For most of modern medicine, neurology and psychiatry have existed as separate worlds. Neurologists treated diseases of the brain, while psychiatrists treated disorders of the mind. They developed different training programs, professional societies, diagnostic frameworks and therapeutic approaches. Yet the more we learn about the brain, the harder it becomes to justify such a clean division.

That is why I was interested to see a recent Forbes article by Naveen Rao about Radial’s acquisition of Mindful Health Solutions framed around the emergence of a broader category: brain medicine. The transaction itself is interesting, but I think the terminology is the bigger story. Neurology and psychiatry are beginning to converge around the understanding that many of the conditions they treat are manifestations of the same extraordinarily complex biological system.

The question, however, is not simply whether neurology and psychiatry become brain medicine. The much more consequential question is where this new discipline should live. If brain medicine becomes another specialist category that patients enter only after significant neurological or psychiatric symptoms appear, we will have recreated one of the biggest problems with the current system. In my view, brain medicine ultimately has to move upstream into primary care.

The Artificial Divide Between Neurology and Psychiatry

The historical distinction between neurological and psychiatric disease makes increasingly less sense when viewed through the lens of modern biology. Depression, anxiety, cognitive impairment, Alzheimer’s disease, traumatic brain injury and many other conditions may receive different diagnostic labels, but they share overlapping biological terrain. Sleep, metabolic health, vascular function, inflammation, hormones, environmental exposures, nutrition, exercise, stress and social connection can all influence how the brain functions.

At the same time, psychiatry is becoming increasingly neurological. Brain imaging, EEG, TMS, neuromodulation and other technologies are giving clinicians new ways to measure and influence brain function rather than relying exclusively on symptoms and clinical observation. Neurology is moving in a complementary direction as we increasingly recognize that neurological diseases cannot always be understood simply by identifying a lesion, a protein or a diagnosis. Brain function emerges from networks, and those networks are influenced by what is happening throughout the rest of the body.

Ultimately, the brain does not know whether the doctor treating it has the word “neurologist” or “psychiatrist” on the door. These specialties are approaching the same organ from different historical directions, and increasingly they are meeting in the middle. Brain medicine is a useful way of describing that convergence.

The Neurologist Cannot Be the Starting Line

The problem is that our current neurological system is largely designed to intervene after something has already gone wrong. This is particularly obvious with cognitive decline. A patient notices memory problems, or more commonly their spouse or children notice them. Eventually the issue is raised with a primary care physician. Testing begins, referrals are made and, at some point, the patient arrives at the neurologist.

The neurologist is essential at that stage, but from the perspective of prevention and changing the long-term trajectory of disease, we may have missed years of opportunity. The biological processes associated with Alzheimer’s disease can begin many years before someone receives a diagnosis of dementia. Metabolic dysfunction, vascular disease, poor sleep, physical inactivity, hearing loss and other modifiable risk factors can accumulate over decades.

Cardiovascular medicine offers an obvious comparison. We do not wait until someone has a heart attack before becoming interested in their cardiovascular system. Primary care routinely measures blood pressure, lipids, glucose and other indicators because we understand that cardiovascular disease develops over time. We identify risk and intervene long before the cardiologist or cardiac surgeon is needed.

We need to start thinking about the brain in the same way.

Primary Care Needs an Early-Warning System for the Brain

There is an important practical problem with that vision. We cannot simply tell primary care clinicians to start treating brain health earlier. We have to give them a system that tells them when the process of brain dysfunction has begun.

This is where some of the most exciting developments in brain medicine are happening.

New blood biomarkers, including phosphorylated tau assays such as p-tau217, are creating the possibility of identifying Alzheimer’s-related pathology through a blood draw. As these technologies mature and become integrated into clinical practice, they have the potential to fundamentally change where and when conversations about cognitive health begin.

Instead of waiting for obvious cognitive impairment followed by specialist referral and expensive diagnostic workups, we are moving toward a world in which signals of emerging pathology can potentially be detected much earlier and much closer to primary care.

That is an enormous advance, but it only solves part of the problem.

A biomarker can tell us that a pathological process may be underway. It does not necessarily tell us why this particular person’s brain is becoming dysfunctional, which factors are accelerating that process, or what we can do today to change the trajectory.

That is where precision brain medicine becomes necessary.

