The Dementia Supplement Dilemma: Separating Marketing from Medicine

By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living

Walk through any pharmacy, and you’ll find shelves of “memory support,” “brain boost,” and “cognitive enhancement” supplements. Many promise to “sharpen focus,” “improve memory,” or even “prevent dementia.”

One of the most heavily marketed is Prevagen, which claims to support brain function using a jellyfish-derived protein called apoaequorin. Other popular products include ginkgo biloba, omega-3 capsules, B-vitamin complexes, phosphatidylserine, and “nootropic” blends.

The global brain-health supplement industry now exceeds $10 billion per year, driven largely by fear—fear of cognitive decline, Alzheimer’s disease, and loss of independence.

But do these supplements actually work? And are they safe?

At Beyond Health, we believe cognitive longevity requires physiology, not pseudoscience. Let’s examine what’s known, what’s marketing, and what truly supports brain health.

1. Prevagen and the Rise of the “Brain Booster” Industry

What Prevagen Claims

Prevagen (apoaequorin) is a synthetic version of a calcium-binding protein originally found in jellyfish. Its makers claim that it “improves memory, supports healthy brain function, and is clinically shown to help with mild memory loss associated with aging.”

What the Evidence Shows

Despite aggressive advertising, the scientific evidence for Prevagen is extremely weak:

• The manufacturer’s own study—the Madison Memory Study—showed no statistically significant improvement on any of nine pre-specified cognitive tests. Only after post-hoc reanalysis of a small subgroup did the company report a benefit (Maki et al., Adv Mind Body Med, 2016).
• The FTC and New York State Attorney General filed suit against Prevagen’s parent company in 2017 for deceptive marketing. The court allowed the false-advertising claims to proceed, citing lack of credible evidence (Federal Trade Commission v. Quincy Bioscience, 2019).
• No independent randomized, placebo-controlled, peer-reviewed trial has ever replicated benefit.

Biologic Plausibility (or Lack Thereof)

Apoaequorin is a protein that would be digested in the GI tract, not absorbed intact into the brain. There is no plausible mechanism by which oral apoaequorin can affect neuronal calcium signaling or memory.

In other words, Prevagen doesn’t just lack evidence—it lacks basic biological plausibility.

2. Other Popular “Memory Supplements” and Their Evidence

A. Ginkgo Biloba

• Once the most popular “memory herb,” ginkgo biloba has been extensively studied.
• The Ginkgo Evaluation of Memory (GEM) Study, a randomized trial of 3,069 older adults, found that 120 mg twice daily did not reduce incidence of dementia or cognitive decline (DeKosky et al., JAMA, 2008).
• A 2020 Cochrane Review confirmed no convincing evidence for dementia prevention, though minor cognitive benefits in vascular dementia remain possible (Yang et al., Cochrane Database Syst Rev, 2020).

B. Omega-3 Fatty Acids (Fish Oil)

• DHA and EPA are critical for neuronal membranes and synaptic signaling.
• However, the VITAL-COG trial and other large RCTs found no significant improvement in global cognition or prevention of dementia with supplementation in cognitively healthy adults (Yurko-Mauro et al., Alzheimers Dement, 2020).
• Modest benefit may exist in mild cognitive impairment or in those with dietary deficiency (Freeman et al., Front Aging Neurosci, 2021).

C. B Vitamins (B6, B12, Folate)

• Elevated homocysteine is associated with dementia risk; lowering it with B vitamins theoretically supports brain health.
• Yet the VITACOG trial showed slowed brain atrophy only in participants with baseline homocysteine >13 µmol/L (Smith et al., PLoS One, 2010).
• For those with normal levels, benefit is minimal. Oversupplementation can cause neuropathy or interact with medications.

D. Phosphatidylserine and “Nootropic Blends”

• Phosphatidylserine, once derived from bovine cortex (now soy-based), may support membrane fluidity. Small studies in older adults show minor short-term improvements in attention but no effect on dementia progression (Jorissen et al., Nutr Neurosci, 2001).
• Proprietary “nootropic stacks” (combining herbs, caffeine, L-theanine, etc.) lack high-quality data, and long-term safety is unknown.

3. The Hidden Risks of OTC Cognitive Supplements

A. Regulatory Gaps and Product Adulteration

• The FDA does not pre-approve supplements for safety or efficacy. Many “brain boosters” contain inconsistent doses or undeclared ingredients.
• A 2023 JAMA Network Open analysis found that over 50% of nootropic supplements contained inaccurate labeling or non-disclosed compounds (Wong et al., JAMA Netw Open, 2023).

B. Drug Interactions

• Ginkgo biloba increases bleeding risk with anticoagulants and antiplatelet drugs.
• High-dose vitamin E (sometimes in brain supplements) may increase hemorrhagic stroke risk (Miller et al., Ann Intern Med, 2005).
• Stimulant blends may elevate heart rate and blood pressure.

