Cognitive health
The Bredesen Protocol
A structured, personalised programme for people with mild cognitive impairment or early Alzheimer's disease, and for those with a family history who want to act while there is most to be gained. The aim is to halt further progression.
The premise
Cognitive decline rarely has a single cause. In most people who come to see me, several things are contributing at once: insulin resistance, chronic inflammation, poor sleep, nutrient deficiency, hormonal change, vascular disease, sometimes chronic infection or toxic exposure. Each is modest on its own. Together they matter.
Dr Dale Bredesen's contribution was to treat that as the starting point rather than a complication, and to build a systematic way of working out which contributors are active in a given person. That is what this programme does. It is not a drug, and it is not one intervention applied to everyone.
What I am aiming for
The primary aim is to halt further progression. That is the realistic goal, it is what I work towards in every case, and it is a worthwhile outcome in a condition that is otherwise expected to worsen.
I have seen improvement in symptoms in some patients, most often those who presented early and at a younger age. That does happen. It is not guaranteed, it is not the expected result, and I would be doing you a disservice if I let you plan around it. Outcomes depend on many factors: the stage at which you start, which contributors the testing identifies, other medical conditions, and — a great deal — how fully the programme can be followed and sustained over time.
That last point deserves emphasis. This is a demanding programme. Diet, sleep, exercise, supplementation and follow-up all have to hold together over months, usually with family support. Adherence is one of the largest determinants of how well anyone does, and it is the part I cannot do for you.
Being straight about the evidence
The published work is largely case series and small trials reporting improvement in people with early decline. That is meaningful, and it is why I trained in this approach. It is also not the same as large randomised controlled trial evidence, which does not yet exist.
So I will not promise to reverse your Alzheimer's disease. What I will do is investigate thoroughly, tell you honestly what the testing shows, treat what is treatable, aim squarely at stopping further decline, and be clear when something is outside what this approach can offer.
What the programme involves
Four stages, over several months.
Assessment
A comprehensive first consultation, with time to explore the case in depth. Cognitive history, medical history, family history, medication, sleep, diet, exposures. Where appropriate I will ask to see previous investigations and correspond with your GP or neurologist.
Testing
Detailed blood work across metabolic, inflammatory, nutritional and hormonal markers, plus genetics where useful, including ApoE status. Testing for chronic infection or toxic exposure when the history points that way.
Interpretation
We go through the results together. The point is to identify which contributors are active in your case, because they differ substantially between people who arrive with similar symptoms.
The programme
A written plan covering diet, exercise, sleep, cognitive activity, targeted supplementation and, where indicated, treatment of specific findings. Reviewed and adjusted over the following months.
Common questions
What is the Bredesen Protocol?
A structured approach to cognitive decline developed by Dr Dale Bredesen, based on the premise that decline usually has several contributing causes operating together rather than one. Instead of treating a diagnosis, it identifies which factors are active in an individual - metabolic, inflammatory, nutritional, hormonal, toxic, vascular - and addresses those.
What does the evidence actually show?
The published work consists mainly of case series and small trials reporting cognitive improvement in participants with mild impairment or early Alzheimer's disease. That is genuinely encouraging, and it is also a lower grade of evidence than a large randomised controlled trial. There is not yet trial evidence of that standard. I think the approach is worth pursuing on the basis of what exists, particularly early in the course of decline, but you should go into it understanding what the evidence base is and is not.
Who is it suitable for?
It is best suited to people with subjective cognitive decline or mild cognitive impairment, and to those with a family history or known genetic risk who want to act early. The earlier the stage, the more there is to work with. In advanced dementia the realistic goals are different, and I will say so rather than take on work unlikely to help.
What results should I expect?
The aim is to halt further progression, and that is the outcome I work towards. Some patients, most often those who presented early and at a younger age, have seen improvement in symptoms - but that is not guaranteed and it is not what I would have you expect. Others hold steady, which in a progressive condition is itself worth having. Some continue to decline. Outcome depends on the stage at which you start, which contributors the testing finds, other medical conditions, and how fully the programme can be followed and sustained. Anyone who offers you a firmer answer than that is guessing.
How much does it cost?
The programme runs over several months and includes the initial assessment, testing, interpretation and follow-up reviews. Testing is a substantial part of the cost and varies with what is clinically indicated. Current fees are set out on the fees page, and I will give you a clear estimate before you commit to anything.
Do I need a diagnosis first?
No, and many people come before any formal diagnosis, often because they have noticed changes themselves. If your assessment suggests you need neurological investigation you have not had, I will say so and help you get it.
Talk it through first
A discovery call costs nothing and commits you to nothing. It is the sensible way to find out whether this is the right approach for your situation before you spend money on testing.