APOE ε4, the door to insulin-resistant dyslipidemia and brain fog? A case-Another case report of Ketogenic Diet Benefit.

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Michae_M
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APOE ε4, the door to insulin-resistant dyslipidemia and brain fog? A case-Another case report of Ketogenic Diet Benefit.

Post by Michae_M »

Seth Stoykovich and Kelly Gibas give us another case report of the reversal of early stage AD-Montreal Cognitive Assessment improved from 23/30 (mild AD) to 29/30 (normal ≥ 26) in only 10 weeks with a ketogenic diet.

We may be near the point where it is unethical to not offer this option to individuals with diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423699/
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Re: APOE ε4, the door to insulin-resistant dyslipidemia and brain fog? A case-Another case report of Ketogenic Diet Bene

Post by NF52 »

Michae_M wrote:Seth Stoykovich and Kelly Gibas give us another case report of the reversal of early stage AD-Montreal Cognitive Assessment improved from 23/30 (mild AD) to 29/30 (normal ≥ 26) in only 10 weeks with a ketogenic diet.

We may be near the point where it is unethical to not offer this option to individuals with diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423699/
Welcome, Michae_M,
Thank you for posting the link to this very encouraging case study report. It is in line with other population-based studies such as the Finnish FINGER study and subsequent intensive intervention studies with at-risk people in mid-life based on that: WorldWide FINGERS. While not necessarily focused solely on a ketogenic diet or individuals with T2D, it seems that many agencies and governments would agree with you that a combination of interventions with careful monitoring can be effective, especially in MCI or early AD.

The one point that concerned me in the article is their statement that that this individual had mild AD based on the MOCA, without any imaging tests or a full battery of extensive neuro-cognitive testing and their assertion that
The Montreal Cognitive Assessment is considered to be a gold standard assessment in the diagnosis of early AD.
Here is a quote from what I believe is a more consensus view of the MOCA as a 10-minute validated screening tool to assess probability of Mild Cognitive Impairment (MCI) and a revised recommendations for scoring cut-offs, with bold font emphasis added:
The Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) is a cognitive screening tool that aims to differentiate healthy cognitive aging from Mild Cognitive Impairment (MCI). Several validation studies have been conducted on the MoCA, in a variety of clinical populations. Some studies have indicated that the originally suggested cutoff score of 26/30 leads to an inflated rate of false positives, particularly for those of older age and/or lower education...We conducted a systematic review and meta‐analysis of the literature to determine the diagnostic accuracy of the MoCA for differentiating healthy cognitive aging from possible MCI...analysis revealed a cutoff score of 23/30 yielded the best diagnostic accuracy across a range of parameters.
Conclusions
A MoCA cutoff score of 23, rather than the initially recommended score of 26, lowers the false positive rate and shows overall better diagnostic accuracy. We recommend the use of this cutoff score going forward.
[url=https://onlinelibrary.wiley.com/doi/abs ... 2/gps.4756]A re‐examination of Montreal Cognitive Assessment (MoCA) cutoff scores[/url]

The case study subject still had an impressive improvement on MOCA score and biometrics, but since under the recommended cut-off he would have been considered at the first level of MCI, not mild AD (which I have seen as a score of 16 or lower), it seems reasonable to say that this suggests an important critical window before more severe loss of function has occurred. As someone who is in a clinical study, with biannual extensive blood tests, cognitive, neuromuscular and daily living assessments, as well as yearly imaging tests, I think the MOCA provides a screening tool for both intervention and, when warranted, further in-depth assessment with a thorough battery of tests, which would be covered by Medicare for someone aged 68.

I hope you continue to share your knowledge with us. Anyone who is reading Elsevier publications is going to be well-versed in topics of interest to the forum!
4/4 and still an optimist!
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Re: APOE ε4, the door to insulin-resistant dyslipidemia and brain fog? A case-Another case report of Ketogenic Diet Bene

Post by SamNZ »

Dear Michae_M, Thanks so much for sharing with us, I look forward to reading the article in the near future. As a Functional Medicine Health Coach I certainly agree that support in changing diet should be part of any protocol that deals with treating any chronic disease. You have obviously had a chance to look around our website over the last few weeks, we really welcome any new members and you obviously have a lot of knowledge and information to offer our community. Thanks again for your post, please feel free to introduce yourself in [/url=viewforum.php?f=2]Our Stories[/url] section of the website. We look forward to hearing more from you soon. - SamNZ
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