• Dr. Rana Mafee

What's Next? Steps To Take If you Suspect Cognitive Decline



It is undisputed that the earlier one detects a decline in their or a loved one’s cognition, the better the chances of stopping progression and possibly reversing the process. In fact, research shows that those with an eventual diagnosis of Alzheimer’s Disease, actually have pathological findings of the disease as far back as 20 years prior to the diagnosis. The same is likely true for other neurodegenerative diseases like Parkinson’s Disease and Lewy Body Dementia. And while not fully yet accepted by most traditional medical organizations, more and more research is showing that diseases like Alzheimer’s, Parkinson’s, and other neurodegenerative diseases have very complex and multifactorial root causes, including metabolic, immunological, toxic, and hormonal factors to name a few. Therefore, since much can be done to stop further degeneration in its tracks, it is vital for those with a hint of decline in their cognition to be proactive and take extra steps to turn back the clock. Similarly, for those with more advanced diseases, know that fruitful interventions beyond traditional pharmaceuticals are possible.


Working with a doctor trained in functional and integrative medicine can help facilitate any barriers you might face when presenting to your primary care provider or even a traditional neurologist. Having had experience working with patients who complain of cognitive decline, I am pleased over and over again with the ability of my expanded toolbox to facilitate the investigative process as well as the healing process.


A recently invented term, “cognoscopy”, sums up the investigative process. Just as a colon cancer screening is recommended at the age of 45, I believe that a cognoscopy should be routinely recommended as well. Anyone noticing a decline in their cognition in themselves or a loved one at any age should pursue a cognoscopy. Additionally, anyone with a family history of Alzheimer’s Disease should pursue having a cognoscopy 20 years prior to the typical age at onset for family members.


So what exactly is a cognoscopy? At a minimum, it encompasses:


  • a complete neurological exam

  • a cognitive assessment performed either by a neurologist or one done digitally at home (recommended by a trained practitioner)

  • a parallel assessment administered by a loved one called an AQ21 to help gauge any symptoms not perceived by the patient.

  • a battery of comprehensive blood tests (looking at inflammation markers, metabolic markers, hormones, nutritional markers, genetic markers, and toxin and detox markers)


In asymptomatic individuals with normal cognitive assessments, labs, and AQ21, further evaluation is not warranted. However, if scoring outside the normal range on cognitive assessments, or if the AQ21 score is 3 or greater, typically imaging of the brain (MRI) is ordered. Recent advancements have allowed for volumetric measurements of specific brain regions related to memory and cognition, which can be ordered with the MRI and can be followed over time. And beyond these assessments, further investigative work and interventions are individualized based on unique patient needs.


Therefore, it is vital that cognitive decline be assessed as early as possible to ensure the best possible outcome. Either work with a trained neurologist who is comfortable with a functional medicine or find a doctor who is open-minded enough to order some extra assessments focusing on the root cause of your condition.




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