Cognitive health
Dementia and Alzheimer’s disease
Most families arrive having been told there is nothing to be done. That is not quite true, and it is not a promise either. The aim is to halt further progression, and how much can be achieved depends heavily on how early you start.
Why I look for contributors rather than a cause
Cognitive decline is rarely the result of one process. Insulin resistance, vascular disease, chronic inflammation, poor sleep, nutrient deficiency, hormonal change, chronic infection and toxic exposure can all contribute, and in most people several are present at once.
None of these explains Alzheimer’s disease on its own. But each is measurable, several are modifiable, and leaving them unaddressed makes everything else harder. That is the case for looking properly rather than assuming nothing can change.
What an assessment involves
A long first consultation covering cognitive history, medical history, family history, medication, sleep and exposures. Where you have already had neurological investigation I will want to see it, and I will correspond with your GP or neurologist where that helps.
Testing across metabolic, inflammatory, nutritional and hormonal markers, and genetics including ApoE status where it will change what I do. Then a written plan addressing what the testing actually found in your case.
Stage changes everything
The earlier the stage, the more there is to work with. Someone with subjective cognitive decline or mild cognitive impairment has more modifiable ground than someone with established moderate dementia, where the realistic goals shift towards function, quality of life and supporting the family.
I will tell you which of those situations I think you are in, and I will decline work that I do not think will help.
Being straight about the evidence
I cannot reverse Alzheimer’s disease and I do not claim to. The aim is to halt further progression. Improvement in symptoms does happen in some patients, most often those presenting early and at a younger age, but it is not guaranteed and depends on many factors including how fully the programme is followed.
The published work supporting this approach is mainly case series and small trials in early-stage decline. That is genuinely encouraging and it is why I trained in it. It is not the same as large randomised controlled trial evidence, which does not yet exist.
Anyone offering you certainty about outcomes in dementia is guessing, and you should treat that as a warning sign wherever you encounter it.
Common questions
My relative already has a diagnosis. Is it too late?
Not necessarily, but be realistic. At moderate or advanced stages the aim is usually stabilisation, function and quality of life rather than recovery of lost ground. I will give you an honest view at the first consultation rather than after you have paid for extensive testing.
Should I get ApoE tested?
Sometimes. It is useful when it will change what we do, and it carries real implications worth thinking about before you know the result, including for family members. I would rather discuss it with you first than order it reflexively.
Does this replace my neurologist?
No. This runs alongside conventional care, not instead of it. If you need neurological investigation you have not had, I will say so.
Related
Discuss your case with Dr Greenland
A short discovery call is the usual starting point. It costs nothing, and it is the fastest way to find out whether this approach fits your situation.