Alzheimer’s Is Optional

How to prevent Alzheimer’s: protect your brain against memory loss and dementia

A conversation about how to prevent Alzheimer’s with neurologist and Alzheimer’s researcher, Dr. Dale Bredesen

A diagnosis of Alzheimer’s disease or dementia is devastating to both the patient and the entire family. However, according to Dr. Dale Bredesen, who’s dedicated his career to Alzheimer’s research and prevention, preventing Alzheimer’s is entirely possible. He’s spent his life focused on one message: it doesn't have to be this way. Decades of research and work with patients has led Dr. Bredesen, an internationally recognized expert in the mechanisms of neurodegenerative diseases and best-selling author, to the conclusion that early detection and lifestyle changes that target the causes of cognitive decline can improve outcomes. Through his research and his practice, he teaches people multi-targeted ways to prevent Alzheimer’s disease.

First-ever proof of concept trial on the effectiveness of the Bredesen Protocol for improving and preventing Alzheimer’s

For decades Dr. Bredesen has been researching Alzheimer’s disease and how to prevent cognitive decline. But for the first time in a recent proof-of-concept trial, researchers, including Dr. Bredesen, used a precision medicine approach to treat Alzheimer’s disease and mild cognitive impairment. They identified potential contributors to cognitive decline and then targeted those specific areas therapeutically. This method of treating and preventing Alzheimer’s disease and dementia is known as the Bredesen Protocol. The goal of a proof-of-concept trial is to prove effectiveness to warrant a larger, randomized, controlled clinical trial. Twenty-five patients with Alzheimer’s disease or mild cognitive impairment, with Montreal Cognitive Assessment (MoCA) scores of 19 or higher, were evaluated for markers of the following: 

• Inflammation
• Chronic infection
• Dysbiosis
• Insulin resistance
• Protein glycation
• Vascular disease
• Nocturnal hypoxemia
• Hormone insufficiency or dysregulation
• Nutrient deficiency
• Toxin or toxicant exposure (metals, organic toxicants, and biotoxins)
• Genetic predisposition to cognitive decline
• And other biochemical parameters associated with cognitive decline

Researchers found that all outcome measures revealed cognitive improvement, including: statistically highly significant improvement in MoCA scores, CNS Vital Signs Neurocognitive Index, and AQ-C were documented. No serious adverse events were recorded. This was a trial that Bredesen and his team of researchers proposed In 2011 to show that lifestyle changes can improve and prevent Alzheimer’s disease. However, at the time, the Institutional Review Board only permitted testing a single variable, rather than a multi-variable trial.  Alzheimer’s disease is not a one variable disease. Researchers instead collected anecdotal evidence of improvement in 2014, 2016 and 2018.  Finally in 2019, the researchers were allowed to do a proof of concept trial of 25 patients to test if they could improve cognition. Good results from that would prove the case for a randomized controlled trial. That RCT is already underway.  For each of the 25 people in the trial, researchers considered 150 different determinants from the participants’ various genetic test results. They worked with Intelex DNA to look at the following: 

• Glutathione related issues
• Methylation related issues
• Thrombosis related issues
• Biochemical parameters
• Microbiological parameters
• Gut status
• And more 

The goal was to get a fairly accurate map of the contributors to cognitive decline. “You virtually never see people with just one contributor. Typically there are multiple things,” says Dr. Bredesen. Dr. Bredesen says the science has shown what areas are priorities for preventing Alzheimer’s disease and minimizing cognitive decline. “We were very excited to see how much better the outcome was with these people than with a typical drug approach to Alzheimer's disease. The team studied participants for nine months, comparing their MoCA scores as the study progressed. MoCA—also known as Montreal Cognitive Assessment or the MoCA Test—is a brief test that helps clinicians detect cognitive impairments. It’s widely recognized as the most sensitive test available for detecting Alzheimer’s disease, measuring executive functions and multiple cognitive domains that are important components not measured by the MMSE. They also looked at the following:

