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.

Peter Attia spends 6 figures annually on longevity medicine for 75 patients. Meanwhile, 60% of people with dementia never get diagnosed. Both are happening in the same healthcare system. Something is deeply broken here. Attia's patients get: 2-day comprehensive evaluations VO2 max testing Full-body MRI scans DEXA scans APOE genetic testing Continuous biomarker monitoring Dedicated physician team Annual cost: $100,000+ The average Medicare patient with memory complaints gets: 15-minute primary care visit Maybe a mini-cog if they're lucky Referral to neurology (6+ month wait) Often dies before diagnosis Annual cost to diagnose: $0 (because they never get diagnosed) I'm not criticizing Attia. His approach is scientifically sound. His patients get extraordinary care. I'm criticizing a system where we've decided preventive longevity medicine is only for people who can pay 6 figures. The tests Attia orders, ApoB, Lp(a), advanced lipid panels, inflammation markers, aren't covered by most insurance. Even when they predict disease decades early. The tools we need for early dementia detection, computerized cognitive testing, blood biomarkers for Alzheimer's, advanced imaging, same story. Not covered. Not accessible. Not standard. So we have two healthcare systems: System 1: Ultra-wealthy get Medicine 3.0. Predict disease 20 years early. Prevent what's preventable. Optimize what's optimizable. System 2: Everyone else gets Medicine 2.0. Wait for symptoms. Diagnose late. Treat reactively. Hope for the best. The irony: The interventions that work best for brain health aren't expensive. Exercise. Mediterranean diet. Sleep. Social engagement. Blood pressure control. These cost almost nothing. But knowing you need them requires testing. Knowing is motivation. Motivation is behavior change. And testing costs money if insurance won't cover it. My patients ask me: "Should I get an ApoB test? Should I check my APOE status? Should I get computerized cognitive testing?"

Marshall Foundation for Community Health brought together close to 60 attendees and more than a dozen community partners and vendors who are committed to supporting individuals and families navigating dementia. Guests had the chance to learn from dementia expert Laura Wayman, known to many as the “Dementia Whisperer,” whose compassion and practical guidance resonated deeply with the audience. One attendee shared, “I came feeling overwhelmed and left feeling supported, informed, and hopeful.” Events like these remind us of the powerful ways philanthropy and community connection come together at Marshall. Thank you for being part of this ongoing story. Every contribution and every moment of engagement helps carry our mission forward. Watch the short video! (View on LinkedIn)

Sarah, 61, came to my clinic convinced she had early Alzheimer's. Forgetting words mid-sentence. Couldn't focus through meetings. Walking into rooms and forgetting why. Her mother had died from Alzheimer's at 68. Sarah was terrified she was next. I ran the full workup: Cognitive testing: normal for age. Brain MRI: no concerning findings. Biomarkers: no evidence of Alzheimer's pathology. But something was clearly wrong Then I looked at her labs: A1c: 6.1% (prediabetic) Blood pressure: 148/92 (hypertension) LDL: 156 (elevated) Body weight: 42 pounds over healthy range Sleep: 5-6 hours, poor quality Her brain wasn't failing. Her body was failing her brain. I prescribed something no pharmaceutical company makes: Lose 25 pounds over 6 months. Walk 30 minutes daily. Mediterranean diet. Sleep 7-8 hours nightly. Manage stress actively. Sarah looked disappointed. She wanted a pill. A diagnosis. Something medical. Not "eat better and exercise." That felt too simple. Too much like failure. But she agreed to try. Three months with a health coach. Daily accountability. Structured program. Here's what happened: Month 1: Lost 8 pounds. Sleep improved to 7 hours. Brain fog "maybe 10% better." Month 2: Lost another 7 pounds. A1c dropped to 5.8%. "I can think again during afternoon meetings." Month 3: Lost 6 more pounds. Blood pressure 128/84. "I haven't felt this sharp in 5 years." Six months later: Lost 23 pounds total. A1c: 5.4% Blood pressure: 118/76 LDL: 112 Sleep: 7.5 hours average Cognitive complaints: resolved. Sarah didn't have dementia. She had metabolic dysfunction causing reversible cognitive impairment. Fix the metabolism. Fix the brain. This isn't rare. I see it constantly: Sarah asks me now: "Why didn't my last doctor tell me this?" Because we're trained to diagnose disease, not reverse dysfunction. We're good at spotting Alzheimer's. Terrible at recognizing reversible metabolic cognitive impairment. The difference matters enormously. One is progressive and irreversible. The other responds to lifestyle intervention within months.