Dementia and Cognitive Impairment
Dementia and cognitive impairment are terrifying conditions that steal the parts of people that make them who they are – their personality, memories, and ability to take care of themselves. Of the top 10 causes of death from disease in the United States, dementia (specifically Alzheimer’s Disease) is the only one without an effective treatment.
Typically, dementia is a gradual process that may lead to symptoms of impairment long before the diagnosis of dementia is made. This impairment may be detected by the patient, their family members, and perhaps by cognitive testing at a medical provider’s office. These conditions are called subjective cognitive impairment (SCI) or mild cognitive impairment (MCI).
What is Cognitive Impairment?
Subjective Cognitive Impairment (SCI)
Subjective Cognitive Impairment (SCI) is a decline in your thinking processes that you notice about yourself, most often in loss of memory. It is subjective because others may not have observed any difficulty and you may score very well on cognitive tests designed to screen for dementia. However, you realize there is a problem. For example, you may notice that your memory is not as good as it used to be, or that it's more difficult to recall the right word you want to use to describe something.
Mild Cognitive Impairment (MCI)
MCI causes a slight yet noticeable decrease in memory and other cognitive skills. It is not severe enough to interfere with daily life, thus individuals rarely seek treatment. It is detectable in cognitive tests. Unfortunately, MCI affects 15-20 percent of people over the age of 65 and may lead to the development of Alzheimer’s disease and dementia.
MCI has two types: amnestic MCI, which a person may begin to forget information that they had previously recalled easily, for example, recent conversations or events; and nonamnestic MCI, which is characterized by its impact on decision making as well as simple thinking tasks, such as visual perception or time management.
The cause of MCI is unknown at this time, however many physicians believe it to be caused by the early neurological changes that occur in Alzheimer’s disease.
Dementia is a global cognitive decline in which many mental abilities are lost. Memory loss is often one of the first symptoms, but also difficulty with reading, writing, speaking, following a conversation, reasoning, calculating, organizing and planning.
Alzheimer's is a form of dementia marked by amyloid plaques and neurofibrillary tangles in the brain. Diagnosis is normally made from cognitive test results, but definitive tests such as PET scanning and lumbar puncture may be required.
One in 10 individuals in the United States age 65 or older has Alzheimer’s disease.
According to a 2017 report by the Alzheimer’s Association, an estimated 5.5 million Americans are living with Alzheimer’s disease. There has been an 89 percent increase in deaths due to Alzheimer’s between 2000 and 2014. Additionally, the number of affected individuals is increasing as the population ages, and it is projected that the population of Americans age 65 and older will double by the year 2050. Up until now, there has been very little that can be done to prevent, reverse or slow cognitive decline. But that is changing – Alzheimer’s disease and cognitive impairment are now treatable conditions.
The ReCODE Program
Dr. Dale Bredesen has worked and researched with other scientists for over 30 years to develop The Bredesen Protocol. This groundbreaking program has been shown to reverse cognitive decline in patients with early Alzheimer’s, MCI (mild cognitive impairment) or SCI (subjective cognitive impairment). Read Dr. Bredesen’s paper here. The Center for Functional Medicine is excited to offer this program to our patients. Dr. Clarke and Dr. Whelchel are certified practitioners of this protocol and have been trained by Dr. Bredesen.
Reversing and preventing cognitive decline is a complicated issue. Single medications don’t work…in fact, every clinical trial testing medications to reverse cognitive decline has been ineffective. There really is no easy fix.
The process of the ReCODE Program involves gathering a variety of data including questionnaires, diagnostic imaging studies, lab work, and neurocognitive testing to prepare a ReCODE Report. This report analyzes your personal risk factors and calculates which treatments may be most effective. Under the direction of the doctors at the Center for Functional Medicine, a customized treatment plan will be prepared and implemented for you.
