11d • General discussion
I Diagnosed 1,000 Dementia Cases Before I Realized I Was Too Late
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.
But I can change how I practice and tell other doctors: Stop waiting for obvious dementia before you intervene.
⁉️ If you could detect dementia risk 5-10 years early, would you want to know?
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I Diagnosed 1,000 Dementia Cases Before I Realized I Was Too Late
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