Dr. Marjorie Ordene, MD

Functional Medicine Doctor

Cognitive Decline Expert



Genetics vs. Lifestyle | Cognitive Decline Stages | Protocol Basics

Cognitive decline doesn’t have to go hand in hand with aging, even if you are genetically predisposed to Alzheimer’s disease. With the dim statistic that one in ten Americans over 65 has dementia[1], many people are falsely resigning themselves to the fact that Alzheimer’s is an inevitable part of aging.

According to emerging research however, we know this isn’t the case. Alzheimer’s can be prevented with the right interventions. There are many things you can do at all stages of life to preserve cognitive function and drastically reduce your risk of Alzheimer’s.

Do not wait until severe symptoms of cognitive decline show up. Lifestyle and Alzheimer’s are intimately connected, and as such, the time to start an Alzheimer’s prevention protocol is now.

What Causes Alzheimer’s? Genetics vs. Lifestyle

Everyone in the general population has a 9% risk of developing Alzheimer’s. That risk may go up to anywhere between 18 – 50% based on your genetics. The most common gene linked to late-onset Alzheimer’s disease is a gene called apolipoprotein E 4 variant (APOE). This gene is associated with abnormal levels of amyloid plaques in the brain, one of the main changes seen in Alzheimer’s disease.

While genetics plays a role, a growing body of evidence suggests that lifestyle factors can help prevent or slow down the progression of Alzheimer’s disease. It is important to understand that even without genetic risks, I do see many patients with Alzheimer’s who have no family history of the disease. Genetics isn’t destiny, there are many other factors involved in your risk of developing the disease.

So, how is lifestyle connected to Alzheimer’s?

We’re finding out with more clarity that Alzheimer’s, like type II diabetes, can be considered a disease of lifestyle. This means that lifestyle choices we make throughout our lives contribute to our risk of developing the disease.

In fact, even high blood sugar can be linked to Alzheimer’s. This is why we see an increase in the population of people with both type II diabetes and Alzheimer’s. Poor diet, lack of sleep, a sedentary lifestyle, and other factors in our control, can all increase the risk to develop type II diabetes, Alzheimer’s, or both.

Genetics isn’t destiny when it comes to Alzheimer’s. Your lifestyle choices can change the course of the disease leading you in the direction of prevention or illness. The choice is yours.

Early Evaluation is Key to Prevention

Under the umbrella diagnosis of dementia, there are many levels of severity as the disease progresses. Since there is no cure, prevention is the key. While early stages may be reversed, once things have advanced, it is much harder to get back and effectively restore what you have lost.

“A sign of decline is being unable to do something you could do in the past. For instance, if you used to remember numbers in your head, and now you need to write them down.”

Dr. Dale Bredesen, M.D.

If you are showing signs of decline, you may want to speak with your doctor to evaluate the possible causes. Certain cognitive dysfunction tests, such as the Montreal Cognitive Assessment (MoCA) assessment, can help determine how advanced the condition is. It can also help identify the best course of treatment. These tests can help recognize Alzheimer’s at the earliest stages when lifestyle interventions are most effective. A few of the early stages of cognitive decline are:

SCI (Subjective Cognitive Impairment)

At this stage a person might realize that they are becoming more forgetful and less focused. This stage is considered more challenging to assess with tests, since most of the symptoms during this time are considered subjective. At this stage, the functional medicine Bredesen Protocol (see below) can help stop or reverse the cognitive decline. A functional medicine doctor who is trained in this protocol can work with you to identify this challenging early stage.

MCI (Mild Cognitive Impairment)

As the cognitive decline progresses, there may be more apparent symptoms present. This stage typically involves greater issues with memory, language, thinking, and judgement that go beyond the normal “senior moments.” A low score on the MoCA test can capture the mild cognitive impairment. Again, lifestyle changes can help halt or reverse this deterioration.

Remember, once you have settled into a more advanced stage of cognitive impairment, you may be given a diagnosis of Alzheimer’s. This means there may be some irreversible damage already done to your brain. You can still, even at this point, help slow the effects of Alzheimer’s and live your best life using lifestyle changes found within the Bredesen Protocol.

The Bredesen Protocol

After many years of researching cognitive decline, Dr. Dale Bredesen, an internationally recognized expert in neurodegenerative disease, believes that with proper attention to lifestyle factors Alzheimer’s should be a rare disease.

