Preventing and Reversing Cognitive Decline

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The End of Alzheimer’s, the recent book by UCLA neurology professor Dale Bredesen —#3 on the Nov. 12 New York Times Science bestseller list—describes interventions that in small numbers of patients have not only halted the progression of Alzheimer’s disease (AD) but reversed symptoms of memory loss.

While some 200 drugs have been tested and failed to make much difference for Alzheimer’s patients, Bredesen’s protocol involves mechanisms similar to those proposed for drug development, such as fighting inflammation and improving blood sugar regulation—interventions for which there is “good evidence” of potential effectiveness, according to DC-area psychiatrist Susan Molchan.

With genetic testing currently available and less expensive blood tests anticipated for the near future, Bredesen’s successes may help answer the question: why get tested? Based on his findings, someone who learns they carry “the most important genetic risk factor for AD”—two copies the Apo-E4 gene —finally have some recourse and thus some reason for hope.

Dale Bredesen first made news in 2014 with a small study of 10 patients who were struggling with memory loss at work, some of whom had quit their jobs as a result. Of these, nine patients who chose to implement different elements among Bredesen’s list of 36 possible interventions experienced a groundbreaking reversal of symptoms.

Persevering with a second group of 10 patients, Bredesen reported similar positive results in 2016 and has since developed a complicated algorithm called Reversal of Cognitive Decline (ReCODE) to evaluate the status and needs of each patient. At this point, more than 1,000 people are enrolled in the protocol, with 150 currently being followed actively, and 450 physicians worldwide have been trained to use it.

Many in the scientific community criticize Bredesen’s studies for their small numbers and lack of controls, but these qualities of good research are hard to impose on his protocol, because assessments of need and subsequent recommendations are so different for each person.

Dr. Mikhail Kogan, head of the Center for Integrative Medicine (CIM) at George Washington University, has been trained to use ReCODE to slow or reverse symptoms of AD by addressing its metabolic roots.  Kogan offers these personally tailored evaluations and recommendations at his newly established MK Cognition Institute.

For more than 10 years at CIM, Kogan has created similarly individualized treatments for those with AD as well as those with chronic health complaints that traditional medicine has failed to resolve.

Bredesen bases his treatment on a novel concept of AD: that mental deterioration is caused not by amyloid plaques but by imbalances in the body that allow for the invasion of the brain by pathogens.  The brain responds to these pathogens by amassing sticky plaques of amyloid-beta protein—which in turn destroy synapses crucial to nerve cell communication, according to Kathleen Doheny on Senior Planet.

Some three dozen imbalances—created by such factors as inflammation, hormonal status, vitamin levels and toxins —are described by Bredesen as “holes in the roof” that contribute to cognitive decline.  “You cannot just plug one hole,” Bredesen told MyLittleBird.

Many of Bredesen’s interventions are intuitive: less stress; more sleep and more exercise; less processed food and more vegetables and fruit.  Other diet recommendations include avoiding all simple carbohydrates, all sugar, all gluten—and adding herbs such as turmeric as well as coconut oil, fish oil and blueberries.

A related measure is a three-hour fast between dinner and bed to allow after-meal insulin levels to go down before sleeping, because increased circulating insulin levels have been linked to AD.  Also recommended is a 12-hour fast between dinner and breakfast to provide time for the amyloid-beta proteins to be flushed out of the brain, a process aided by melatonin. Other supplement interventions include vitamins B, C, D and E, antioxidants, omega-3 fatty acids and probiotics.

About the most controversial recommendation, hormone replacement therapy—because of the link between HRT and increased risk of breast cancer—Bredesen believes the trade-off (increased risk of future cancer vs. immediate and worsening symptoms of dementia) is worthwhile, and his patients back that up.  Bredesen told Senior Planet, “Hormones levels play a critical role in cognition…one husband said that he and his wife would monitor her status regarding cancer, but that they’d both rather do that than continue to watch her cognitive decline.”

Bredesen agrees that his protocols can be demanding—rigid sleep times, exercise prescriptions and dietary restrictions—but that “when people start getting very mild cognitive impairment, they’ll have the incentive.  Right now what keeps people away is thinking they can do nothing.”

As a spouse of one of Bredesen’s patients who did well on the protocol wrote on Amazon: “[Bredesen’s] book and the ReCode protocol offers something that cannot be measured, real hope.”

—Mary Carpenter
Well-Being Editor Mary Carpenter often writes about new studies related to cognition, memory loss and the brain.