C. Opportunity Cost and False Hope

Perhaps the greatest harm is distraction. Patients invest time, money, and belief into supplements instead of proven interventions—exercise, vascular risk control, and cognitive training. By the time memory truly worsens, valuable years for prevention are lost.

4. What Actually Supports Cognitive Longevity

The best evidence for protecting the brain has nothing to do with supplements and everything to do with lifestyle, vascular health, and physical fitness.

A. Physical Activity

• Regular exercise—especially aerobic and resistance training—consistently improves cognition, hippocampal volume, and executive function.
• The FINGER trial (Ngandu et al., Lancet, 2015) showed that multimodal lifestyle intervention reduced cognitive decline by 25% in at-risk adults over two years.

B. Metabolic and Vascular Optimization

• Hypertension, insulin resistance, and dyslipidemia accelerate vascular dementia.
• Controlling blood pressure and blood glucose reduces dementia risk by up to 20–30% (Livingston et al., Lancet, 2020).

C. Sleep, Nutrition, and Inflammation

• Sleep consolidation supports glymphatic clearance of amyloid.
• Mediterranean-style diets (rich in omega-3s, polyphenols, and fiber) consistently correlate with lower dementia risk (Scarmeas et al., Ann Neurol, 2018).
• Anti-inflammatory nutrients (berries, olive oil, fish) are protective—unlike isolated high-dose supplements.

D. Cognitive Engagement and Social Connection

• Intellectual stimulation, learning, and social interaction activate neuroplasticity and reduce cognitive decline independent of pharmacology (Fratiglioni et al., Lancet Neurol, 2020).

5. Beyond Health’s Perspective

At Beyond Health, we integrate brain health into the broader framework of longevity and performance.

Our approach:

• Test, don’t guess. Identify deficiencies (vitamin D, B12, homocysteine) before supplementing.
• Optimize physiology. Target vascular health, sleep, hormones, and exercise capacity (VO? max).
• Use evidence-based adjuncts. Consider omega-3s or B vitamins only when deficiencies exist.
• Avoid false precision. Supplements like Prevagen offer placebo at best, deception at worst.
• Educate and empower. Cognitive health is earned through lifestyle, not purchased in a bottle.

Conclusion

The dementia supplement market thrives on a universal fear—losing memory, autonomy, and self. But no over-the-counter product has ever been shown to prevent Alzheimer’s disease or meaningfully improve cognition in healthy adults.

Prevagen and its peers capitalize on marketing, not medicine. Meanwhile, the true interventions—exercise, metabolic health, sleep, and purpose—remain freely available yet underused.

At Beyond Health, our stance is simple: brain health is built, not bought.

References

1. Maki PM, et al. A Randomized, Double-Blind, Placebo-Controlled Study of Apoaequorin in Community-Dwelling Older Adults. Adv Mind Body Med. 2016;30(4):4–11.
2. Federal Trade Commission v. Quincy Bioscience. U.S. District Court for the Southern District of New York. 2019.
3. DeKosky ST, et al. Ginkgo Biloba for Prevention of Dementia: The Ginkgo Evaluation of Memory Study. JAMA. 2008;300(19):2253–2262.
4. Yang Y, et al. Ginkgo Biloba for Cognitive Impairment and Dementia. Cochrane Database Syst Rev. 2020;3:CD003120.
5. Yurko-Mauro K, et al. Effect of Long-Term Omega-3 Supplementation on Cognitive Function in Older Adults: VITAL-COG. Alzheimers Dement. 2020;16(5):732–740.
6. Freeman MP, et al. Omega-3 Fatty Acids and Cognitive Aging. Front Aging Neurosci. 2021;13:695081.
7. Smith AD, et al. Homocysteine-Lowering by B Vitamins Slows Brain Atrophy in Mild Cognitive Impairment. PLoS One. 2010;5(9):e12244.
8. Jorissen BL, et al. Soy-Derived Phosphatidylserine Improves Memory Function in the Elderly. Nutr Neurosci. 2001;4(2):121–134.
9. Wong A, et al. Adulteration of Cognitive Enhancement Supplements in the United States. JAMA Netw Open. 2023;6(4):e236107.
10. Miller ER, et al. High-Dose Vitamin E Supplementation and All-Cause Mortality: Meta-analysis. Ann Intern Med. 2005;142(1):37–46.
11. Ngandu T, et al. A 2-Year Multidomain Intervention of Diet, Exercise, Cognitive Training, and Vascular Risk Monitoring in At-Risk Elderly People (FINGER): Randomised Controlled Trial. Lancet. 2015;385(9984):2255–2263.
12. Livingston G, et al. Dementia Prevention, Intervention, and Care: 2020 Report of the Lancet Commission. Lancet. 2020;396(10248):413–446.
13. Scarmeas N, et al. Mediterranean Diet and Risk for Alzheimer’s Disease. Ann Neurol. 2018;84(1):27–37.
14. Fratiglioni L, et al. Influence of Social Network on Occurrence of Dementia. Lancet Neurol. 2020;19(9):901–912.