sleep. Likely caused by age-related cognitive decline, nutritional gaps and neuroinflammation.
Key factors considered
· Cognitive decline – While some level of cognitive slowing is expected during the aging process, more severe or progressive impairment can indicate neurodegenerative disorders such as AD. Age-related brain atrophy is driven by synaptic loss rather than neuronal death, whereas AD is characterised by substantial loss of neurons and synapses.
· Neuroinflammation & oxidative stress – Neuroinflammation and oxidative stress are central to the onset and progression of neurodegenerative disorders. These processes are bidirectionally linked; oxidative stress activates pro-inflammatory pathways, and inflammatory cells generate reactive species that further exacerbate oxidative damage. The brain is particularly vulnerable to oxidative stress because of its high metabolic rate and oxygen consumption. Mitigating oxidative stress is imperative for managing the neuroinflammatory cascade associated with cognitive decline.
· Nutritional gaps – Adequate nutrition plays an important role for maintaining cognitive health. Protein, B group vitamins, vitamin D, iron, polyunsaturated fatty acids (PUFAs) and antioxidants are key nutrients that help protect against cognitive decline.
· Mild anxiety & sleep disturbances – Anxious feelings can disrupt sleep and poor sleep quality is known to worsen cognitive performance. Addressing anxiety and improving sleep hygiene may support better cognitive functioning.
· Gut-brain axis – A healthy gut microbiome is linked to better brain function and mental well-being and is mediated through this axis. The gut microbiota affects brain health through the release of endotoxins and SCFAs (short-chain fatty acids) that modulate gut permeability and various immune functions. Emphasising the importance of dietary fibre and probiotics to ensure a healthy microbiome.
Herbal medicine
Ginkgo (Ginkgo biloba) – Enhances cognition and working memory by reducing neuroinflammation and inflammatory markers, particularly when ageing is a contributing factor. Its constituents ginkgolides, kaempferol and quercetin exert potent antioxidant properties to support cellular regeneration.
Bacopa (Bacopa monniera) – A nootropic herb that enhances cognitive function and memory. It works by stimulating dendritic growth to improve neuronal communication. Its antioxidant properties protect neurons from oxidative stress, which is a key factor in cognitive decline.
Lion’s Mane (Hericium erinaceus) – Clinically shown to cross the BBB (blood brain barrier) and stimulate the NGF (nerve growth factor), exerting notable neuroprotective properties. It supports the growth, maintenance and repair of neurons and has been shown to improve mild cognitive impairment and mood disorders.
Turmeric (Curcuma longa) – A potent anti-inflammatory and antioxidant that is clinically shown to protect against lipopolysaccharide damage and neuroinflammation. It has shown additional benefit in reducing damage to the blood-brain barrier and suppressing mitochondrial-mediated neuronal death.
Black pepper (Piper nigrum) – Enhances the absorption and bioavailability of curcumin, to amplify its therapeutic properties. A potent antioxidant to neutralise reactive oxidative species (ROS).
Passionflower (Passiflora incarnata) – A nourishing herb for the nervous system, it works to alleviate feelings of anxiousness and induce relaxation and calm. Its hypnotic properties support deep and restful sleep.
Skullcap (Scutellaria lateriflora) – Acts as a tonic for the nervous system to relieve anxiety. Its neuroprotective and antioxidant properties work to reduce oxidative stress associated with cognitive decline.
Valerian (Valeriana officinalis) – A calming herb that relieves anxiety and supports healthy sleep patterns.
Herbal formula for cognition support – 200 mL
Ginkgo (Ginkgo biloba) 3:2 – 40 mL
Bacopa (Bacopa monniera) 1:2 – 50 mL
Lion’s Mane (Hericium erinaceus) 1:2 – 50 mL
Turmeric (Curcuma longa) 1:1 – 55 mL
Black pepper (Piper nigrum) 1:2 – 5 mL
Dosage: 7.5 mL twice daily (BD).
Herbal formula for sleep and anxiety – 200 mL
Passionflower (Passiflora incarnata) 1:2 – 60 mL
Skullcap (Scutellaria lateriflora) 1:2 – 60 mL
Valerian (Valeriana officinalis) 1:2 – 80 mL
Dosage: 10 mL 30 minutes before bed. Another 5 mL if the client wakes during the night.
Additional recommendations
Dietary modifications
· Increase omega-3 intake – Include oily fish in the diet 2×/week. Consume 2 Tbsp walnuts, hemp seeds or chia seeds daily, cycle these for variation. Omega-3 fatty acids are critical for neuroprotection; DHA alone accounts for over 40% of PUFAs in neuronal tissue. Adequate intake is associated with improved memory, enhanced cognitive function and reduced neuroinflammation.