According to Dr. Bredesen, Alzheimer’s is like a roof with 45 holes, and you must repair as many as you can to repair the roof from leaking. With lifestyle changes, you can plug many of these holes.

As a result of his extensive research, Dr. Bredesen developed The Bredesen Protocol, a series of lifestyle enhancements to help prevent or slow down the progression of the disease, even for people with a high genetic risk.

“A roof full of holes”

Dr. Bredesen sees cognitive decline as a roof full of holes, each hole represents one cause that can lead to Alzheimer’s. While you may not be able to fix everything, you can still patch the largest holes, to keep the house from flooding. You don’t have to wait until the entire house is flooded to start taking care of the holes and prevent the worst effects of Alzheimer’s.

Many people start getting a routine colonoscopy after the age of 45. Considering the high rise of Alzheimer’s, dementia and cognitive decline, Dr. Bredesen believes it is time to start doing a cog-noscopy as well around the same time or even earlier.

The key takeaway: evaluate your cognitive function as soon as you notice signs of cognitive decline to see if there are holes need to be patched.

The Bredesen Protocol Basics

The Bredesen protocol is based on the premise that an Alzheimer’s diagnosis is not a death sentence. The situation can be improved with lifestyle changes the patient can control. The protocol is designed to find individual risk factors and causes for each patient, using the right testing and medical assessment tools.

A functional medicine doctor trained in this protocol can help you identify which of the main 45+ causes might apply to you. The goal is to then develop a personalized treatment designed for the individual. Many of these treatments will include lifestyle changes that you can immediately implement.

While the protocol should be tailored to you, there are a few major components that you can easily apply to your daily life:

Alzheimer’s Prevention Diet

It starts with a healthy diet that eliminates exposure to toxins and food sensitivities. And it’s not just about what you eat, but when you eat as well. Both diet and intermittent fasting are a major part of the Bredesen protocol.

To learn more, see: Alzheimer’s prevention diet.

Avoid Nutritional Deficiencies

As a part of the diet, making sure you aren’t deficient in vital nutrients is critical, as these may contribute to your risk of Alzheimer’s. In many cases, the standard diet doesn’t supply all the needed nutrients for optimal health. It is therefore necessary to take supplements to help address deficiencies. As a part of the protocol, we use lab testing to identify these nutritional gaps, and address them with a personalized diet and supplements plan. These gaps may be different from one patient to another.

Exercise: Body & Brain

You should be moving at least 45 minute per day, even if it’s just walking. And yes, I do mean every day! Keep it simple and fun, so it is sustainable. According to recent studies, exercise may help to prevent or slow cognitive decline in older adults who are at a high risk of developing Alzheimer’s.

You should give your brain a workout as well, with several minutes of brain games or mind stimulating activities per day. Keeping the brain active is the best way to maintain healthy cognitive function. Certain brain training apps, such as BrainHQ, which we recommend as a part of the protocol, are actually shown in studies to improve brain function.

Get Enough Sleep

Sleep is a key factor. Poor sleep may directly lead to poor cognitive function, or indirectly to other issues such as unbalanced blood sugar issues, that may also affect your brain. Aim for at least 7 hours a night.

Get Social

Having a purpose and a social connection to your family or community has also been shown to help reduce the risk of dementia and Alzheimer’s.

Very often, certain lifestyle changes may disrupt or challenge your current routine. While this may be difficult at times, we do find these essential.

I once had a patient whose test scores were not improving after making several changes, so I knew something wasn’t right. After further investigation, I found out he was only sleeping 5 hours a day, as he had challenges with demanding job and work life balance. Once he changed his schedule and got more sleep, we noticed improvements.

So, you might have to find ways to lighten your load, take on less responsibility or delegate tasks in order to make your health a priority, even if it is a challenge.

To prevent Alzheimer’s, people need to get educated. We once thought Alzheimer’s to be an inevitable part of aging, we now know that cognitive decline can be prevented. There is no reason why most people can’t live well into old age with a sharp mind.

Early detection and lifestyle prevention methods such as diet, exercise and personalized supplements are critical to battling Alzheimer’s. If you or a loved one is showing signs of cognitive decline, do not wait until symptoms become more severe. A functional medicine doctor can help you evaluate the possible causes for the cognitive decline, and the treatment options you may need.

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