At Risk for Dementia?
Why you might want to know
As a medical student I was repeatedly taught to ask myself one question prior to ordering a laboratory test – Will the result change clinical management? Just because we have the capacity to know information about a lot of things, testing for everything as an academic exercise is fraught with risks. First, it generates unnecessary expense in an already financially overburdened system. But more concerning is the risk of a false positive that leads to unnecessary intervention or a true positive that you can’t do anything about. The latter has largely been the case with regards to assessments of cognitive function – we can see brain atrophy, amyloid plaque, poor neurocognitive function – but the only action we could take was to tell our patients was to get their affairs in order.
If you could look into a crystal ball and know if you were destined to get Alzheimer’s disease, would you want to know? Probably not. Until very recently Alzheimer’s disease was a guaranteed steady downward trajectory of progressive loss of memory, function and independence. I say "until very recently" because I have had the privilege of receiving some targeted functional medicine training focusing on the preservation and restoration of cognitive function in individuals with early onset memory loss.
Dr. Dale Bredesen, through his research, has identified a number of risk factors which combine to create a “perfect storm” for the human brain contributing to the loss of neurons and the development of cognitive decline. The most exciting piece of his research, however, is that most people have MANY underlying contributors which act in concert to create an environment unfavorable to the protection and regeneration of our nerve cells. Most of these contributors are reversible with diet, exercise, stress reduction, brain training, and targeted nutritional support. Dr. Bredesen is so excited by the outcomes he has been seeing and so impressed with the ability to restore to FULL FUNCTION patients in the very earliest stages of cognitive decline, that he advocates the idea of a “cognoscopy” for everyone around age 45. This would be a comprehensive assessment of risk factors for Alzheimer’s disease so that action could be taken to reduce this risks BEFORE cognitive decline begins.
The research today is clear, cognitive decline starts YEARS before the clinic signs of dementia are apparent and often presents as what we call SCI or subjective cognitive impairment. SCI describes those many individuals I have seen over the years who complain of feeling “less sharp” or “not as on the ball as I used to be” yet testing reveals no cognitive impairment. This is the best time to consider a cognoscopy as issues are more likely to be fairly easily reversible.
I am excited to have this new training under my belt and to have access to Dr. Bredesen’s Recode program which helps to prioritize interventions for individuals with cognitive decline. If you or a loved one feel you may benefit from more information I urge you to look at Dr. Breden’s book, The End of Alzeheimer’s. And, if you are a patient of mine over the age of 45 – be prepared to discuss the possibility of completing a baseline cognoscopy at your next visit. Because the results WILL change clinical management and just might keep you in a better state of mind as you age.