· Increase dietary intake of polyphenols – Polyphenols are abundant in brightly coloured fruits and vegetables, whole grains, nuts, seeds and culinary herbs. They can cross the BBB, where they suppress neuroinflammation by downregulating inflammatory markers including IL-1β, IL-6 and TNF-α. Their potent antioxidant activity helps neutralise excess ROS, supporting cognitive resilience.
· Introduce breakfast – Start small, manageable options such as a handful of nuts, ½ cup berries or 2 Tbsp of Greek yogurt with chia seeds. The intention is to increase nutrient intake without overwhelming the client, as meal size and diversity can be built overtime.
· Increase protein intake – Protein is essential for brain health and neurotransmitter functioning. Animal sources include eggs, poultry, red meat, fish, shellfish and dairy. Plant-based sources include tofu, tempeh, legumes, nuts and seeds.
· Add rosemary sprigs to water – For additional cognitive support, rosemary stimulates circulation to enhance blood flow to the brain, supporting memory and mental clarity.
Lifestyle modifications
· Increase social interaction – Join a community group that aligns with her personal interests (gardening, crocheting, cooking, chess group). Social engagement is a well-established protective factor against cognitive decline and dementia. It helps reduce risk by increasing cognitive reserve and supporting brain maintenance through stress reduction. Research indicates that individuals with diverse social interactions tend to have greater gray matter volume, which is essential for memory, decision making and emotional regulation. Engaging with community activities can also provide a stronger sense of purpose, which is associated with improved verbal fluency, better episodic memory and lowered risk of mild cognitive impairment.
· Increase physical activity in nature – Aim for at least 30 min of moderate aerobic activity (brisk walking) 4x week outdoors. Outdoor exercise increases cerebral blood flow and enhances executive functions including attention, memory and inhibitory control. Researchers found study participants who walked in nature performed significantly better on a cognitive task compared to those who walked in an urban environment. Revealing outdoor exercise to enhance cognitive function to a greater extent than indoor exercise.
· Sleep hygiene – Establish a regular sleep–wake schedule, reduce evening screen time, create a restful sleep environment and use herbal sleep formula just before bed to support deep sleep. During deep sleep, the brains glymphatic system is activated, clearing out wastes and harmful proteins such as amyloid-β. This process is critical for maintaining brain health and function.
· Cognitive stimulation – Engage in mentally stimulating activities including reading, puzzles, sudoku and social activities. Cognitive stimulation enhances neuroplasticity and builds a functional reserve of neurons against future cell loss.
· Stress management – Practice relaxation techniques including mindfulness meditation, breathing exercises, yoga or tai chi to reduce stress and support cognitive resilience.
Supplements
· Vitamin B-complex – Folic acid, B12 and B6 vitamins are particularly indicated for preserving cognitive function.
· Vitamin D – Low levels are associated with impaired cognitive function.
· Iron – For the transport of oxygen to the brain. IDA (Iron deficiency anaemia) is a risk factor for short- and long-term cognitive impairment.
· Magnesium-L-threonate – Optimal levels of magnesium are associated with lower risk of dementia, as it protects neurons and preserves cognitive function. Magnesium-L-threonate can cross the BBB where it works to improve neuronal plasticity.
· Strain-specific probiotic – To support cognitive health via the gut-brain axis. Lactobacillus plantarum, Lactobacillus brevis, Bifidobacterium adolescentis, Bifidobacterium angulatum and Bifidobacterium dentium are known to produce GABA. As an inhibitory neurotransmitter, GABA is vital for cognitive functions including attention, memory and learning.
Referrals
· Considering her family history, the client was referred to her GP to be assessed for AD. A complete blood count, iron studies, B12, folate and vit D were also recommended.
Follow up
During the four-week follow-up, the client reported a noticeable improvement in her brain fog and expressed that her mind feels ‘clearer and sharper’. She noticed a reduction in short-term memory lapses, particularly when keeping track of everyday items. Her sleep showed mild improvement, waking only once during the night where she will take a 2nd dose of her sleep formula. Although still somewhat anxious about her cognitive decline, she reports the nighttime formula has helped her feel more settled in the evenings.
AD was not diagnosed during the GP appointment, however her blood results revealed suboptimal iron and vitamin D levels. Following this, she has been advised to supplement iron bisglycinate (12 mg/day) and vitamin D3 (1000 IU/day).
Overall, the client appears motivated and is gradually integrating the dietary and lifestyle recommendations. Further encouragement and continued adherence were advised to support ongoing cognitive and emotional improvements