Are You Chronically Forgetful? Do You Have Brain Fog? Prime Cognition, Featuring The Bredesen Protocol: Part 1


At Philadelphia Integrative Medicine we provide comprehensive outpatient care to find the individual root cause/s for your symptoms so your care is designed around you and we can partner together for your wellness.

Did you know there are six contributing root causes of early cognitive impairment and early Alzheimer’s?

Cognitive difficulties, including problems with personal concentration, recall and personal orientation do not have a consistent or singular cause--and Alzheimer’s does not have a consistently uniform etiology. Dr. Dale Bredesen, MD identifies six types of Alzheimer’s disease; inflammatory “hot”, “atrophic”,  “cold”, toxic “vile”, “sweet”, “pale”, and “dazed.” This breakdown of root causes for cognitive concerns can help treat mild cognitive impairments as well as more advanced conditions such as the early stages of dementia.

Inflammatory or “hot” Alzheimer’s can result from any type of inflammatory cause/ condition. Some causes of inflammation may be long-term exposure to pathogens, ApoE 3/4 and ApoE 4/4  genes, imbalances in fatty acids, or sugar damaged proteins. It is common in families, and people with this type lose the ability to form new memories.

The second type, atrophic or “cold” Alzheimer’s, can result from lack of nutritional elements, hormone imbalance, insulin resistance, or a loss of nerve growth factor. Again, the ability to form new memories is lost. A characteristic is loss of sex hormones, adrenal hormones, and vitamin D.

Type 1.5, or the “sweet” type of Alzheimer’s, is kind of in between type 1 and 2. It involves insulin resistance and blood sugar instability. Glycation occurs, meaning sugar glycates/bonds onto red blood cells creating inflammation. Our bodies essentially become “sticky buns.” Too much sugar can also create inflammatory markers. This is one of the major causes of decreased cognition, since sugars have become a major culprit in modern meals.

The third type, toxic or “vile” Alzheimer’s, can result from exposure to heavy metals, biotoxins, pesticides, mold, or organic pollutants, as well as chronic infections which can take place in gut, teeth, and sinuses. Examples are arsenic, paint, cigarettes, and even non-organic chicken! It affects the entire brain, and often presents itself in younger individuals. It can result in depression and Adult Onset Attention Deficit Disorder. Stress can play a large role! You also need to be able to detox. This includes our bowels, liver, kidneys, lungs, and skin.

Type 4 is “pale” Alzheimer’s. This presents itself as lack of blood flow to the brain.

“Dazed” alzheimer’s includes brain trauma which can result from falls and sports. Within 24 hours of getting a concussion, you also get leaky gut, which worsens inflammation.

Sometimes the conditions are experienced individually, and sometimes the disease can result in an overlapping of multiple conditions, which is why it is important to practice lifestyle techniques that limit and prevent all six types!

Annmarie McManus, PA-C, IFMCP is certified in the Bredesen Protocol

The Bredesen protocol is a comprehensive approach to the treatment of cognitive impairment and early Alzheimer’s. There is not currently any specific drug that cures Alzheimer’s, but there is a combination of lifestyle approaches which can greatly reduce symptoms and increase brain function. Dale Bredesen has found 36 contributing factors to the disease, which is why there is no singular cure-all drug that can be found. Annmarie describes these factors like 36 holes in your roof; as you start patching the holes, you begin to see more improvement. All protocols are personalized to the patient’s specific type of cognitive impairment, there is no “cookie-cutter” treatment, as there is no “cookie-cutter” form of the disease.

Some protocols include:

-Nutrition plans



-Hormonal evaluation and support


-Brain Training: Brain HQ

-Stress management

-Synaptic support

-Health coaching

Again, treatment is always personalized, because specific combinations of these techniques may work better than others.

What can I do RIGHT NOW?

-Keep your brain engaged!

-SLEEP! Set a ritual for yourself. Turn off electronics at least 30 minutes before bed. Lights keep your RAS (reticular activating system) awake! Sleep with your head flat or slightly down in order to drain lymphatic system. GOAL: 7 hours of sleep.

-Eat well and include fiber! 8-12 servings of vegetables a day! Include probiotics and prebiotics.

Please join us for a lively, FREE discussion on Prime Cognition and optimizing brain health at Eastern University on November 14th! It will be led by Annmarie McManus, PA-C, PT, IFMCP. and Georgia Tetlow MD, ABIOM. & Click the following link for more information:

Join our Prime Cognition Membership Program at Philadelphia Integrative Medicine, led by our Institute for Functional Medicine certified PA-C Annmarie McManus. Annmarie is certified in Bredesen Cognition protocol. Optimize your brain health and prevent cognitive impairment!

Click the following link for more information on our Prime Cognition program and access to a wonderful talk by Annmarie McManus on brain health:

PIM wants to hear from you! Do you have an experience with brain fog? Do you find this article helpful? Share your thoughts in the comments below!

If you or your loved one needs help, perhaps you are suffering from the effects of ongoing stress, mood or hormone imbalance, including thyroid imbalance, or you or they are already working with a doctor to address a condition but want a more comprehensive, empowering approach schedule your a 20 minute free consultation or an appointment with Annmarie McManus, MMSc, PA-C, PT, IFMCP or Lauren Houser, MS, MSN, CRNP today! Not quite ready to schedule and have questions, quickly get in touch with us today!

Written by Dani Mortimer


Bredesen, Dale. “A New Approach to Treating Alzheimer's.” Goop, Goop, 13 Sept. 2018,

Rambaran, Roma N, and Louise C Serpell. “Amyloid Fibrils.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2008,