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Hi, I’m Dr. Heather Sandison, and I’m here to take you through the top 10 tests that you can do to determine if you are at risk for developing dementia. Dr. Bredesen coined the term cognoscopy and this is kind of a funny thing that refers to a colonoscopy. Not comfortable for anyone, but something that we routinely do for anyone when they turn 50 to understand if they’re at risk for developing colon cancer. Well, we can do the same thing for your brain. We can do the testing that’s necessary and relevant to understand if you have the causes of dementia. Many people will say, oh, beta amyloid plaques are the cause of dementia. No, I would argue that is not the case. And what we really wanna know is what causes beta amyloid plaques? Someone might say that inflammation is the cause of Alzheimer’s, and I would, I would argue that no, what we wanna understand is what causes inflammation. So I’m gonna take you through the top 10 tests that you can do to understand your risk.

1. The Montreal Cognitive Assessment

First is a MoCA score. The Montreal Cognitive Assessment is a validated worksheet that someone in a clinic who’s trained can help you do and take you through to understand if your cognitive function is being affected in a measurable way. This is a great number to have. Don’t be afraid of this number if it’s a low number. It tells us where you’re starting from. It tells us it’s time to get started doing the interventions that are necessary to reverse that decline. If you’re at 30 and you’ve already noticed some changes, if you have a perfect score, a 30 out of 30, then sometimes this is, this is a blunt instrument, and we’re not always catching the decline that happens in highly educated people or people who are sensitive to changes in their, in their cognitive function.

So just know if you have a 30, but you’re experiencing symptoms, you can still intervene and definitely work on prevention. If you’re a little more advanced, we need to get started right away. But again, this MoCA score gives us a baseline or a place to start. In my clinical practice, we test a MoCA score every 90 days. So every three months, we wanna look at where people are. We expect changes in this in about six months. If you’re not getting changes with your Bredeson trained provider, after six months, it’s time to double down on this lab work and maybe check these boxes. Make sure that if you haven’t done one of these, you might be missing something. I believe there’s a cause for all dementia, and that if we look hard enough, we can find it.

2. Full Male or Female Panel

The second test that I recommend is a Full Male or Female Panel. What this looks like is what your conventional provider would do, but on steroids, right? We are looking for inflammatory markers like Lp-PLA2 that might indicate infections in the mouth, which can then cause inflammation in the brain. We’re looking at things like vitamin D, B vitamin levels, cholesterol levels, usually making sure there’s enough, not too worried about too much, but not that there’s the right types, the good cholesterol is there, and your risk risky cholesterols are not elevated. We also wanna look at your thyroid panel. Having enough trophic support in the form of hormones, whether they’re stress hormones, sex hormones, thyroid hormones, and even vitamin D. All of these trophic factors or growth factors are associated with good cognitive function. I’ve seen patients in my office where just changing their thyroid support, just adding thyroid support is enough to help them think more clearly.

3. Metabolic Panel

And so we wanna take a really good assessment of all of these things. Also, liver, kidney function, so a complete metabolic panel, a CBC or a complete blood count, understanding if there’s some anemia, of course, we’re gonna be fatigued and our brain won’t work if we can’t get oxygen delivery to the brain. And sometimes that shows up as anemia. We also wanna understand if there’s a urinary tract infection, we screen for those routinely, particularly in the elderly population, because often as we age, particularly for for women, elderly women, we don’t have the classic signs of urgency, frequency, and burning on urination with urinary tract infections. Instead, it can show up as cognitive decline or changes in affect, in mood in very vague ways. And so testing routinely for that can be important. And sometimes we find things that we are not expecting.

4. Blood Ketone Reading

We can also test ketones in urine. So this gives us an indication if you are getting into ketosis, we also test it in blood, and I highly recommend that. Another test, another great test on this list is a Blood Ketone Reading. And you can do that at home from the comfort of your own home to test whether or not you were in ketosis. 

