I have begun work with close to 30 patients for either prevention or reversal of cognitive decline. I have learned many things along the way, and have streamlined my approach, introduced practices to make it more comprehensive, as well as interventions to get to the root cause of the dysfunctions that lead to cognitive decline.
There is so much to teach each patient that I have finally written a 70 page Handbook that provides much detail. It will soon be available on this website for $9.95. I will update the link when I upload it.
Here are some lessons I have learned.
THREE ASPECTS OF COGNITION
I’m not talking here about underlying causes, but about what it looks like on computer testing.
We use online computer cognitive testing to understand the pattern of people’s cognitive struggles. The program is called “CNS Vital Signs.” It is a only a 30-minute assessment and therefore cannot give us nuanced information. However, people seem to be declining in one aspect of cognition and sometimes not the others, as far as I have been able to see. It tends to be one of the following:
- the speed of understanding, processing information, and responding: low scores in scales such as “motor speed,” “reaction time,”, and “psychomotor speed.”
- the formation of memories: “verbal memory” (remembering words) seems to sometimes behave quite differently from “visual memory,” which is memory for going back to places you’ve previously visited, and remembering where you parked your car.
- organization, focus, attention, reasoning
WHO IS AVERAGE?
Many people who come to my office to optimize cognition were previously functioning at very high levels, typically in the “above average” range. Scores in the “average” and “below average” category for them represent cognitive decline. The good thing is that they are still in a position to partner with me to understand and be motivated to follow the program. They are not dependent on their spouse or adult child.
If I’ve learned anything, it’s how much easier it is to do this work when the decline is still relatively mild.
WHAT HAPPENS ON THE PROTOCOL
The first few weeks after the initial visit, people are often overwhelmed and confused. The testing we use is complicated and unfamiliar. We have to be in contact so I can answer questions and we can move forward. Thus I have now added an hour to go over the report and recommendations from the first visit.
At the results follow up visit, we go over test results and I show people what we will address first and how. Within a few more weeks, we see changes in energy and in any chronic medical conditions.
Subsequent visits see us revisiting the basic medical issues, “deprescribing” (getting off) medications that stand in the way of health, and adopting protocol recommendations as new lifestyle habits. We also see new problems emerge and have to address those.
Most people say they are thinking better within about 2-3 months. Memory has improved: how quickly people can access words that used to escape them, or the ability to multitask, engagement with other people, sleep, headaches sometimes, digestion almost always, anxiety level sometimes, and overall energy often.
I have follow up data on only 4 patients at present. The improvements so far are very exciting and we’re not even done! I will tell each of their stories briefly in the next blog post.
THE SPEED OF NERVE IMPULSES
I worry that people with below average motor speed or reaction time will be at high risk of falls, injuries, or if they are driving, of auto accidents. One of the correlations so far has been the role of toxins. I often see high lead and mercury levels among patients seeing me for cognitive decline. I had not seen such high levels with patients who were not affected cognitively. Indeed there is research to show that lead (from the leaded paint and gasoline of the past, or from recent exposures such as working with stained glass, handling ammunition, and others) actually slows down impulse conduction speed from one end of the nerve cell to the other. Neurons talk to each other slower. Thus of course one perceives the world slower, processes inputs slower, and responds slower. When that gets much too slow, organization and memory are affected too. Literally people seem to be forgetting what they were about to do.
There is evidence that carefully removing toxic metals leads to an improvement in this process. I have not yet had the chance to verify this for myself because it takes 9 months to a year to significantly reduce heavy metals. And before I even start the process, I have to make sure a patient is healthy enough for the testing itself (testing can involve the use of a medication that chelates heavy metals, that is it goes looking for them and pulls them out, and if it finds a large quantity, we can measure it in the urine). Treatment involves removing these metals a little at a time so they never overwhelm the body’s detoxification capacity, as they would redistribute and cause further harm. It is done through a combination of sweating (infrared sauna for example) and the use of supplements, herbal remedies, and medications.
PRESENCE OF SEVERAL UNDERLYING CAUSES AT ONCE
All my cognitive decline patients have several harmful processes going on at the same time. The groups defined by Dr. Bredesen are a good framework for me, but none of my patients have had only inflammation, or only high blood sugar, or only lead or mold. My sense is that by themselves, these may cause illness, but rarely cognitive decline. For example, I would see patients with leaky gut and fatigue or joint pain, or autoimmune disease, but mentally they were as sharp as ever.
