We’re making a small shift to better support you, and we’re excited to share it with you all! Beginning this month, we’re introducing a monthly Dementia Lifeboat podcast, called Port of Call. This is a space where everyone can listen in as we explore the questions caregivers ask most, share trusted guidance, and deepen dementia awareness together. To make room for this, we’ll be moving from two Poolside Chats a month to one. Our Poolside Chat will continue on the fourth Tuesday of each month, offering a live, supportive space to connect, ask questions, and speak directly with dementia experts. Think of it this way: Port of Call: Listen, learn, and gain perspective Poolside Chat: Talk, connect, and feel supported This is a positive step forward, giving caregivers both education and community in ways that fit real life. We can’t wait to welcome you into this next chapter of The Dementia Lifeboat. Please be sure to RSVP to our next Poolside chat on January 27: https://us02web.zoom.us/meeting/register/PRzPtXKIRf-NNdHzhSToUg And keep an eye out for our new podcast later this month!

I diagnosed my first thousand dementia cases before I realized I was doing it wrong. The diagnosis was right. The timing was wrong. By the time patients reached my clinic, the window for meaningful intervention had mostly closed. The patient: Robert, 73. Retired engineer. His wife: "Forgetting things. Repeating questions. Confused paying bills." Standard workup: MOCA 21/30 (moderate impairment) Brain MRI: Moderate atrophy (especially in a pattern consistent with Alzheimer's) Diagnosis: Probable Alzheimer's, moderate stage I prescribed donepezil. Discussed prognosis. Provided resources. Standard care. Good care. But symptoms started "maybe 2 years ago." By the time he reached me, he'd lost 2+ years of brain function. Fast forward 10 years. Now I see Robert's equivalent 5 years earlier. "Bit more forgetful. Takes longer to find words. Nothing dramatic." MOCA 27/30 (mild impairment) But I look differently now: A1c: 6.2% (prediabetic) ApoB: 125 mg/dL (high CV risk) hs-CRP: 3.2 mg/L (inflammation) Sleep study: Moderate apnea His brain isn't failing from Alzheimer's alone. His body is failing his brain. The intervention: Treat sleep apnea. Lower A1c. Reduce CV risk. Address inflammation. Mediterranean diet. Exercise program. Did this cure early Alzheimer's? No. Did it buy 3-5 years of better function? Probably yes. The difference: Old: Diagnose when obvious. Prescribe meds. Manage decline. New: Identify when subtle. Address reversible factors. Optimize brain health. Same patient. 5 years apart. Different trajectory. What changed my practice: By the time dementia is obvious, I've missed the window. The goal is earlier identification plus aggressive treatment of everything making it worse. I can't cure Alzheimer's. But I can treat sleep apnea, hypertension, diabetes, inflammation early. When I treat those early, cognitive decline often stabilizes. Thousands of Roberts I diagnosed correctly but too late. I can't give them those 5 years back.

What emotion are you feeling right now? Whatever it is, it's the right way to feel. And what other people are feeling is the right way for them to feel, also. When my kids were little, and they told me they were feeling a negative emotion, I would often try to talk them out of it. I would say some version of, "Oh, don't be sad. Everything will be OK. Let's go for a walk or watch a movie, and hopefully you will feel better." I didn't know what I didn't know at the time. But by doing this, I was sending them the signal that negative emotions are to be avoided, and you shouldn't feel them or at least try to get rid of them as fast as you can. If I had it to do over, I would now say some version of, "Oh, I'm sorry you are feeling sad. I've been sad before, too, and I know it doesn't feel great, but it's just fine to feel that way. You can be sad for as long as you need to be sad, and I just love you. I'm here if you want to talk about it." As a coach, I am here to help my clients stop feeling an emotion like sadness, but ONLY if that's what they want. Not because they shouldn't feel that way. I can teach them the exact reason they are feeling sad. I can teach them the skill of CHOOSING what they want to feel instead and how to generate that new emotion. Let other people choose their emotions and turn your focus to who you want to be and how you can support them. Love each other. Choose your own emotions. Let yourself feel whatever you need to feel for as long as you need to feel it. Then, if and when you want to change it....do it. Not because you should. But because you can...... It's like your superpower. (Thank you @Jocelyn Ives!)

The 5 lab tests I order for every patient worried about Alzheimer's. Not the tests you'd expect. Most doctors order specialty referral or brain imaging first. I start with these blood tests. Cheaper. Faster. Actionable. Test 1: Hemoglobin A1c Measures: 3-month average blood sugar Why it matters: Every 1% increase in A1c increases dementia risk by 20-40%. Even in people without diabetes. Target: Under 5.7% (ideally 5.0-5.5%) What I do if elevated: Diet modification, exercise, metformin if prediabetic. See results in 90 days. Test 2: ApoB (Apolipoprotein B) Measures: Number of atherogenic particles in your blood Why it matters: Better predictor of cardiovascular disease than LDL. Cardiovascular disease doubles dementia risk. Target: Under 80 mg/dL (some experts say under 60 mg/dL) What I do if elevated: Statins, ezetimibe, supplements, lifestyle modification depending on level. Test 3: High-sensitivity CRP (hs-CRP) Measures: Systemic inflammation Why it matters: Chronic inflammation drives neurodegeneration. Target: Under 1.0 mg/L (ideally under 0.5 mg/L) What I do if elevated: Look for source. Treat sleep apnea. Optimize diet. Address metabolic dysfunction. Test 4: Homocysteine Measures: Amino acid that damages blood vessels when elevated Why it matters: Elevated homocysteine independently increases dementia risk. Often easily correctable. Target: Under 10 μmol/L (ideally under 8 μmol/L) What I do if elevated: B vitamins (B6, B12, folate). Recheck in 3 months. Test 5: APOE Genotype Measures: Genetic risk for Alzheimer's Why it matters: APOE4 carriers have 3-12x increased Alzheimer's risk. Changes prevention strategy. Target: This is information, not a target What I do if positive: More aggressive prevention. Earlier screening. Closer monitoring. The tests I don't routinely order: Specialized imaging (e.g. amyloid PET): $5,000+. Not covered by insurance. Doesn't change management in asymptomatic people. Brain MRI: Useful for diagnosis. Less useful for prediction in healthy people.