Dale Bredesen, MD, author of The End of Alzheimer’s: The First Program To Prevent and Reverse Cognitive Decline, refers to the tests you should undergo if you’re concerned about brain health as a “cognoscopy,” sort of a colonoscopy for your brain. Perhaps thinking back on your own colonoscopy, it’s reasonable to ask, “Do I really need a cognoscopy?”
There are three groups of people I recommend give these tests serious consideration. (And at least a cognoscopy doesn’t require a laxative.)
- If mid- or late-life dementia runs in your family. (“Grandma was showing confusion in her late 60s and spent her final ten years in a nursing home.”)
- You’re middle aged and experiencing too many senior moments. No one else notices, but you do, which is why it’s called subjective cognitive impairment.
- You’re middle aged and people around you have expressed concern about changes in your cognitive skills (missed appointments, late for meetings, third iPhone replacement). This is mild cognitive impairment.
Although it’s been long established that a protein called amyloid deposited in your brain is the culprit behind the dementia that characterizes Alzheimer’s, there are three primary amyloid triggers: inflammation, atrophy, and toxins.
Before you do any detailed testing, ask your doctor to check your APOe (the Alzheimer gene) status. While dementia can occur among APOe-negative patients, being APOe-positive can increase your risk dramatically.
Here are tests for inflammation
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- hsCRP (high sensitivity C-reactive protein) measures inflammation throughout your body.
- A/G ratio (ratio of albumin to globulin), a test that complements the hsCRP.
- Ratio of omega 6 to omega 3 fatty acids in your blood cells (ditto).
- IL-6 (interleukin 6) and TNF (tumor necrosis factor), both of which increase during chronic inflammation.
- Gluten sensitivity (though simply eliminating gluten for 14 days and finding you feel better and then re-introducing it and feeling worse is an excellent self-test).
- Leaky gut (intestinal hyperpermeability).
Tests for atrophy (nutritional and hormonal deficiencies)
- Vitamins B-1 (thiamine); B-6; B-12; D; E; and folate.
- Thyroid: Free T3, Free T4, TSH, reverse T3, thyroid antibodies.
- Sex hormones: estradiol, progesterone, testosterone, DHEA, pregnenolone.
- Adrenal hormones: AM and PM cortisol, the stress hormone (via the Genova Adrenocortex Stress Profile).
- Homocysteine (an amino acid linked to brain atrophy, which can be lowered by taking adequate amounts of B vitamins).
- Fasting insulin; fasting blood sugar; HbA1c (hemoglobin A1c). All test for insulin resistance and early diabetes, both common with early dementia.
- Serum zinc, copper, glutathione, selenium, red blood cell magnesium.
Tests for toxins (chronic infections, environmental toxins)
- Mercury (inorganic mercury=dental fillings; methyl mercury=fish).
- Arsenic, lead, cadmium.
- Lyme disease screening.
- Mycotoxin (black mold sensitivity) screening.
- C4a (inflammatory marker for Lyme and mold toxicity).
- TGF-Beta 1 (inflammatory marker).
- HLA-DR/DQ (genetic test for susceptibility to chronic inflammation of Lyme and mold).
- Intestinal microbiome (gut bacteria).
Other useful dementia-related tests
- Hearing (long-term hearing loss increases risk for dementia).
- Cholesterol profile (high LDL increases risks for dementia caused by multiple small strokes).
- Sleep study (untreated sleep apnea can cause brain amyloid deposits).
- MRI of brain with measurements of brain volume (for people at high risk or who have mild cognitive decline).
- Professional screening of your mental status by a psychologist.
Will your health insurance pay for all this? In fact, most of the tests listed above are not considered alternative or experimental and indeed are covered by most PPO policies, although with health insurance nothing is for certain.
It’s easier to list tests that are only partially covered: the functional tests for leaky gut and adrenal function. Not covered by insurance are the confirmatory tests for Lyme (Igenex) and mold (Great Plains Mycotox Profile).
If you have concerns about your susceptibility to Alzheimer’s, print this series of Health Tips and take them to your primary care physician. Read Dr. Bredesen’s book and encourage your doc to read it as well.
Once we have your test results back, nutritionists Marla Feingold and Seanna Tully will be added to your team. If you want psychological testing for mild impairment, schedule with psychologist Dr. Janet Chandler.
Next week, the last in this series, what you can start doing right now to improve your brain and reduce your risks.
David Edelberg, MD