“Your disease doesn’t begin when your symptoms begin. Your disease begins when your pre-disease begins.”
– Kristine Burke, MD
Proactive cognitive screening and early treatment decisions were the focus of this week’s TruNeura Mastermind.
Dr. Burke shared her practice of screening all of her older patients for cognitive decline risk using p-tau 217 and Aβ42/40. The current standard of care is to assess cognitive function when symptoms are reported, but these two markers can change up to two decades before symptoms appear and provide clinicians with an opportunity to intervene before cognitive deficits develop.
Abnormalities in p-tau 217 and Aβ42/40 provide early identification of pathology that can lead to Alzheimer’s if left unaddressed, but they are not diagnostic of Alzheimer’s in the absence of measurable cognitive impairment.
Dr. Burke makes sure this is crystal clear for her patients. “This doesn’t mean you have Alzheimer’s. It doesn’t mean you’re getting Alzheimer’s.”
Instead, the finding is a chance for Dr. Burke to provide preventive medicine and give her patients a 20 year head start. She uses the early screening to educate the patient, address any underlying abnormalities, and optimize cognitive health to prevent the development of Mild Cognitive Impairment (MCI) and Alzheimer’s.
As an example, the group discussed a patient who had been diagnosed with MCI based on positive findings of an online cognitive assessment (not the more standard MoCA score), p-tau 217 and Aβ42/40, and amyloid PET scan. Upon further evaluation, the patient was high functioning and cognitively intact, but was still being considered for anti-amyloid therapy.
The group weighed the benefits and risks associated with anti-amyloid therapy in an asymptomatic patient and what other interventions with less risk might be appropriate.
The precision medicine approach that Dr. Burke teaches in the TruNeura Mastermind offers many different tools to improve the systems that support healthy brain function and remove inflammatory, infectious, and toxic burdens without significant side effects.
This approach to care provides the patient with a solid foundation for brain and overall health to prevent and reverse cognitive decline through multimodal precision medicine interventions. And gives the practitioner more tools to support cases like this where the clinical picture is mixed.
These are the types of cutting-edge clinical discussions that are happening in the TruNeura mastermind every week to support our growing network of cognitive decline experts.
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