Detection Is Only the Beginning

Imagine a 58-year-old patient coming into primary care. Perhaps their p-tau217 begins to suggest Alzheimer’s-related pathology. Perhaps a cognitive assessment has changed from their previous baseline. Perhaps other emerging biomarkers or digital measures identify a concerning trajectory.

That should be an alarm bell, not the end of the investigation.

The next question is: Why?

What is happening with insulin sensitivity and metabolic health? What is happening with vascular function? Is the patient sleeping properly? Is sleep apnea present? What is happening with inflammation? What medications are they taking? What is their nutritional status? Are hormones relevant? What is happening with exercise, hearing, stress and social connection? Are there environmental exposures or other contributors that deserve investigation?

This is where our existing medical architecture struggles. The information necessary to answer these questions is distributed across specialties. One piece belongs to neurology, another to psychiatry, another to endocrinology, another to cardiology, another to sleep medicine and another to primary care.

Yet the patient has one brain.

Precision brain medicine has to bring those pieces together.

Learning Precision Brain Medicine Together

We are already seeing what this looks like inside the TruNeura community. In our TruNeura Mastermind, we have neurologists, psychiatrists, family medicine and primary care clinicians, and functional medicine practitioners learning together. They arrive with very different training and different clinical experiences, but increasingly we are developing a common language around precision brain medicine.

That diversity is important because no single specialty owns everything necessary to understand brain dysfunction.

Neurologists bring deep expertise in neurological disease, diagnosis and pathology. Psychiatrists bring expertise in mood, behavior and psychiatric disease. Primary care and family medicine clinicians understand longitudinal health and are positioned to identify changes years before many patients require specialty care. Functional medicine clinicians bring experience investigating the metabolic, inflammatory, environmental and lifestyle contributors that can drive complex chronic disease.

The opportunity is not to decide which of those groups should own brain medicine. It is to build a system that allows all of them to contribute.

This Is Where TruNeura Is Starting

This is the problem we are focused on at TruNeura.

If precision brain medicine is going to move into primary care, clinicians need more than another test. They need a system that can recognize when brain dysfunction may be emerging, organize the enormous amount of relevant clinical information around that patient, help identify the potential drivers of dysfunction and support the clinical team in developing and following an individualized plan.

The first part of that equation is becoming increasingly possible because of advances in biomarkers such as p-tau217, cognitive testing, imaging and other forms of measurement. The next challenge is understanding the drivers.

That is where we are starting with TruNeura.

We are working to build the clinical infrastructure for understanding the different factors that can contribute to cognitive dysfunction and giving clinicians a systematic way to evaluate them. Rather than seeing Alzheimer’s simply as a diagnosis that eventually arrives in the neurologist’s office, we want clinicians to be able to recognize a changing trajectory earlier, investigate what may be driving it and intervene while there is still meaningful opportunity to influence brain health.

Over time, I believe these two sides of brain medicine will come together. We will have increasingly sophisticated systems for detecting the earliest signals of brain dysfunction, alongside precision medicine systems for understanding and addressing the factors driving that dysfunction.

When that happens, brain medicine will no longer have to begin in the neurologist’s office.

It can begin in primary care.

That may ultimately be the most important implication of the convergence happening between neurology and psychiatry today. We are not simply creating a larger specialty called brain medicine. We have an opportunity to create an entirely different model of brain care, one that starts earlier, measures continuously, understands the individual and brings together expertise from across medicine.

The future of brain medicine is not waiting for disease and then referring to a specialist. It is detecting dysfunction early, understanding what is driving it, and giving primary care the tools to change the trajectory.

That is precision brain medicine.

What do you do when a patient has cognitive decline, elevated inflammatory markers, evidence of chronic infection, and a history of mold exposure, but no single result gives you the full answer?

When does a positive ANA warrant action, even if the rest of the autoimmune workup is negative?

How do you decide whether a patient with cognitive decline should remain on a statin when cardiovascular risk and cognitive concerns are both part of the picture?

Those were some of the questions that came into our latest TruNeura Mastermind AMA with Kristine Burke, MD.

The session covered a wide range of topics, but a common theme emerged: the value of understanding what a finding means in the context of the whole patient.

Looking Beyond a Single Lab Result

One member asked about patients with significantly elevated TGF-beta. Another asked how to approach an elevated ANA when more specific autoimmune markers were negative.

Neither conversation led to a simple “if this, then that” answer.