• CNS vital signs score
• Alzheimer's Questionnaire (AQ) change score
• MRI volume metrics
• Gray matter and hippocampal volumes
• Brain HQ
• Whether loved ones noticed any improvement

Researchers found the following results from the trial: 

• At three months: Mild improvement just reaching statistical significance
• At six months: Statistical significance 
• At nine months: Increasing improvement 

“We had people who went from MoCA scores of 19 to 30, perfect scores of 30,” says Dr. Bredesen.  There were also some less dramatic improvements. Overall, 84 percent of the people improved their CNS vital science scores, 76 percent of the people improved their MoCA scores. Their MRIs and AQ change scores improved as well. “It really supports the idea that targeting the things that are driving the decline is the way to go,” says Dr. Bredesen. 

Preventing Alzheimer’s and cognitive decline with lifestyle changes vs drugs 

On average, someone with Alzheimer's or MCI loses on average about 3.4 points on a 30 point scale per year, says Dr. Bredesen. “Whether you're talking about MMSE or MoCA, you're losing a little bit each year.” The best drug to treat Alzheimer’s and MCI is Aducanumab, which was just approved in June 2021 by the FDA. In one trial, it failed completely. In another trial at one dose, it slowed the decline by 22 percent. It's not helping people have a better cognition; it's just slowing the decline.  “Many neurologists have said, this is not the drug we were looking for. This is a drug, but it's not the goal,” says Dr. Bredesen. 

Lifestyle changes that improve cognition also improve other areas of health

In contrast to existing Alzheimer’s drugs that have shown little effectiveness, lifestyle changes in the Bredesen Protocol have other positive health outcomes.

Some of the areas patients in the study saw improvement included the following: 

• Better weight control
• Improved lipid profile
• Improved glycaemic profile
• Improved insulin sensitivity
• Improved microbiomes
• Improved depression
• More energy
• Improved sleep

“Human beings are complex organisms. And I think we're now understanding that there is so much more that we can do to address the physiological parameters that are driving the decline to begin with,” says Dr. Bredesen. The key to having a chance at preventing Alzheimer’s and cognitive decline says Dr. Bredesen, is early detection and early intervention.

Four stages of Alzheimer's disease progression

There are four stages to people who develop Alzheimer's disease. By the fourth stage, the patient has typically had underlying issues for two decades. Key to preventing Alzheimer’s and cognitive decline is supporting people during the first and second stages of memory loss, says Dr. Bredesen. Presymptomatic stage: you can already pick up changes on PET scan and spinal fluid. Subjective Cognitive Impairment (SCI): typically lasts about 10 years. According to Dr Bredesen, it's easy during that time to reverse the decline, but very rarely do people do anything about it.  Mild cognitive impairment: At this point, you're relatively late in the pathophysiological process.  Alzheimer's disease: A patient is losing activities of daily living. 

What is the fundamental nature of Alzheimer’s disease? 

The fundamental nature of cognitive decline is a network insufficiency, says Dr. Bredesen. So just as a deficiency of vitamin C results in scurvy, this simply is a more complex deficiency. It's an insufficiency of an entire network.  Over a lifetime, a patient’s brain is exposed to pathogens, such as P-Gingivalis, various fungi, herpes simplex, Lyme disease, environmental toxins and more. “Your brain is saying, okay, I'm going to go into a protective downsizing mode,” says Dr. Bredesen. Considering the future of Alzheimer’s prevention and care, as well as other neurodegenerative diseases, Dr. Bredesen says, ”I do think the future is going to be to combine targeted drugs, along with the protocols where we can target the sources that are causing the problem.”

