I first heard Dr. Bredesen speak at a conference more than five years ago when he related his experiences halting and reversing Alzheimer’s Dementia. Pretty bold claims but since then he has published his findings in various recent papers (see references).
Dr. Bredesen postulated that there is no single, primary cause of Alzheimer’s Disease and treatment would have to address multiple issues through a Functional/Integrative Medicine approach: diet, physical exercise, brain exercise, hormones, supplements, sleep hygiene, targeted testing, removal of toxic influences, and identification of genetic susceptibilities. He went on to show that this approach works-although it hasn’t been validated in large trials.
Is it a magic bullet? No. But it appears that Alzheimer’s Dementia now falls into the category of other lifestyle-related chronic degenerative diseases such as Type II Diabetes, cardiovascular disease, osteoporosis, osteoarthritis, autoimmune diseases and so forth. It’s not an inevitable consequence of aging. It’s treatable. Therefore, it makes perfect sense to assess your cognitive function proactively, just as we keep tabs on our blood pressure and our insulin-glucose axis parameters.
I plan to get into the nuts and bolts of the Integrative Medicine approach to cognitive decline in the companion post that will follow later this month. Right now, I want to keep the horse in front of the cart and talk about a great way that you can assess your cognitive function, in conjunction with your Integrative Medicine practitioner, to see if concerns you might have about your cognitive capacities are warranted.
In Medical School, we were taught to administer a rapid cognitive screening test called the Mini Mental Status Exam (MMSE), devised in 1975. In the MMSE subjects performed various tasks such as drawing a clock showing a specific time, remembering words, doing mental mathematics, naming objects and demonstrating orientation (person, place, time). It could certainly identify severe problems but couldn’t detect early, subtle mental decline.
In 1996 a similar assessment called the Montreal Cognitive Assessment (MoCA) came on the scene. It takes a few more minutes to administer and is a little more in-depth. Here’s an image of the scoring sheet for the MoCA. (The horse and the tiger just had a fight and now the tiger is sulking and is seriously considering having the duck for supper.)
In 2006, another cognitive test came on the scene: CNS Vital Signs Neurocognitive Testing. It’s pretty much the Maserati of cognitive assessment instruments, as far as I’m concerned. I recently decided to take the assessment at our clinic, partly due to the actors and actresses thing, partly due to the advances that have been made in treating cognitive decline but mostly so I could have something to write about for this post. (Kidding.)
Here is a slightly-edited list, adapted from the CNS Vital Signs website, of the advantages of their offering, compared to the older, simpler, tests:
- CNS Vital Signs technology delivers a rapid and non-invasive neurocognitive assessment
- Can be done in-clinic or at home (logging into a secure site)
- Available in over 60 languages
- Suitable for repeat testing
- Good test-retest reliability
- Well-validated in peer reviewed publications
- Large database (1600 normative ranges spanning ages 8 to 90)
- Used by over 2000 investigator sites worldwide
- Versatile and can be used for many other purposes/cognitive problems
Per the foregoing list, I exercised the option to test at home by logging into a secure site via a password set up through the EvolveWell Clinic staff.
Editor’s Note: This author might be guilty of writing what follows simply in order to fill space. When I asked him about it he said it’s a free country and he just thought readers might be curious. I find it a bit concerning that the author might also be posing as the editor though.
“Self-talk may have several benefits. It causes no significant health risks unless a person also experiences other symptoms of a mental health condition, such as hallucinations. While performing a task with a set of instructions, self-talk may improve control over the task, concentration, and performance. It may also enhance problem-solving skills.” (https://www.medicalnewstoday.com/articles/talking-to-yourself#is-it-healthy)
It’s actually fun to do. Like taking your brain to a CrossFit class. Just be forewarned that every response you give is analyzed in terms of correctness but also the time taken to respond and the ability to remain focused on any given mental task. Turns out that slowed processing speed is a crucial tipoff to declining cognitive ability, whether the ability is processing of words, images, speech, mental math, puzzles, making rapid choices, emptying the cat’s litterbox on a regular basis, shaving regularly and so forth.
Anyway, in no particular order, here’s a capsule summary of the test:
I was presented with a stream of fifteen words spaced three seconds apart and then had to try to pick them out of a longer stream of words with the original fifteen interspersed in the stream. Ditto with a series of fifteen sets of shapes.
My ability to rapidly tap on the space bar with both index fingers (not at the same time) was assessed via three 10-second trials for each finger. That made my forearms sore. Not whining. Just saying.
I had to fill in numbers to match symbols in a table, based on a key table, sort of like the codes you used to fool around with if you were a nerdy kid. Some of the symbols might be reminiscent of Norse runes, or maybe Elvish, not that it matters. The intent of this exercise was to see how fast and how accurately I could complete the tables.
I was presented with a random stream of five different letters including the letter B, tapping the space bar whenever the letter B came up. The other letters were R, S, and P. Wait! That’s only three other letters! I forget what the other letter was. (Kidding. It was H.)
Then came the infamous Stroop Test where I was presented with sequences of words like
green, green, green, blue, blue, yellow, red…
I had to either pick out the name-letter color matches or else pick the instances when the names didn’t match the colors of the letters. The test assesses your ability to rapidly switch mental paradigms but also assesses your response time.
There were some other tests but I forget what they were. (Kidding again.)
There was a test where you were confronted with a colored shape and were told to choose between two other shapes below based on matching color or matching shape. So. For the triplet immediately below you would press the right shift key if you were told to match on color and for the second triplet you would press the left shift key if you were told to match on shape. Tricky, huh?
In another test there were four parts. In the first part I was presented with a continuous stream of colored shapes and had to press the space bar for every shape (measures visual reaction time). Next, I had to press the bar only when a specific shape came up. For part three, I had to press the bar when there were two matching shapes in succession. Lastly, I had to press the bar whenever two matching shapes were separated by a different shape. That is the heinous “Two-Back” test. I needed to maintain a continuously-updating mental picture of three consecutive shapes as a new shape arrived:
The grand finale was for me to repeat the very first exercise, which was to pick out the same fifteen words and fifteen sets of shapes from the longer streams of words and shapes that had been presented to me 35 minutes before.
The results were available almost immediately and it turns out I did pretty well (despite my going blank when I try to recall the names of actors and actresses). Therefore, I promptly poured myself a shot of Scotch, ignoring the fact that ethanol can be neurotoxic. (Kidding about pouring the shot.)
All kidding aside, this is a very serious topic. There’s a ton of stuff we can do to hang on to our mental faculties as we age. Mainstream medicine has little to offer. I’ll talk more about Dr. Bredesen’s approach next post and we’ll cover a lot of ground, as you might imagine. The EvolveWell Clinic is fully prepared to assess your cognition and partner with you to improve things, need be!
I hope you’ll tune in.
Just don’t forget to clean the litterbox between now and then. Especially if you have cats.