What do you do when a patient has cognitive decline, elevated inflammatory markers, evidence of chronic infection, and a history of mold exposure, but no single result gives you the full answer?
When does a positive ANA warrant action, even if the rest of the autoimmune workup is negative?
How do you decide whether a patient with cognitive decline should remain on a statin when cardiovascular risk and cognitive concerns are both part of the picture?
Those were some of the questions that came into our latest TruNeura Mastermind AMA with Kristine Burke, MD.
The session covered a wide range of topics, but a common theme emerged: the value of understanding what a finding means in the context of the whole patient.
Looking Beyond a Single Lab Result
One member asked about patients with significantly elevated TGF-beta. Another asked how to approach an elevated ANA when more specific autoimmune markers were negative.
Neither conversation led to a simple “if this, then that” answer.
Instead, Dr. Burke discussed looking at what else is happening. Is one inflammatory marker abnormal, or is there a broader pattern? Are there signs pointing toward biotoxin exposure, chronic infection, immune dysregulation, vascular inflammation, or ongoing tissue damage?
That distinction can change the next step.
An elevated number on its own may tell you something is happening. The work is figuring out what it means for that particular patient and whether changes in the broader picture are moving in the right direction.
As Dr. Burke noted during the session, sometimes the goal is not getting every marker into a perfect range. Sometimes meaningful progress is seeing the overall inflammatory burden begin to shift as underlying drivers are addressed.
What Happens When the Immune System Can’t Get Ahead?
Chronic viral activation was another major area of discussion.
A member asked about patients with high EBV and CMV titers, and the challenge many practitioners face: antibodies are common, but not every patient with antibodies has an active problem requiring treatment.
The conversation explored how the team distinguishes between evidence of past exposure and signs that a virus may still be actively contributing to a patient’s clinical picture. It also touched on the importance of asking why the immune system is struggling to maintain control in the first place.
Environmental exposures came up repeatedly in that context.
Dr. Burke shared that in some patients, particularly those with significant mold exposure and immune dysfunction, aggressively pursuing antiviral treatment before addressing the environment may not get clinicians very far. The goal is not simply to keep adding therapies. It is to create conditions where the patient’s immune system has a better chance of doing its job.
That approach also helps explain why two patients with similar-looking lab results may require very different strategies.
Not Everything Has to Be Added Up Front
Peptides and plasmalogens brought up another recurring question in cognitive decline care: when does an additional therapy actually move the needle?
Members asked which peptides Dr. Burke is seeing consistent benefit from and where they fit into treatment. Her answer was notably measured. These therapies may have a role, but they are not necessarily the first thing a patient needs, and the field is still evolving.
The same principle came up with plasmalogens.
Dr. Burke discussed them as part of the body’s broader membrane and antioxidant defense system, rather than a standalone answer to cognitive decline. She shared observations from practice, including some striking improvements in individual patients, while emphasizing that not every patient will need the same intervention long term.
That was an important theme throughout the AMA.
There is a difference between knowing a therapy can be useful and knowing when it is useful for the patient in front of you.
When Vascular Risk and Cognitive Decline Collide
One of the longest discussions of the session centered on statin therapy.
The question was straightforward: when do you use a statin in someone with significant cognitive decline, and when might you consider withdrawing it?
The answer was not that statins are always good or always bad.
Dr. Burke walked through how she thinks about the difference between treating a number and treating demonstrated risk. A patient with established vascular disease, significant plaque burden, or other clear signs of cardiovascular risk may be a very different situation from someone taking a statin solely because of an elevated cholesterol level.
The group discussed looking more deeply at the vascular picture, including plaque burden, vascular inflammation, and other risk markers, rather than making decisions based on one cholesterol number alone.
Dr. Burke also shared examples of what can happen when underlying drivers are addressed. In one case, a patient’s LDL dropped by approximately 100 points after she was removed from a moldy environment, without that being the primary lipid-focused intervention.
That does not make mold the explanation for every elevated lipid panel. It does illustrate the larger point of the session: sometimes the finding you are trying to manage changes when you address what may be driving it.
The conversation also touched on the practice’s long track record of preventing cardiovascular events while taking this broader approach to vascular health.
The Value of Bringing the Real Questions
The AMA also covered mold testing, heavy metals, cerebral amyloid angiopathy, vascular barrier integrity, immune support, and how practitioners are approaching therapies where the evidence and clinical experience are still developing.
What made the session valuable was not that every question had a simple answer.
It was that practitioners could bring in the questions they are actually facing.
The patient with a high marker that does not fit neatly into a diagnosis. The patient with several possible contributors. The treatment that might help, but adds cost and complexity. The medication with a potential benefit and a potential downside. The case where the question is not just, “What can I give them?” but, “What should I look at next?”
Those are the conversations happening inside the TruNeura Mastermind.
And when clinicians can hear how other experienced practitioners are thinking through those decisions, ask follow-up questions, and compare what they are seeing in practice, they leave with more than another list of protocols.
They leave with a clearer way to approach the next case.
