A Precision Approach to Preventing and Treating Cognitive Decline

by Dr. Susan Tanner, MD

I recently attended a conference in which I was fortunate enough to hear the lecture of Dale Bredesen, MD, a Duke-trained neurologist who created a twenty-first-century approach to predicting and preventing cognitive decline through holistic lifestyle changes. I feel a particular interest in his work because he offers hope and answers for this dreadful disease and makes his approach available to the masses in several books, The End of Alzheimer’s being the first and most recognized. In researching for this article, I did find that there are some detractors regarding Dr. Bredesen’s work; however, when I studied the rationale for their critiques, most had to do with inadequate sample size and not with the actual factors and interventions found to be helpful. It is not surprising that Bredesen’s study cohorts are not as large as those for Alzheimer’s drugs, though. Funding for studies that do not involve pharmaceutical products and potential for large financial gain are generally pushed to the back of the line. It is also not surprising that many people are unaware of some of the simple lifestyle changes that have been found in Bredesen’s studies to make a large impact on slowing Alzheimer’s-related cognitive decline. Thus, I feel the need to share that info, and much of what I will write about covers Bredesen’s teachings; I hope my explanations do them justice.

Current Alzheimer’s Treatment

The problem with current Alzheimer’s treatment is that it is only attempted in the later stages of the disease with pharmaceutical agents lacking efficacy. There have been attempts made to identify the underlying drivers of the disease, but most treatments are focused on a drug to reverse the pathology, not on causation and prevention. Families of patients already in severe decline are not encouraged to begin active prevention. Patients demonstrating memory loss early on are encouraged to wait a year or two to see if it progresses. And, with the cost of supporting a patient with this disease being an average of $350,000, many families are left in dire financial straits when all is said and done. For perspective, the COVID-19 pandemic has been attributed to the deaths of approximately 1,000,000 Americans, while Alzheimer’s will lead to death in nearly 50 times that number.

A Precision Approach

The current and traditional standard approach is to treat Alzheimer’s as one disease with one treatment option being one of several similar medications which, at best, may slow the progression in about 30% of patients, but there is no reversal or prevention. Advanced research findings, however, give us a different approach: there are 35 recognized contributors, 6 subtypes of the disease, and many personalized programs for treatment and prevention. In this precision approach, the 6 types of Alzheimer’s disease are classified as follows:

Type 1- Inflammatory – Secondary to infections, autoimmune diseases, etc.

Type 2- Atrophic – Reduced hormones and nutrients, usually in combination with other factors.

Type 3- Glycotoxic – Relates to insulin resistance or “diabetes of the brain”. The impact of high sugars and insulin levels can cause damage even before type 2 diabetes is diagnosed and treated.

Type 4- Toxic – Pollution, chemicals, heavy metals, and biotoxins such as mycotoxins.

Type 5- Vascular – Reduced circulation within the brain due to arterial narrowing or poor oxygen delivery. Very similar pathology to the development of cardiovascular disease.

Type 6- Traumatic – From head/brain trauma. Deposits of amyloid in the brain tissue are an early response.

We mention amyloid accumulation relating to trauma but bear in mind that this also occurs with the aforementioned biochemical abnormalities and toxic exposures. Amyloid is initially a protective mechanism to buffer the brain tissue but accumulation and hardening are what is found in autopsy of many Alzheimer’s victims. In families in which Alzheimer’s is felt to be hereditary, it is likely a genetic variant that fosters inflammation or hinders normal detoxification pathways.

The common thread with all of this is to become aware of risks early on and be very proactive in mitigating them. Just as we recommend a colonoscopy in patients over 50, why not have a similar approach to neurogenerative diseases such as Alzheimer’s?

There are several recommendations to improve this system of approach, in hopes of making Alzheimer’s a rare disease:

1. Everyone over the age of 45 should have a cognoscopy (more on this later).

2. Use a multi-tiered public health approach. Public health measures include minimizing pollution, processed foods, and avoiding pesticides to reduce exposure to “dementogens”. This s a new word I learned from Dr. Bredesen, and describes biochemical processes, such as type 2 diabetes, as well as toxins, which cause disruption to normal brain activity and structure.

3. Prevent and treat in the first 2 phases- presymptomatic and subjective cognitive impairment, rather than the last two phases, MCI (marked cognitive impairment) and dementia.