Instead, Dr. Burke discussed looking at what else is happening. Is one inflammatory marker abnormal, or is there a broader pattern? Are there signs pointing toward biotoxin exposure, chronic infection, immune dysregulation, vascular inflammation, or ongoing tissue damage?

That distinction can change the next step.

An elevated number on its own may tell you something is happening. The work is figuring out what it means for that particular patient and whether changes in the broader picture are moving in the right direction.

As Dr. Burke noted during the session, sometimes the goal is not getting every marker into a perfect range. Sometimes meaningful progress is seeing the overall inflammatory burden begin to shift as underlying drivers are addressed.

What Happens When the Immune System Can’t Get Ahead?

Chronic viral activation was another major area of discussion.

A member asked about patients with high EBV and CMV titers, and the challenge many practitioners face: antibodies are common, but not every patient with antibodies has an active problem requiring treatment.

The conversation explored how the team distinguishes between evidence of past exposure and signs that a virus may still be actively contributing to a patient’s clinical picture. It also touched on the importance of asking why the immune system is struggling to maintain control in the first place.

Environmental exposures came up repeatedly in that context.

Dr. Burke shared that in some patients, particularly those with significant mold exposure and immune dysfunction, aggressively pursuing antiviral treatment before addressing the environment may not get clinicians very far. The goal is not simply to keep adding therapies. It is to create conditions where the patient’s immune system has a better chance of doing its job.

That approach also helps explain why two patients with similar-looking lab results may require very different strategies.

Not Everything Has to Be Added Up Front

Peptides and plasmalogens brought up another recurring question in cognitive decline care: when does an additional therapy actually move the needle?

Members asked which peptides Dr. Burke is seeing consistent benefit from and where they fit into treatment. Her answer was notably measured. These therapies may have a role, but they are not necessarily the first thing a patient needs, and the field is still evolving.

The same principle came up with plasmalogens.

Dr. Burke discussed them as part of the body’s broader membrane and antioxidant defense system, rather than a standalone answer to cognitive decline. She shared observations from practice, including some striking improvements in individual patients, while emphasizing that not every patient will need the same intervention long term.

That was an important theme throughout the AMA.

There is a difference between knowing a therapy can be useful and knowing when it is useful for the patient in front of you.

When Vascular Risk and Cognitive Decline Collide

One of the longest discussions of the session centered on statin therapy.

The question was straightforward: when do you use a statin in someone with significant cognitive decline, and when might you consider withdrawing it?

The answer was not that statins are always good or always bad.

Dr. Burke walked through how she thinks about the difference between treating a number and treating demonstrated risk. A patient with established vascular disease, significant plaque burden, or other clear signs of cardiovascular risk may be a very different situation from someone taking a statin solely because of an elevated cholesterol level.

The group discussed looking more deeply at the vascular picture, including plaque burden, vascular inflammation, and other risk markers, rather than making decisions based on one cholesterol number alone.

Dr. Burke also shared examples of what can happen when underlying drivers are addressed. In one case, a patient’s LDL dropped by approximately 100 points after she was removed from a moldy environment, without that being the primary lipid-focused intervention.

That does not make mold the explanation for every elevated lipid panel. It does illustrate the larger point of the session: sometimes the finding you are trying to manage changes when you address what may be driving it.

The conversation also touched on the practice’s long track record of preventing cardiovascular events while taking this broader approach to vascular health.

The Value of Bringing the Real Questions

The AMA also covered mold testing, heavy metals, cerebral amyloid angiopathy, vascular barrier integrity, immune support, and how practitioners are approaching therapies where the evidence and clinical experience are still developing.

What made the session valuable was not that every question had a simple answer.

It was that practitioners could bring in the questions they are actually facing.

The patient with a high marker that does not fit neatly into a diagnosis. The patient with several possible contributors. The treatment that might help, but adds cost and complexity. The medication with a potential benefit and a potential downside. The case where the question is not just, “What can I give them?” but, “What should I look at next?”

Those are the conversations happening inside the TruNeura Mastermind.

And when clinicians can hear how other experienced practitioners are thinking through those decisions, ask follow-up questions, and compare what they are seeing in practice, they leave with more than another list of protocols.

They leave with a clearer way to approach the next case.

There’s a way to think about cognitive decline that reframes the entire clinical conversation.

Every patient arrives with anchors attached. Anchors that tie them to neurodegeneration and the progression of cognitive decline and Alzheimer’s.