5. Testing for Toxins

In addition, we wanna test toxins. So the next three tests are Mycotoxins, Heavy Metals and Chemical Toxins. So I think of toxins in three flavors, and when we understand which ones of those are present, if it’s mycotoxins, we’re going to use different binders or different specific ways of getting them out of the system. Toxins directly impact neuronal function. Mercury is highly neurotoxic, and if you’ve heard of Mad Hatters Disease, if that’s familiar to you, mercury can cause suicidality and depression and anxiety in very real ways.

And so getting that out of the system if you are at risk for dementia, is critically important. There are safe, effective, easy ways to do that from home that are not cost prohibitive or the way they used to be when we had to use IV chelation. We can now use specific binders for mercury, arsenic, cadmium that you can use inexpensively from the comfort of your own home. So this is important information to know. One of my regrets, and one of the things that I’ve learned is that testing early is crucial. We don’t wanna get a year into treatment and be wondering, did we miss something? So getting these baseline labs is really, really important. When we find things that are unexpected, maybe you don’t have, you never had mercury amalgams in your mouth. You didn’t realize that fish could contain mercury or there was some other unknown exposure that, you know, we never really pinned down, but for whatever reason, maybe it’s genetically, you hang onto it, you have high levels of mercury or mycotoxin or something else.

Unexpected understanding and knowing this early on in the cognitive decline process can do worlds of difference in terms of the prognosis. So investing a little bit in that testing, I highly recommend. So we have MoCA scores, we have our blood panels, but on steroids, we have toxin testing, mycotoxins, heavy metals, and chemical toxins.

6. Stool and Gut Testing

The next one I find crucially important is Stool Testing or Gut Testing. We wanna understand the gut brain connection and how this manifests for you. Are you able to digest and absorb the nutrients that you’re consuming? So you may be choosing to eat wonderful foods, but are you able to digest and then assimilate them? That is crucially important to getting cognitive decline reversed, right? We gotta have those nutrients that are so essential for brain function. It’s also essential for our neurotransmitter balance, right? We need enough histamine and we need enough tryptophan, and we need enough glutamine in order to create the, we need enough tyrosine.

All of the neurotransmitters like dopamine and serotonin, glutamate, GABA, all of the things that are essential to our cognitive function and our mood. We know that depression is highly related to anxiety. Both depression and anxiety are, are very tightly correlated with dementia. And so having stable mood is critical to brain function, and that is dependent on having enough of those basic nutrients, those amino acids that are the backbones of our neurotransmitters present in the brain. And that happens through the gut. So testing the gut to make sure that you are digesting, assimilating, that you are detoxifying. Our bowels are our primary detox organ. So we need to make sure that that’s functional. And if something’s standing in the way, we wanna address it right away. A leaky gut can often indicate a leaky brain, and we’re gonna use similar things to treat that.

We wanna make sure that there are high integrity barriers, right? These are, these are not promiscuous barriers, just letting anything in and anything out. These are barriers that are choosing very deliberately what to allow in. And so we want all the good stuff and not the bad stuff, both coming in through our guts and going into our brain. So understanding our gut function and infections in the gut. Infections in the gut, like parasites are highly common, kind of gross to think about, but very, very common and should be treated because they are stealing those nutrients. So critical for cognitive function. So we wanna find out if you’ve got the right microbiome that can directly impact both mood, weight, metabolism, cognitive function, and if you have the right assimilation; if there’s inflammation in the gut, we wanna have the opportunity to treat all of those things and really optimize gut function.

7. Testing for Infections

So the next test that I usually recommend is kind of related around infections. There are a handful of infections that we know directly impact the production of beta amyloid plaques, particularly if you are ApoE4-Positive. And then there are some that are just tip associated with more neurofibrillary tangles, plaques, a more robust inflammatory response in the brain when you are exposed to these particular microbes. So those are the Lyme spirochete, Borrelia burgdorferi is one that is known to cause neurological manifestation that can be brain fog or even dementia. So this is directly through the Lyme spriochete, which can be found in the plaques of people with dementia. On autopsy, another is P gingivalis. So I refer to this in the, in the mouth, and we can look for evidence of this using the Lp-PLA2 marker.

