By Dr. Shawna Darou, ND
After reading my recent blog post “Why all women should start thinking about Alzheimer’s prevention in their 40’s”, you may be interested in what an assessment looks like. Dr. Dale Bredesen has coined the term “cognoscopy” to describe the proactive screening we can initiate as young as 40 years old to identify and address your potential risk factors for Alzheimer’s disease. Just as we have screening for breast cancer (mamograms, ultrasounds, breast exams and thermography), colorectal cancer (colonocsopy), and cardiovascular disease (blood pressure, stress tests, echocardiograms), we can use our knowledge of the mechanisms that Alzheimer’s disease begins to create a screening and prevention program.
Why start so early?
Alzheimer’s disease is a condition with a very long latency period, meaning changes in the brain happen 15-20 years before symptoms are first noticed. Our best chances to reverse these changes happen with early interventions. The good news is that the earlier you start, the simpler the changes are – your plan looks like a very healthy lifestyle. On another positive note, these preventative lifestyle changes: nutrition that balances blood sugar and lowers inflammation, optimizing sleep, managing stress and exercising regularly, are equally preventative to other chronic health conditions too.
Who is this for?
This screening program is most recommended for people with a family history of Alzheimer’s disease, those who have noticed a change in their cognition (especially after a period of stress, or with menopause), and those who know they have one of the Alzheimer’s genes (ApoE4). I would argue however, that this type of assessment is recommended for anyone over the age of 45 years, since the prevalence of Alzheimer’s disease appears to be growing. Did you know that if you are a woman, your lifetime chance of developing Alzheimer’s disease is now greater than your risk of developing breast cancer? (1,2,3)
How do we assess for risk factors?
There are several components to this assessment, and it begins with a very thorough review of your current health and health history.
1. Risk factors in your health history:
- Poor sleep quality, sleep apnea or too few hours of sleep
- Sedentary lifestyle
- Diet high in sugar, processed foods, artificial sweeteners, omega-6 fats and simple carbohydrates.
- Toxin exposure: mold, heavy metals, environmental pollutants, pesticides, and more.
- Mood disorders: depression especially
- Brain injury
- Vascular disease / high blood pressure
- Blood sugar issues, type 2 diabetes, insulin resistance
- Chronic high stress and cortisol
- Any current cognitive or neurological changes
- History of infections (Epstein Barr virus, Herpes viruses), Lyme disease, others
- Digestive health and gut microbiome
- Cognitive changes starting at menopause
- Medications used (some medications increase dementia risk)
2. Review of your health timeline:
A health timeline can help us to identify risk factors, life or illness triggers and to understand the development of cognitive changes over time. This is part of the roadmap that allows us to back-track your return to optimal health.
3. Family history notes:
- A careful look at neurological conditions in the family, any cases of Alzheimer’s disease or dementia, and age of onset is helpful in understanding which lab markers and assessments that would be recommended.
- If you have had a family memory with Alzheimer’s disease, understanding their progression, risk factors and the classification of their condition (inflammatory, glycotoxic, loss of trophic factors, toxin-related, vascular) helps tremendously with knowing where to focus our preventative efforts).
4. Lab testing:
- Inflammation markers: C-reactive protein, homocysteine
- Blood sugar metabolism: fasting glucose, insulin and HbA1c
- Hormones: estrogen, testosterone, progesterone, cortisol, DHEA
- Nutrients: Vitamin B12, Vitamin D, Zinc, Copper, Magnesium
- Full thyroid panel: TSH, thyroid antibodies, free T4, free T3, reverse T3
- Markers of kidney function, liver function, lipid panel, CBC
Additional markers that may be recommended (depends on your health history):
- Heavy metal testing
- Organic acid test
- Comprehensive digestive stool analysis
- Markers of mold illness
- Lyme disease testing
- Viral infection screening
- Additional inflammatory markers
During an initial assessment, the lab testing requested can be quite significant. It is extremely important to do this well the first time around, so we know which markers put you at risk and which ones to track over time.
It can be helpful to know some personal genetics, especially whether you carry a copy of the ApoE4 gene because this means that our treatment plan needs to more intensive. Other genes can also be useful, such as MTHFR (affects methylation, GSTM1 (heavy metal detox), VRDR (vitamin D status), and others.
- If there are signs of cognitive change (even subjective ones), we may do an in-office cognitive screen called the MoCA (Montreal Cognitive
- Assessment), which is a standardized test to pick up mild cognitive decline as well as dementia.
- In cases with more severe cognitive changes, referral for neuropsychological testing will be recommended.
- MRI, PET scans, and others may be initiated by a neurologist to look for observable changes in the brain that can indicate Alzheimer’s disease, or indicate other causes of dementia (vascular disease, Lewy Body Dementia, Parkinson’s and others).
- These scans are not part of a Naturopathic or Functional Medicine cognitive assessment, but my be requested to confirm or rule out a diagnosis.
Using this data for your prevention plan
All of the data collected from your health assessment, review of risk factors and through review of lab testing helps us to create your plan for prevention.
First identifying which (if any) type of Alzheimer’s disease you may have an increased susceptibility towards.
- Type 1 = inflammatory
- Type 2 = loss of trophic factors (hormones, nutrients)
- Type 1.5 = glycotoxic (blood sugar / insulin resistance / Alzheimer’s as ‘type 3 diabetes’
- Type 3 = toxic – associated with chemical, metal or biotoxins
- Type 4 = vascular – associated with vascular disease
- Type 5 = traumatic – associated with traumatic brain injury
Implementing a treatment plan to address lifestyle factors:
- Nutrition plan – anti-inflammatory, and very strongly focusing on blood sugar balance and reversing insulin resistance; including some degree of intermittent fasting where appropriate.
- Exercise plan – including at least 150 minutes of exercise per week, as walking and other moderate exercise, and where possible some high intensity exercise too
- Optimizing sleep to be at least 7 hours per night, and treating any sleep disorders (apnea, difficult with sustained sleep, hormones impacting sleep)
- Using targeted supplements to restore balance: This can vary tremendously, and is directly targeting nutrients, hormones, mental focus, adrenal health, gut function, inflammation, mood, and more.
- Correcting for hormone imbalance – considering bioidentical hormone replacement, optimizing thyroid function and rebalancing adrenal hormones.
- Addressing toxins – if mold toxins or heavy metals are found, we will need to address them with specific chelators and binders.
- Setting a future screening and tracking plan – once we know which markers we are following, we can set up a plan for ongoing screening
- Setting a program to maintain neural plasticity through your lifetime. Quite simply, this means constantly learning. The best way to maintain your cognitive function is to challenge it regularly and in different ways.
Personalized and preventative medicine
As you can see, there are many factors to address, and many potential risk factors to assess for. This is why each person’s ‘cognoscopy’ and recommended treatment plan will be different. Obviously in those who are already showing symptoms will have a much more intensive assessment and treatment plan, than those who are aiming for prevention, and also those with a strong family history will begin to implement their prevention plan much earlier.
Remember that although Alzheimer’s disease is a condition that our cultural view is extremely bleak, there is so much we can do preventatively and proactively starting right now.
If you are interested in starting the process of Alzheimer’s prevention, and your personalized plan please book in for an appointment.
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