Mold. Chronic infection. Metabolic dysfunction. Heavy metals. Vascular inflammation. Head injury. Each one is a weight, and together they pull the patient under and hold them there.

The clinical job isn’t to treat “memory.” It’s to identify every anchor and cut as many of them loose as the patient can manage.

That framing came out of this month’s TruNeura Mastermind with Dr. Kristine Burke, who walked the group through two cases she’s presenting as part of an upcoming lecture series. Two men. Overlapping findings. Nearly identical anchors.

One of them got the heaviest weight cut off. One of them didn’t.

Neither one followed the trajectory the disease is supposed to follow.

The expected trajectory of untreated cognitive decline. Roughly two MoCA points are lost per year for patients with a MoCA score in the 20s, and four points are lost a year once a patient drops below 20. Both of these patients cut their anchors and changed their lives.

Left alone, this disease has one direction. Patients in the 20s on MoCA testing lose roughly two points a year. Once they drop below 20, that accelerates to about four points a year.

There is no version of untreated cognitive decline where a patient stays where they are. It is a chronic, degenerative, and fatal disease.

Dr. Burke opens every visit with this graph for exactly that reason. Patients arrive wanting two things that aren’t options: to get better while doing nothing and to do nothing and stay the same.

Patients need to understand that halting and reversing cognitive decline is possible, but it takes significant work to identify their anchors and cut them loose. All successful cases begin with this conversation, agreement, and a partnership between the patient and doctor.

Case one: a 63-year-old who couldn’t add up his dominoes

He ran a transport company. Logistics was his whole professional life, and he’d always been able to run the numbers in his head. Then he started double-checking himself with a calculator.

He couldn’t recall the names of the kids who had grown up next door for twenty years. He couldn’t total the tiles during a game of dominoes the way he always had.

His history read like a list of accumulating hits: hypertension, erectile dysfunction, and headaches all pointing toward vascular and nitric oxide dysfunction. Eosinophilic esophagitis. A history as a soccer player, including concussions well into his sixties.

His workup found more. A P-tau 217 sitting in the intermediate risk range. Elevated Lp-PLA2 with a lipid panel that looked deceptively fine. Low CoQ10, elevated homocysteine, insufficient vitamin D. Fasting glucose and insulin that were clearly off, alongside a beautiful A1 – a pattern Dr. Burke flagged as a tell for inflammatory drivers that have nothing to do with diet.

Then the environmental picture. Multiple chronically active infections. A profound deficiency dysbiosis, with commensal species so depleted they weren’t detectable by PCR. Oral pathogens, including Porphyromonas gingivalis. Hormone disrupting mycotoxins on urine testing, corroborated by elevated TGF-beta 1 and markedly elevated MMP-9.

And an ERMI of 18 on his home. Fourth quartile, deep into the moldiness index.

That’s a lot of anchors.

What happened when Dr. B and the patient worked together to cut them loose?

Four months into treatment, he was finding words faster. Name recall with clients had improved. His handwriting, which he’d written off as ordinary aging, got noticeably better. He could do the mental math again. His wife noticed he had energy and interest he hadn’t had in years.

His MoCA score moved from 23 to 24.

One point. After four months of significant work.

Dr. Burke’s read on that is worth sitting with. Cognitive testing doesn’t always capture the domains that recover first in any given person, which is exactly why single instrument assessment is so limiting. Despite the one point change, the patient’s life and function had dramatically improved.

A year in, with mold remediation done, small particle cleanup completed, detoxification underway and chronic infection treatment layered in, he was back to playing soccer. His MoCA score improved to 26. At his final testing he mentioned he’d been rattled by catching his own mistakes mid-test.

At follow-up several months later, he scored a 30. A perfect score.

Case two: six of seven CIRS markers

A 76-year-old retired nurse practitioner. Prior cardiac arrest, known coronary artery disease, mixed hyperlipidemia with a high LDL particle count and a very high ApoB. Arthritis. Depression layered over the cognitive symptoms, which is its own clinical problem when the thing slipping away is the part of you that feels most like you.

He arrived already on Aricept, already taking a long list of supplements, already having read Dr. Bredesen’s book. But he wasn’t getting better.

His history: recurrent childhood ear infections and the antibiotic exposure that came with them. Special forces medical training and tear gas exposure. Multiple tick bites without a Lyme diagnosis. Documented black mold at a former residence, and mold identified in his current home.