There is hope when it come to an MCI or dementia diagnosis

Dr. Bredesen says that when it comes to a diagnosis of cognitive decline, patients and their families are typically told that the arsenal is zero. There's nothing that can prevent, reverse or delay the decline of Alzheimer's. This means people don’t bother even checking for a genetic disposition, such as APOE genetic status.  The truth is just the opposite, according to Dr. Bredesen. The arsenal is huge, and the critical piece is knowing when to use it, how to use it, what to target and what the critical species are.  While following the Bredesen Protocol, patients will, however, sometimes improve cognitively and then plateau. In this case, there's something missing, says Dr. Bredesen. One example from a patient, who did very well, started having problems that turned out to be undiagnosed Babesia. For others, it turns out to be leaky gut or undiagnosed toxins that were present. One recent person was under additional stress, and just removing that stress helped. “Things like meditation, which we never considered in a laboratory, turn out for some people to be absolutely crucial to getting best outcomes,” says Dr. Bredesen. Bredesen and the team of researchers are now looking to take large sums of data for many practitioners. There are over 2000 practitioners who are trained in the Bredesen Protocol. Among them, some support dramatic improvements, while others “are getting almost nobody to get better,” says Dr. Bredesen. 

Introducing the ‘cognoscopy’: a cognitive check up to prevent Alzheimer’s

Part of early detection of cognitive decline is tracking personal health data. At 50, everyone knows to get a colonoscopy to decrease the risk of dying from colorectal cancer. Similarly, Dr. Bredesen recommends getting what he calls a “cognoscopy” at 45 or older, and perhaps younger if there's Alzheimer's in the family. He recommends looking for the following: 

• Ongoing pathogens
• Ongoing toxins
• The status on trophic support
• Cell hormones and nutrients 
• The status on energetics: cerebral blood flow and oxygenation (especially for people with sleep apnea)
• Mitochondrial function
• Ketones 
• Inflammation
• Gut microbiome

Dr. Bredesen expects wearables will become more prevalent as people want to monitor more health data. You can see where your glucose stands as you eat throughout the day. Those who do continuous glucose monitoring may be surprised by peaks and valleys, both of which are bad for the brain. Stress can cause glucose to spike, and meditation and deep breathing can improve it.  According to Dr. Bredesen, following blood pressure, looking at nocturnal oximetry to monitor oxygen at night and checking ketone levels are all important metrics. Of course, knowing your APOE gene status can be very helpful for this as well. ”We really have so much control over our own future,” says Dr. Bredesen. 

A future of preventing Alzheimer’s, improved cognition and better health

With results from his recent trial and his lifetime of work, Dr. Bredesen can imagine a time when Alzheimer’s disease is rare, and awareness about improving cognitive care is standard. Dr. Bredesen’s vision of a healthier society doesn’t end with cognitive care. He’s thinking about ways technology, medicine and lifestyle changes can come together to support healthier and longer lives. Take Google, for example, says Dr. Bredesen. They know where you shop, how you live and what you’re wondering. Dr. Bredesen imagines how that data could lead to Alexa picking up changes in the way a person is speaking. Or changes in keystrokes that indicate a slower response time and fine motor skills. “Why are we not using that same sort of technology to identify people in their earliest changes?” he wonders. “I think for the future, having the earliest ability to recognize cognitive decline is absolutely feasible and will be the way of the future.”  Dr. Bredesen’s hope is that treating people earlier, for Alzeheimer’s prevention or earliest reversal, will make neurodegenerative diseases rare.  Citing a recent paper, Dr. Bredesen even hopes that one day scientists and doctors can reverse biological aging. A paper by Dr. Kara Fitzgerald looked at aging parameters, essentially methylated regions of the DNA that are shown to be associated very closely with biological aging. The study showed that lifestyle changes not only can improve cognition better, but also reverse the biological agent. She saw about 3.26 younger years of people who were on a protocol.  This is more good news for Dr. Bredesen. “I look forward to a day when we really make these problems rare.” Dr. Dale Bredesen is an internationally recognized expert in the mechanisms of neurodegenerative diseases. His research on Alzheimer’s disease has led to the discoveries that today underlie the Recode report. Dr. Bredesen is the author of the New York Times bestsellers "The End of Alzheimer's" as well as "The End of Alzheimer's Program."   For more information and to get more support, go to Apollo Health.