Dementia Diagnosis. What Now?

70 year old female with a history of depression was given a dementia diagnosis from her medical team last week.

While she will very likely be told "it's Alzheimer's" (which, if you familiarize yourself with Dr. Alzheimer's actual work-- and his famous patient, and the vast body of follow-on studies, or Karl Herrup*-- you'll soon realize means absolutely nothing; actually, worse than nothing: it means your life & health are currently in the hands of nincompoops) at the next visit, even a diagnosis of one of the less common dementias (LBD, FTD, vascular dementia, Parkinson's dementia) lends itself to this "assess/optimize" whole-body approach.

And don't forget normal pressure hydrocephalus, if urinary incontinence and trouble walking are also present. This is, surprise I know, often not known or not mentioned. (And actually linked to gut microflora imbalances!) B12 deficiency & toxic exposures should also be pre-dx investigations. (In my ideal world, so would metabolic endotoxemia and even Candida albicans overgrowth (similar but distinct). Hey, a guy can dream!)

The depression (& anything else she might care to share of her) history here actually helps immensely-- because we already know where the body "biochemistry-physiology" of dementia & depression often overlap. As well as what may be causing them. Take a look:

	Nutritional Deficiencies Common In Depression	Nutritional Deficiencies Common In Dementia	Nutritional Deficiencies Common In American Diet	Nutritional Deficiencies Common In Veg Diets	Nutritional Deficiencies Seen When Stomach Acid Is Low	Nutritional Deficiencies Seen When Bile Acid Is Low
B6	✓	#3
B9 (folate)	✓	#3
B12	✓	#1		✓	✓
Vitamin D (needs magnesium to function)	✓	#2	✓	✓		✓
Magnesium	✓	#5	✓		✓
Zinc	✓			✓
Omega-3 fatty acids	✓	#4
Iron	✓			✓	✓
Selenium	✓
Amino acids	✓				✓
Vitamin C		#6	✓		✓
Vitamin E			✓			✓
Calcium			✓	✓	✓
Iodine				✓
Vitamin A (requires zinc to function)	*		✓	*		✓
Potassium			✓
Vitamin K						✓

(I personally would also want to know glutathione status, CoQ10, manganese...)

NutrEval results alone will tell you all of this† and more. More than worth the cost.

• See a full, 12-page NutrEval sample report (pdf) here.

• Request one from your HCP, or order yourself at Rupa Health here.

Folks who live in repressive states of NY-NJ-RI, often use an office or vacation or relative's address. Access Medical Labs and AnyLabTestNow can do phlebotomy & handling-shipping for you (they appear to be state agnostic), generally for a (cash) fee of $20-35. I have state by state list of additional sites as well as mobile phlebotomists. Just ask.

And as we wait for our nutritional/gut health/mitochondrial health/digestive health/toxic exposure/detox capacity/oxidative stress report, let's look at nutritional (& some lifestyle) interventions that in many people (but not all) tend to produce the quickest, most notable changes:

1. Vitamin D (target level: 50-80 ng/ml)

2. B vitamins, especially 6-9-12 but also 1-2-3 (MD/NP could check your B12, but they often think 400 is okay-- when you really want 500-600+)

Homocysteine (serum)	4-7 micromolar
B6 (plasma)	12-50 micrograms per liter
B9 (folate) (serum)	11-25 ng/ml
B12 (serum)	500-1,500 pg/ml

3. Oftentimes, low-dose Dhea +/- pregnenolone  (ask MD/NP to check your Dhea, E2, T, pregnenolone)

	Target Range for Women	Target Range for Men
Dhea-S (serum)	100-380 mcg/dl	150-500 mcg/dl
Pregnenolone (serum)	100-250 ng/dl	same
Total testosterone (serum)	>25 ng/dl	500-1,000 ng/dl
Free T (serum)	0.02-0.5 ng/dl	6.5-15 ng/dl
Estradiol (serum)	50-350 pg/ml	<39 pg/ml*
Progesterone (serum)	1-20 ng/ml	<1.4 ng/ml

*Men with significant belly fat or BMI >30 might want to check their estrone (E1) levels as well, as this is an especially inflammatory estrogen associated with obesity & gut health issues.

4. More fat (ensuring proper digestion thereof)

5. More protein (ensuring proper digestion thereof)

Longer term:

6. Check blood for elevated levels of lead (older adults <2 mcg/dl) , mercury (<4 mcg/l; ideally <2), arsenic (<7 ng/ml), cadmium (<2.5 mcg/l)  (have MD check your levels)

7. Wean oneself off the blood glucose rollercoaster

8. Work on sleep (implementing #3, #4, #5, #6, #7, #9, #10 will help immensely)

9. Work on strength training

10. Work on Zen (finding calm/turning off chattering mind throughout the day; releasing accumulated musculoskeletal tension)

Longer, longer term:

11. Gut rehab

12. Immune support to keep chronic infections in check

13. Rule out oral health issues: P. gingivalis, T. denticola, prime among them

14. Rule out apneic events during sleep (typically resolved when insulin resistance (even if sub-clinical) & hormone insufficiency issues are fixed)

    
    

Metabolic endotoxemia (neuroinflammatory effects of LPS from overgrowths of gram negative bacteria in GI tract), SIBO, SIFO, general inflammatory microflora imbalance, and gut barrier issues (i.e., sieve) are the most under-investigated. Second being occult oral infections. Third being heavy metals & inhalation toxicities (herbicides, pesticides, off-gassing after home renovation, and moldy home).

You can do this!

*If you haven't yet picked up Karl Herrup's gutsy, super-smart kind of Alzheimer Inc exposé, you absolutely must. And for extra credit, read up on both Auguste Deter (his prize patient) and Emil Kraepelin (his boss who decided to use the case to fundraise for his institute).

Prof Herrup likens the amyloid="Alzheimer's" link to having a bowl of Granny Smith, Golden Delicious, and Gala apples before you. You select the Granny Smith only to find a worm inside. You then declare that all green apples have worms.

Because of my acupuncture training (and the epidemic of low-back pain, even hip pain), it also reminds me of how shifty surgeons, even sometimes chiropractors, will do a scan of your spine, find a bulging or compressed disc and explain to you that that's what is causing your excruciating pain-- and that surgery will fix it.

Only you can pull 20 or 100 people in off the street, scan their lumbar spines, and find compressed discs in just about all of them. But only a handful of them are experiencing back pain.

And are often no better after the offending disc problem is excised.

Brains full of amyloid can be 100% tip top cognitively. Ditto for tangles. Conversely, upon autopsy brains of people who had been told they were suffering from Alzheimer's had no amyloid at all.

And more recently, people with a diagnosis of Alzheimer's who had their amyloid completely cleared-- experienced no improvement. None. In fact, many of them actually got worse. And nowadays far too many are dying. Suddenly. In violent, thrashing fits.

So please do your homework.