Using a systematic approach, cognitive decline can be prevented and reversed. Lifestyle modifications including diet, exercise and stress management are critical. We want to be upfront and let you know that this requires effort, but it is worth it! We are committed to partnering with you every step of the way. Through the nutritionist, fitness trainers, health coaches and doctors at CFM, you will learn the lifestyle modifications needed to have success in the program and will be given a treatment plan that is personal to you and your situation.
Dr. Bredesen explains this protocol in detail in his book The End of Alzheimer’s.
When beginning the program, our primary goal is to gather information. Prior to your first visit, a cognitive test such as the MOCa or CNS Vital Signs will be given to you as well as other questionnaires. Your first visit with a doctor at CFM will last about an hour and a half and will include an extensive history and physical examination as well as ordering of various diagnostic tests. We will gather all this data and submit your information to Dr. Bredesen, and the result is the ReCODE Report.
Based on your results, we will create a custom treatment plan involving supplements, online brain games and most importantly, lifestyle modifications. You will be referred to our nutrition, fitness, and health coaches so you will have ongoing support every step of the way. A follow-up visit with the doctor will be typically scheduled every 2 months to monitor your progress and make any necessary adjustments to your treatment plan.
It is strongly recommended that patients also register with AHNP Precision Health so that they can get a ReCODE Report as well as access additional resources provided by AHNP. The AHNP program was designed by Dr. Bredesen. There are two options:
RECODE – Provides a single ReCODE Report. Includes all labs.
REVERSE – Includes multiple ReCODE Reports, access to BrainHQ, and many other resources that can be utilized throughout your treatment program.
We generally recommend the REVERSE option. It will allow submitting your labs to insurance to get the best possible rates and allow you to utilize AHNP resources throughout your treatment. You can get more information or register here. After you register, you can choose either Dr. Bruce Clarke or Dr. Jeffery Whelchel as your provider. For REVERSE members, we will get repeat ReCODE reports every 3-6 months or sooner at the discretion of the physician.
Treatment at the Center for Functional Medicine using the Bredesen Protocol costs $1995/year and includes:
1 ½ - 2-hour appointment with either Dr. Whelchel or Dr. Clarke. Both are certified Bredesen Protocol providers.
CNS Vital Signs and/or MOCa testing
Physical exam with body comp analysis
2 visits with our nutrition coach
2 visits with our fitness coach
Up to 5 additional doctor visits over the next year.
Monthly communication with a health coach.
Reduced price for supplements.
Reduced price for lab testing (when possible).
Data entry and physician analysis of results
Treatment plan development by the physician
What is not included:
MRI of the brain with volumetric analysis – the majority of this test cost should be covered by your Medicare or insurance.
Sleep Study – either at a local sleep lab or with a home sleep study machine.
Referral for neuropsychological testing and evaluation (as determined by physician).
Laboratory testing – initial labs available at a reduced cost. These labs include the following: ApoE status, homocysteine, hemoglobin A1c, fasting insulin, lipid panel, comprehensive metabolic panel, hs-CRP, estradiol, DHEA-s, total testosterone, free testosterone, TSH, free T3, free T4, reverse T3, progesterone, cortisol, TPO ab, and thyroglobulin ab. Other labs will likely also be needed after the treatment plan is started. Many will not be covered by insurance.
Membership to the ReCode program - $75 per month
Office visits for issues not pertaining to this program, or additional visits beyond the 6 allotted visits ($275/hour with the physician, $150/hour with a midlevel provider).
Supplements required for the program will be available at a reduced cost through our clinic.
The yearly cost for the program or the ReCode membership cost will not be submitted to insurance or Medicare.
This is an effective program that has been shown to slow down and even reverse cognitive decline. We look forward to welcoming you into the Center for Functional Medicine as we begin this journey together. Please call our office at 806-350-7807 to get started. Our front desk staff and nurses are happy to answer any other questions you may have. They will also provide you access to paperwork and questionnaires to be completed before your first appointment.