September is Alzheimer’s month, and perhaps the best thing we could all do for Alzheimer’s month is to reduce the frequency of this horrible, all-too-common disease. But what would it take to make Alzheimer’s truly optional, so that no one would need to develop Alzheimer’s, and anyone who wanted to avoid it could do so?

The first step would be to encourage everyone to be evaluated and begin active prevention. We all know to get a colonoscopy when we turn 50, but many do not realize how important it is to get a “cognoscopy” if you are 45 or older. This is pretty easy to do (and a lot less unpleasant than a colonoscopy) — some blood tests, a simple cognitive assessment, and an optional MRI with volumetrics (unless you already have symptoms, in which case you should include the MRI). A cognoscopy identifies critical, addressable risk factors for cognitive decline. This is especially important for anyone with a family history of dementia or with any symptoms of cognitive decline. We developed PreCODE specifically for prevention of cognitive decline, and we have not yet recorded a single example of someone who started prior to symptoms and followed the protocol yet broke through prevention and developed dementia.

The next step would be to ensure that anyone who develops even mild symptoms of cognitive decline or brain fog undergo appropriate evaluation and be placed on an optimal, personalized program for the reversal of cognitive decline. This is readily achievable in the earliest stages of decline, and indeed, this is one of the key reasons that Alzheimer’s treatment has until now been so ineffective — everything has been geared to late intervention: cognitive complaints are explained away as “you’re just getting older” or “it’s just a few senior moments” and terms like “mild cognitive impairment” (which is actually a late-stage — the third of four stages of Alzheimer’s) delay evaluation and treatment needlessly until very late stages of pathophysiology. Regular screens such as Pap smears, mammography, and chest X-rays have been highly effective at catching early cancers, but in the Alzheimer’s field, early screening tests are not routine, and virtually all evaluation and treatment are focused on the final two stages — MCI and Alzheimer’s — instead of the first two stages, presymptomatic and SCI.

As our recent clinical trial demonstrated, even those with MCI or early Alzheimer’s can, in the majority of cases, be improved. However, with appropriate prevention and early reversal, there is no reason to allow MCI and Alzheimer’s to develop. Combining the ability to identify and address risk factors, recognition of the extended pre-Alzheimer’s period of about two decades, and the successful treatment of SCI and MCI, it is clear that Alzheimer’s can now be averted in the vast majority of cases. It is up to each one of us to get the testing and ensure prevention or early reversal. Alzheimer’s is now truly optional.

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