What Intervention Can Take a MoCA Score from 18 to 28?

A modern day miracle now possible at scale

There are moments in medicine where something happens that forces you to rethink what’s possible. This past week was one of those moments.

In a recent webinar we hosted with Quicksilver Scientific, Dr. Kristine Burke walked through a case from the EVANTHEA trial where a patient went from a MoCA score of 18 to a 28.

If you understand cognitive decline, you know how significant that is. An 18 is not mild. It’s not someone who is just a little forgetful. It’s getting close to a full Alzheimer’s diagnosis.

So this is not a marginal gain. This is not someone improving a couple of points.

This is someone going from major cognitive impairment back to normal function.

That just doesn’t happen in conventional care. It doesn’t happen with drugs. And until now, it hasn’t been shown inside a randomized controlled trial. Check out the video below.

What makes this even more important is that when you watch the case, you realize very quickly that there is no single “intervention” that did this. There’s no protocol you can copy and paste. What you’re seeing is a way of thinking, a way of organizing complexity, and a way of sequencing decisions over time.

Dr. Burke starts by laying out the methodology, and then she walks through the case step by step. What stands out is how many different things are going on at once. This is not a patient with one root cause. This is someone with multiple overlapping drivers of decline all layered together.

And yet, the approach is not to throw everything at the patient at once.

It’s to sequence.

To decide what matters most first. To stabilize before pushing. To open pathways before trying to remove burden. To make sure the body can actually respond before adding more inputs. And then to adjust based on what the data is showing in real time.

That’s the part that most people miss. It’s not just what you do, it’s when you do it, and in what order.

There’s also a deeper layer here that doesn’t get talked about enough, which is delivery. It’s one thing to identify what the body needs. It’s another thing entirely to make sure it actually gets there. In this case, there is a clear emphasis on absorption, on cellular uptake, on whether the interventions are actually reaching the brain and being utilized.

When you put all of that together, what you start to see is not a protocol, but a system.

And that’s really the breakthrough.

For years, functional medicine has had the right idea. Look upstream. Personalize care. Address root causes. But it has been hard to scale because so much of it lives in the practitioner’s head. The sequencing, the prioritization, the constant adjustment. It’s difficult to teach and even harder to replicate.

What this case shows is what happens when that thinking is made visible. When the data is organized in a way that supports decision making. When there is a structure to the process.

This patient was not an outlier in isolation. They were part of the EVANTHEA trial, which is the first randomized controlled trial showing that a precision medicine approach can actually improve cognition. Not just slow decline, but improve it.

That’s a very different conversation than what we’ve been having for the last twenty years.

And it raises a bigger question.

If this is now possible, what would it take to make it standard?

At TruNeura, that’s the focus. How do you take a case like this and make it repeatable? How do you give practitioners a way to organize the complexity, follow a clear process, and track whether patients are actually getting better?

Because ultimately, this is not about one case.

It’s about what this case represents.

A MoCA score going from 18 to 28 is a signal. It tells us that cognitive decline is not necessarily a one-way street. It tells us that the current model is incomplete. And it shows that when you approach this as a systems problem, different outcomes become possible.

The question now isn’t whether this can happen.

It’s how quickly we can make it happen for more people.

If you’re a practitioner and you want to understand how this kind of care is being delivered, and how to bring that into your own clinic, you can learn more about TruNeura and how the system works.