And then if I ever see that elevated, I’m referring you straight to the dentist for a Cone-Beam analysis with a biological dentist for a thorough understanding of what microbes might be in your mouth and how that might be impacting your cognitive function. This also puts people at high risk for cardiovascular disease. So it’s important for many of the reasons that we think of as affecting our health, particularly as we age, both cardiovascular disease and brain health. So P gingivalis, Borrelia burgdorferi, and then Herpes Simplex 1 and 2. So if you’re someone who’s prone to outbreaks, we wanna understand this. We wanna know and we wanna treat aggressively. I’m an naturopathic doctor and I don’t often write prescriptions, but when I do, it’s commonly for acyclovir valacyclovir, some of the antivirals that help people keep their herpes outbreaks under control. Not everyone has herpes outbreaks, not everybody has multiple, but if you do, that puts you at higher risk of developing dementia.

So it’s important to treat aggressively and doing the testing to understand that is helpful. So having a good pathogen profile, the one I use is a Cyrex Array 12, having a good pathogen profile where I think of us as casting a wide net. See what infections are present in your system, is your immune reactivity elevated? And then what can we do about that to support immune recovery? And then also address those pathogens that are directly associated with cognitive decline.

8. Nutrient Panel

The next test I recommend is a thorough nutrient panel. So we’ve learned some of this by looking at the gut and what you’re able to absorb if you’re able to absorb and assimilate nutrients. But then when we look on the plasma side or the intracellular side, we can sometimes understand better what the epigenetics are doing in terms of your ability to use those nutrients at their functional capacity at the cellular level.

And so it may be that somebody needs a little extra glutathione or somebody else needs a little extra riboflavin or vitamin B two, other people may have high levels of yeast that show up on, on this organic acid testing and nutrient testing. So as we look through and delve into the nutrients, we get some information about specifically what will help you.

So we think of this as precision medicine, right? We could all use plenty of nutrients, but how much do you need? Specifically, what are you deficient in specifically? And how can we adjust for that? How can we get you exactly what you need so that you’re not held back by a certain deficiency?

9. APOE Status

The next test I recommend getting is an APOE status. This is a genetic test that tells us about your risk for developing dementia. The general population has a 13% chance of developing dementia in their lifetime.

If you have an APOE status of, with a four in it with one four, you get one from mom, one from dad, and your options are two, three or four. If you have one four, you have a 30% chance of developing dementia. If you have two fours, one from mom and one from dad, AOE four four, you have a 50% chance or a one in two chance of developing dementia. If you have a two, three or a 2, 3, 3, you have a 9% chance of developing dementia. So you actually are protected compared to the general population. Understanding this risk is important because if you have a three four or a four four, then you have to work a little harder. You’re invited to work a little harder than maybe your spouse or your neighbor who doesn’t have that increased genetic risk. Now, our genetics do not determine our destiny.

We have lots of control of how this manifests. And so if we have an elevated risk genetically, there is so much we can do. And when we know earlier on, my confidence goes up that if you’re younger, you don’t have symptoms yet or in you’re earlier stages of symptoms, then it takes much less work, much less cost to reverse all of that and reduce your risk of having dementia late in life.

10. Imaging

The last test that I sometimes refer to, but not always, is Imaging. So we wanna know if there is a tumor present, if there is something actionable. From a conventional medical perspective, we absolutely wanna know this. If there’s vascular dementia, evidence of, of things that are, we can intervene around, that is really important information, and we gotta get that done right away. However, imaging doesn’t usually change how we are going to treat.

So certainly there is a space for this and I would love to see imaging be more accessible, but it can be highly expensive. And my, if you’re going through this list and you’re prioritizing, this one doesn’t change my intervention as much as the others. So I’d love to get a picture of your brain. Of course, pictures speak a thousand words, and we often get lots of great information, and it’s really fun and exciting when we see brains grow. Dr. Bredesen’s recent research showed that there is gray matter and hippocampal growth on this protocol. So we get, you know what, what, again, what we were told was impossible, that we couldn’t grow our brains as we age. That can happen, and you can see that on imaging. And so if that’s valuable to you, absolutely get that brain and imaging done. But just know that for most Bredesen doctors, that isn’t critically important.