Very often, readers reach out asking for a list of tests to take to their doctor for their own DIY cognoscopy. What follows is not perfect or complete, but it has been very helpful for me in my own wellness journey.
Published in the Impact Journal on Aging in 2014, Dr. Dale Bredesen presents a “novel therapeutic program” for the “reversal of cognitive decline”. A few years later this program was detailed out in his bestselling book, The End of Alzheimer’s.
I took it upon myself to try and replicate as much of this protocol as I could without the use of a Bredesen practitioner. My methodology was simple and unscientific; you can read more about it here.
There is no question that I recommend going full-on Bredesen ReCODE protocol if you qualify and have the money to do it. But many people live on fixed incomes and cannot spend thousands of dollars on tests and doctor visits which are not covered by health insurance. In addition, not all qualify for Bredesen's protocol as it is currently in use for only very specific subsets of people.
The tests below are from my own wellness spreadsheet. They include the CPT codes as well, which your doctor will need to order the lab tests. All tests were ordered using either ICD 10 diagnosis code Z13.89 (encounter for screening for other disorder) or ICD 10 diagnosis code R53.83 (other fatigue).
CBC w/ Diff and Platelet (CPT code 85025) Although not included in the Bredesen/RECode protocol, a complete blood count is a basic component of an annual checkup or wellness assessment. My CBC in 2018 revealed elevated MCH (mean corpuscular hemoglobin) and RDW (red cell distribution width) which — to me — indicated I was drinking too much alcohol and was experiencing nutritional deficiencies and/or macrocytic anemia.
Comprehensive Metabolic Panel (CPT code 80053) This provides a snapshot of the body’s chemistry and metabolic function. Also called a Chem Panel, this is often part of an annual physical and insurance typically covers it without question. Several tests recommended in the bestselling book, The End of Alzheimer’s are included in a standard Chem Panel: glucose (70–90 mg/dL), albumin (>4.5), Vitamin B6 (60–100 mg/L), Vitamin C (1.3–2.5 mg/dL), Vitamin D 25-OH (50–80 ng/mL) and vitamin E total (12–20 mg/dL).
Hemoglobin A1c (CPT code 83036) This is a test that measures average blood glucose levels over a period of months — rather than minutes or hours — and is often used to diagnose and monitor diabetes. According to Bredesen, A1c levels should be below 5.6.
Lipid Panel w/ calculated LDL (CPT code 80061) Lipid panels are pretty standard as well. According to Bredesen, key aspects to look for include cholesterol level (>150), triglycerides (<150), and HDL cholesterol (>50). Yes, you are reading that right…it’s important to have high enough HDL cholesterol when it comes to brain health.
Vitamin B12 Level (CPT code 82607) While not standard for annual physicals, B12 levels are critically important for cognitive health. Studies have shown that increasing B12 levels can slow cognitive decline. Bredesen’s suggested range of 500–1500 pg/mL is higher than what your doctor will be aiming for.
Vitamin D 25-Hydroxy (CPT code 83206) Low levels of Vitamin D are a known risk factor for dementia. Bredesen recommends levels of 50–80 ng/mL.
Vitamin B6 Level (CPT code 84207) Vitamin B6 is a critical player in the methylation process. Deficiencies in Vitamin B6 are associated with elevated homocysteine, which is a known risk factor for cerebrovascular disease. Some people (like me) have too much B6 because of genetic problems relating to methylation. Bredesen recommends levels between 60 and 100 mg/L.
Folate Level (CPT code 82746) Folate is known to reduce inflammation and lower homocysteine levels; both are known to be dementia risk factors. In the Bredesen Protocol, ideal folate levels will be between 10–25 ng/mL.
Vitamin C Level (CPT code 82180) Antioxidants like Vitamin C provide protection against neurocognitive decline. According to Bredesen, you should aim for between 1.3 and 2.5 mg/dL.
Vitamin E Level (CPT code 84446) While not shown to prevent dementia, studies show that Vitamin E may help slow the progression of Alzheimer’s disease. The Bredesen protocol target range for Vitamin E is between 12 and 20 mg/dL.
Insulin Level (CPT code 83525) High insulin levels are associated with diabetes, which is a known risk factor for Alzheimer’s and other forms of dementia. According to Bredesen, insulin levels need to be equal to or below 4.5 µIU per milliliter.
Cortisol (CPT code 82533) Cortisol — also called the “stress hormone” — is a marker of chronic inflammation and early indicator of Alzheimer’s. Bredesen recommends cortisol levels of 10–18 µg/dL.
Mercury Level (CPT code 83825) Silver amalgam fillings contain up to 50% mercury. Mercury is one of the most toxic substances to humans and there is evidence that it plays a role in Alzheimer’s. No amount of trace mercury in the human body is considered “safe”.
Lead Level (CPT code 83655) Exposure to heavy metals such as lead — even in childhood — can lead to neurodegenerative diseases in adulthood. This includes dementia. No amount of lead exposure is safe.
Arsenic Level (CPT code 82175) Arsenic exposure and toxicity are strongly linked to Alzheimer’s. No amount of arsenic should be considered “safe”.
Copper Level (CPT code 82525) & Zinc Level (CPT code 84630) Bredesen recommends a copper:zinc ratio of 0.8–1.2.
Pregnenolone (CPT code 84140) Pregnenolone is a steroid hormone made from cholesterol that is the precursor — or starting point — for the production of testosterone, progesterone, cortisol, estrogen, and other hormones. According to Bredesen’s ReCODE Protocol, optimizing hormones is a key factor in fighting Alzheimer’s disease progression. Accordingly, pregnenolone levels should be in the 50–100 ng/mL range.
There are many tests that I was not able to have done, either because my doctor could not order them or insurance wouldn’t cover because they’re considered “experimental”:
ANA Comprehensive Panel
There were more tests that I took — including sex hormone levels and thyroid function — that are critical to the ReCODE protocol. Target values will naturally vary based on age, sex, and even luteal phase. These include thyroid-stimulating hormone, free T3, reverse T3, free T4, testosterone, DHEA sulfate, estradiol, sex hormone-binding globulin (SHBG), estrogen, progesterone, and free testosterone. According to Dr. Bredesen, you should be aiming for optimal hormones for someone a decade younger than your chronological age.
We are a nation of unhealthy, obese people and “normal” is not what you want to be!