4. Look at larger data sets to aid in early identification and prevention.

5. Combine personalized precision medicine protocols with targeted pharmaceuticals.

Cognoscopy

I mentioned the term, cognoscopy, above. This is a combination of certain tests that Dr. Bredesen coined, which is comprised of the following:

1. A set of blood tests that can reveal risk factors for dementia. These assess many things, including insulin resistance, inflammatory markers, toxic load, etc.

2. Completing a series of simple, online cognitive assessments that indicate whether there are any areas of concern currently.

3. An MRI scan with volumetrics. The MRI is optional for those who have no symptoms but is recommended for those who already have cognitive symptoms or whose cognitive scores suggest any degree of cognitive impairment.

If you are working with an integrative physician, it is quite possible that a cognoscopy may be done within the practice of your practitioner, if not, then you may want to consider ApolloHealth.com to start the assessment. If you are not sure if this is the path for you, completing a MoCa (Montreal Cognitive Assessment) may be done online, the goal being a score of 18 or above. This is repeated to monitor the efficacy of treatments and interventions. If things are not improving, then a deeper dive into factors preventing progress is warranted. For patients with mold-related illness, I think this is a great tool to assess detox from mycotoxins, as brain fog is very often a manifestation, and along with other subjective symptoms can help you see that you are getting better! Another thing to note here is that Dr. Bredesen notes that some of his most rapidly improving patients are those who leave a moldy environment. The toxic onslaught from mycotoxins is so severe that simply leaving produces noticeable cognitive improvement.

Goals of Treatment and Prevention

1. Managing energetics of the cells which may include ketosis diet or addition of dietary ketones), maintaining good cerebral oxygenation, and optimizing mitochondrial function

2. Maintain insulin sensitivity

3. Support growth factors, with the use of prescribed or balanced hormones and nutrients

4. Resolve inflammation and prevent further inflammation by removing the source (i.e. mycotoxins), diet, etc.

5. Treat pathogens, and optimize the microbiome of the small intestine.

6. Detox the body which may be more aggressive initially and more maintenance-based going forward Always remember, reduce the total body load!

7. Stimulation with brain training or light or magnetic training. There are several methods and products for this.

8. Reduce amyloid beta, largely through the support of oxygenation, detoxification, and insulin control.

9. Support regeneration in all ways.

Each of these goals could have much written about it, but for brevity here I would simply say that the general recommendations are:

1. Plant-based mildly ketogenic diet such as KetoFLEX 12/3. Simply put, eat only within a 12-hour window and not within 3 hours of going to bed. There are many iterations of ketogenic diets, see what works best for you!

2. Exercise: both aerobic and weights, 45 minutes 5 days a week. This can make a huge difference on so many levels, including oxygenation, hormonal, and mitochondrial.

3. Sleep at least 7-8 hours maintaining an oxygen saturation of 96-98% Make sure that sleep apnea is evaluated and treated! Sleep apnea is vastly underdiagnosed, not all who have it are snorers, and a sleep study is easily done to address this if a problem!

4. Manage stress (meditation, prayer, HeartMath) even 5 minutes a day can make difference. Stress hormones, most notably cortisol, can elevate blood sugar, inflammation, blood pressure, and heart rate. This must become a practice as routine as brushing one’s teeth.

5. Brain Training, such as Brain HQ, Double Decision, and Hawkeye, for 30 minutes 3 times a week. Sudoku, and most recently Wordle, are also great for keeping the brain more flexible.

6. Targeted supplements as indicated by testing. Gingko Biloba, for example, has long been touted as an aid for memory and cognition, but there are many other things that can help. CellTropin contains this powerful extract in homeopathic doses.

7. Support all detoxification mechanisms, but first, be sure that the influx of toxins is halted as much as possible. You cannot live in mold and detox fast enough to stop the physical decline.

8. Heal the gut, and optimize the microbiome. Eating the right foods is of course the first step but probiotics and immune gut support may also be indicated.

9. Hormone replacement if labs support this. At the very least, the use of CellTropin also can support all hormonal functions in a safe and gentle way.

In discussing this topic and approach, it is hard to know how detailed to be in this introduction, but I hope that it gives you a new way to look at a horrible disease as something that can be prevented, progression minimized, and possibly even improved in more severe cases. The Precision Medicine Trial for Alzheimer’s and mild cognitive impairment is the first published trial of its type, putting together the goals and testing mentioned above. The implications of this study are that cognitive decline is reversible for most when treated EARLY! For those in which these steps are not successful more contributors need to be sought. A larger, randomized controlled trial is set to begin now in 2022 and as this work continues, we will have more to offer.