Age-related cognitive decline

Subjective memory complaints and mild objective cognitive decline in adults over 50–60 without criteria for dementia. Some progress to Alzheimer disease or vascular dementia, some remain stable. Baseline assessment by a geriatrician or neurologist includes MoCA or MMSE, TSH, B12, homocysteine, 25(OH)D, complete blood count, liver tests and, if suspicious, neuroimaging. No proven pharmacotherapy slows age-related decline in people without dementia: cholinesterase inhibitors and memantine are approved only for confirmed dementia. EFSA approved no supplement in this category. The FDA in 2003 granted phosphatidylserine a qualified health claim «may reduce risk of cognitive dysfunction in the elderly, very limited evidence», with an explicit disclaimer about weak supporting data. Lifestyle (Mediterranean diet, 150 min/week activity, blood-pressure and glucose control, social engagement, 7–8 hours of sleep) is the only strategy with proven effect on dementia risk in the FINGER 2015 trial.

ICD-10 R41.81 drug

Also known as: Age-associated memory impairment, Subjective memory decline, Mild cognitive impairment, Cognitive ageing, Pre-dementia memory loss

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

CPhosphatidylserineNot recommended · Phospholipid (soy- or bovine-derived) supplement, marketed for age-related memory decline and cognitive biohackingPhosphatidylserine is an OTC supplement with one of the loudest US marketing histories. The FDA in 2003 granted a qualified health claim worded verbatim «consumption of phosphatidylserine may reduce the risk of cognitive dysfunction in the elderly, very limited supporting science». The «very limited evidence» disclaimer is part of the claim itself, not a footnote. The Kato-Kataoka RCT (J Clin Biochem Nutr 2010) of soy PS in 78 older adults with memory complaints at 300 mg/day for 6 months showed a small word-recall improvement; effect size was small and the trial was industry-funded. The 2017 Cochrane attempt at a systematic review of PS in cognitive impairment and dementia found too few quality RCTs to pool. AAN 2018 on mild cognitive impairment does not recommend supplements; no pharmacotherapy slows age-related decline in people without dementia, while lifestyle modification per the FINGER 2015 protocol is effective. If phosphatidylserine was bought instead of seeing a geriatrician for memory complaints, discuss with a doctor; occult depression, B12 deficiency, hypothyroidism and sleep disturbance also impair memory and are treatable.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit