Achieving Optimal Outcomes with the Bredesen Protocol in Cognitive Decline

By Dave Jenkins

Agenda

• Introduction

• The Critical Success Factors

• Common Factors that Drive Poor Outcomes

• Creating the Ideal Environment for Success

• How Practitioners can Support their Patients on the Bredesen Protocols

1

2

Introduction

Types of Dementia

20-30% is Non Alzheimer's Dementia

• Vascular 17%

• Alcohol related

• Parkinson's

• Fronto temporal

• Other such as Lewy Bodies

70-80% is Alzheimer’s Disease

• Professor Bredesen has identified 5 Subtypes

3

4

Statistics of Alzheimer’s Disease

• There are >350,000 Australians living with dementia and this number is expected to more than double by 2050.

• Almost 10% of the population over 65 has dementia, the single greatest cause of disability in Australia.

• > 20% of population over 65 has Subjective or Mild Cognitive Impairment.

• Dementia is the 2nd leading cause of death in Australia, and number 1 for women.

• Millions suffering (including carers), costing billions in treatment and lost quality of life.

• Total health and aged care spend on dementia >$5bn pa and predicted to be greater than 1% GDP.

“There is no cure or disease-modifying treatment for dementia”

~ Alzheimer's Research UK

However:

• Finnish FINGER Study

• Brain Consortium Study

• Professor Bredesen’s Anecdotal Cases

• “Our Collective” 100 Reversal Cases Publication

5

6

Finnish FINGER StudyThe Lancet: Volume 385, Issue 9984, P2255-2263,

June 06, 2015

Brain Consortium StudyNature: Scientific Reports volume7, Article number: 39471,

January 03 2017

7

8

100 Cases of Documented Reversal of Cognitive Decline

The Critical Success Factors

9

10

The Critical Success Factors

• Start early in the process of neurodegeneration. SCI and MCI

• < 75 years of age

• Physically able and capable of improving strength and fitness

• Nil or few chronic and complex diseases

• Correctable perturbations

• Computer literacy

• Social support that leads to high compliance

• Financial resources. Can afford multiple testing, iterations, and trials of

advanced strategies

Common Factors that Drive Poor Outcomes

11

12

Common Factors that Drive Poor Outcomes

• Age and Advanced Disease, rapid recent decline

• “Rich man syndrome”

• Lives in a Rest Home

• Frailty

• Multiple complex perturbations, especially toxins and mould

• Amyloid angiopathy, CVAs, mixed Vascular Dementia

• Poor genetics e.g. ApoE4/4 combined with poor detoxification

• Psychological e.g. anxiety, depression, PTSD, poor vagal tone, lacks

will to live, lacks purpose, etc.

ApoE4 – Cognitive Prognosis

Neurology® 2008;70:1842–1849

13

14

Creating the Ideal Environment for Success

– Medical and Cognitive

– Nutrition• Foods – what type of foods, fish, meats, organic• Portions – how many servings• Timing – when do they eat, fasting• Habits – cooking, pace

– Lifestyle and Ecosystem• Exercise• Stress• Mental Environment• Social Environment

– Cognitive Stimulation• Children, grandchildren• Friends, community groups• Games, novel challenges, dancing, music

Comprehensive Assessment including Ecosystem

15

16

Create a Supportive Ecosystem

Memberships

Participant

Doctor

Partner

Friends/Family

Clubs/Centres

Trainers

Coach

– Facilitates behaviour change

• Create awareness

• Address barriers to change/mindset/beliefs

• Environment, Choice architecture

– Accountability

• Check ins, BrainHQ, weekly worksheets

– Consultations fortnightly/monthly

• Home visits, meet family, doctors

• Home makeover, share a meal

– Support

• Online – webinars, Facebook group, nudges

Coaching Increases Positive Outcomes

17

18

How Practitioners Can Support Patients on the Bredesen Protocol

• Establish Screening for SCI and MCI

• Establish annual “cognoscopy” protocol such as risk factor analysis, assessments and tracking cognitive test scores

• Take complaints of cognitive loss seriously

• Investigate and refer for a formal assessment from a Neurologist/Geriatrician

• Quickly identify Type 3’s (Toxic)

Screen for Suitability for the Bredesen Protocol

19

20

• Inform and encourage patients but manage expectations

• Collect large data sets

• Seek to optimise not just normalize perturbations e.g. Vitamin B12 and D, and Zinc

• Reach target levels for all perturbations and sex hormones

• Provide educational resources and support

• Establish a team around the patient and their support persons

• Refer to specialist practitioners, naturopaths and coaches

Supporting Patients on the Protocol

• Use and understand the ReCODE Report

• Keep up to date on new developments, the Bredesen Protocol guidelines and targets are revised as needed

• Be careful about drugs and drug interactions that impede cognition including OTC such as antihistamines

Utilising the Bredesen Protocol

21

22

• Buy items you already have

• Find difficulty keeping up with everyday tasks

• Struggle making everyday decisions

• Experience personality changes

• Friends and family show concern

• You’re known to repeat yourself in conversations

• You get lost while taking familiar routes

• You frequently put things in strange places

Memory Loss That Might Be ABNORMAL

Case 1: Sue – Cognitive Scores

Mar 2018

NCI: 55MoCA: 30

BASELINENov 2017

NCI: 23MoCA: 22

23

24

Screening – Quick Online Test

cft3.foodforthebrain.org

25

26

• MOCA (Montreal Cognitive Assessment)

• ACER (Addenbrooke’s)

• MMSE (Mini-Mental State Examination)

• GP COG (General Practitioner Assessment of Cognition)

• Symptom check lists

• 10 word recall

Paper and Other Manual Tests

The Program

• Optimise, not just normalise metabolic perturbations

• Reach a threshold (change the APP signaling)

• Brain optimising diet

• Stimulate autophagy

• Exercise

• Sleep

• Meditation and stress management

• Brain Training

• Nutraceuticals

• Specialised coaching

• External neuromodulation (beyond Bredesen)

27

28

The Future Vision

• Trials of current protocols. Early phase has started in USA

• Live in Intensives

• Online Coaching Courses and Client Membership Group

• Practitioner Membership Group

• Integrate new drugs, neuromodulation and supplements

• Easier screening strategies e.g. blood/retinal amyloid markers

• Government and Alzheimer's Association support

www.endalzheimers.com.auwelcome@endalzheimers.com.au

Bredesen Protocol Programs

29

30

The End

31