In my experience, cognitive patients have a pile-up of several impacts, and I believe they all contribute. Patients are typically inflamed: one patient has celiac disease, several had very high levels of antibodies to gluten. They typically also have excess glucose, some vitamin deficiencies, a few hormone deficiencies, and most likely either a heavy metal, mold exposure, reactivated Epstein-Barr virus, or exposure to Lyme disease. While it is conceivable that some of these impacts are not bothering them, I don’t see how I can leave any in place and just work on others. I believe that what I am seeing is that while there are many paths to becoming cognitively impaired, it isn’t actually noticeable until a critical mass of body functions are affected.
I have seen patients come from other providers who were not thorough in addressing all the pieces above. I think that is unfortunate because the longer we wait, the harder it is to reverse the damage already done. Having seen the number of different things that are wrong with each person, my concern would be that I am doing too little, not too much, from the start.
I have also seen patients come from providers who were not using the “optimal” ranges for lab values in Dr. Bredesen’s book. I don’t think we have the luxury of relaxing these ranges, quite yet. Just my 2 cents’. I also worry about the use of weak supplements, doses that are too low, or herbal shortcuts. I fear that even if they work, these leave people vulnerable to setbacks.
THE NEED TO USE FUNCTIONAL MEDICINE
The dysfunctions we uncover are all related to each other. For example, the most significant cause of high blood glucose is inflammation. The most common source of inflammation is increased intestinal permeability (leaky gut). Patients with excessive intestinal permeability cannot efficiently detox heavy metals, and other toxins. Heavy metals of course cause high blood glucose, and inflammation. So the patients are running several sets of interlocking vicious cycles, and the work we do is to extricate them systematically from these situations. Thankfully, functional medicine offers guidance for this. None of these links are commonly recognized or addressed in conventional medicine. I don’t believe I could do this work without an excellent foundation in functional medicine.
In addition to interlocking vicious cycles, patients are also on medications that lock in their dysfunctions. For example, many have heartburn and take proton pump inhibitors, which worsen the absorption of a number of nutrients. The first job is to heal the underlying cause of the heartburn. This has to happen as we replenish the most critical nutrients and reverse inflammation. Again, the functional medicine tools allow me to move forward. Before I studied functional medicine, I used to have patients on chronic proton pump inhibitors that simply could not get well. I did not know how to guide them to digestive wellness.
MAKING AND KEEPING PEOPLE WELL
We have to find alternatives to conventional medical treatment that work just as well if not better. For example, it won’t do to put patients on non-steroidal anti-inflammatory drugs (NSAIDs), on acid blockers, on anti-anxiety medications, on medications for sleep, on statins (they worsen glucose regulation, harm mitochondria, and interfere with myelin synthesis), on antibiotics (unless there is a life-threatening situation), and more. But we can’t leave people untreated for any of the conditions for which these would normally be prescribed. Again, functional medicine comes to the rescue: these conditions have diet and lifestyle solutions.
We have to keep patients safe while they are focusing on reversing their cognitive decline. Fractures, surgeries, illnesses, stressful life events, new mold or Lyme exposure, and ongoing environmental toxin exposures, all must be avoided if at all possible, or their impact must be reduced. It becomes necessary to discuss how to avoid household toxicants, how to avoid getting colds, how to better address a conflict with another person (all that is in the e-book), and more.
At the same time, our interventions must be safe. Many patients need to start a ketogenic diet, because ketones are a better source of energy for the brain in decline. But the ketogenic diet clearly poses major challenges. Excessive weight loss, loss of enjoyment, friction with family and friends, and loss of social contact due to not being able to enjoy some of the previously enjoyed foods - all these can be harmful.
We need to proceed efficiently, cautiously, quickly, be comprehensive, incredibly organized, forgiving, optimistic, strategic, and compassionate. I won’t lie, it is a challenging field!
I’m in awe, every day, of the dedication and sense of agency of my patients. I hope that everyone at least learns about this protocol so they can take immediate action when they suspect the start of cognitive decline. We should remove the stigma of impaired cognition, so we can address the topic with each other and support each other in making lifestyle changes. I believe this is what we all have to do to create the end of Alzheimer’s.