Reversal of cognitive decline: A novel therapeutic program

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Published online 2014 Sep 27.
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Table 1

Therapeutic System 1.0
Goal Approach Rationale and References
Optimize diet: minimize simple CHO, minimize inflammation. Patients given choice of several low glycemic, low inflammatory, low grain diets. Minimize inflammation, minimize insulin resistance.
Enhance autophagy, ketogenesis Fast 12 hr each night, including 3 hr prior to bedtime. Reduce insulin levels, reduce Aβ.
Reduce stress Personalized—yoga or meditation or music, etc. Reduction of cortisol, CRF, stress axis.
Optimize sleep 8 hr sleep per night; melatonin 0.5mg po qhs; Trp 500mg po 3x/wk if awakening. Exclude sleep apnea. [36]
Exercise 30-60′ per day, 4-6 days/wk [37, 38]
Brain stimulation Posit or related [39]
Homocysteine <7 Me-B12, MTHF, P5P; TMG if necessary [40]
Serum B12 >500 Me-B12 [41]
CRP <1.0; A/G >1.5 Anti-inflammatory diet; curcumin; DHA/EPA; optimize hygiene Critical role of inflammation in AD
Fasting insulin <7; HgbA1c <5.5 Diet as above Type II diabetes-AD relationship
Hormone balance Optimize fT3, fT4, E2, T, progesterone, pregnenolone, cortisol [5, 42]
GI health Repair if needed; prebiotics and probiotics Avoid inflammation, autoimmunity
Reduction of A-beta Curcumin, Ashwagandha 43–45
Cognitive enhancement Bacopa monniera, MgT [46, 47]
25OH-D3 = 50-100ng/ml Vitamins D3, K2 [48]
Increase NGF H. erinaceus or ALCAR [49, 50]
Provide synaptic structural components Citicoline, DHA [51].
Optimize antioxidants Mixed tocopherols and tocotrienols, Se, blueberries, NAC, ascorbate, α-lipoic acid [52]
Optimize Zn:fCu ratio Depends on values obtained [53]
Ensure nocturnal oxygenation Exclude or treat sleep apnea [54]
Optimize mitochondrial function CoQ or ubiquinol, α-lipoic acid, PQQ, NAC, ALCAR, Se, Zn, resveratrol, ascorbate, thiamine [55]
Increase focus Pantothenic acid Acetylcholine synthesis requirement
Increase SirT1 function Resveratrol [32]
Exclude heavy metal toxicity Evaluate Hg, Pb, Cd; chelate if indicated CNS effects of heavy metals
MCT effects Coconut oil or Axona [56]

CHO, carbohydrates; Hg, mercury; Pb, lead; Cd, cadmium; MCT, medium chain triglycerides; PQQ, polyquinoline quinone; NAC, N-acetyl cysteine; CoQ, coenzyme Q; ALCAR, acetyl-L-carnitine; DHA, docosahexaenoic acid; MgT, magnesium threonate; fT3, free triiodothyronine; fT4, free thyroxine; E2, estradiol; T, testosterone; Me-B12, methylcobalamin; MTHF, methyltetrahydrofolate; P5P, pyridoxal-5-phosphate; TMG, trimethylglycine; Trp, tryptophan

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