The numbers were striking. Six of seven CIRS markers are abnormal. MMP-9 well over 500. TGF-beta 1 in the 9,000s. No detectable MSH. Very low ADH, which as Dr. Burke pointed out, often shows up in men as urinary frequency and gets filed under prostate hypertrore.phy. Mercury at 4.6 above the 95th percentile. Ochratoxin is roughly twelve times the 95th percentile. An ERMI of 14.5.

His MoCA score at the initial consult? 26. Noticeably better than his symptoms suggested, which is another lesson on relying on one cognitive test alone. The best time to reverse cognitive decline is in the early stages and we need more advanced screening to become the standard of care.

Two and a half years into treatment, after multiple areas of the home were found to be affected, the family was done. Done with remediation, done with the expense, done with the disruption.

The heaviest anchor stayed attached. His MoCA score stayed steady at 26/30 – on the cusp of mild cognitive impairment and normal.

He was stable. Not improving, but not declining.

While the first case shows us that when all the anchors are cut, reversal is possible. The second shows us that reversal isn’t possible without cutting all the anchors, especially when that anchor is mold exposure in the home. However, stabilization is still possible.

If the 76 year old in the second case hadn’t addressed the root causes of his cognitive decline at all, he would have been expected to decline, lose function, and drop from a 26 to a 21 after two and a half years.

Instead, he maintained function and avoided the progression of cognitive decline.

One patient improved from 23 to 30. One patient maintained from 26 to 26. On paper those look like completely different outcomes, and in one sense they are. But measured against the expected decline and loss of function, both were positive outcomes.

See every anchor before you build the plan.

TruNeura brings every driver of cognitive decline into one clinical view, so you know what you’re working with, what order to work in, and what to tell your patient about what’s possible. Proof points: Track cognitive trajectory against projected decline Surface every driver up front, not one test at a time Turn complex protocols into a system patients can follow.

What started as a music and media festival in Austin expanded into film, technology, entrepreneurship and culture, and in the process helped lay the foundation for Austin’s emergence as one of America’s great cultural and innovation hubs. SXSW didn’t just reflect what was happening in Austin. It helped create the conditions for musicians, filmmakers, technologists, entrepreneurs and investors to keep showing up there, year after year, until Austin itself became synonymous with what was coming next.

That is why it is always interesting to look at what is bubbling up at South by Southwest.

And when you look at what people are proposing for SXSW 2027, one trend is hard to miss.

The brain is everywhere.

At the beginning of this year, we predicted that 2026 would be the Year of the Brain. Our thesis was that brain health was finally going to move from being a relatively specialized corner of medicine into the center of healthcare, technology and culture.

Eight months in, that prediction is looking pretty good.

Now we are seeing the same shift reflected in the proposals for SXSW 2027.

Every August, SXSW opens up community voting through its PanelPicker process. The public gets a chance to help determine which conversations deserve a place on one of the world’s most influential stages for emerging ideas.

And this year, TruNeura founder Dr. Kristine Burke has been proposed for a panel alongside Dr. Dale Bredesen, one of the pioneers of the precision medicine approach to cognitive decline.

We would love your help getting them to SXSW.

Vote for Dr. Kristine Burke and Dr. Dale Bredesen at SXSW 2027

But their panel is also part of something much bigger.

Look through the proposed SXSW programming and brain health starts showing up everywhere. Dr. David Perlmutter has a proposed conversation around his new book, Brain Defenders. Search more broadly and you find proposals touching psychedelics, mental health, neurotechnology, artificial intelligence, human performance, longevity and cognitive decline.

At first glance, these may look like separate conversations.

They aren’t.

What we are watching is the brain escaping the neurological silo.

Brain health is becoming connected to metabolic health. Mental health is becoming connected to inflammation and the microbiome. Psychedelics are forcing new conversations about neuroplasticity. AI is changing how we understand diagnosis and cognition. Longevity medicine is increasingly recognizing that lifespan without brainspan is not much of a victory.

At the same time, policymakers and economists are beginning to recognize that cognitive health is not merely an individual healthcare problem. It is a societal asset.

That is the idea behind the emerging Brain Economy: healthy brains create enormous economic value through productivity, creativity, relationships and our ability to continue participating meaningfully in society as we age.

And there may be no more appropriate place for this conversation than Austin.

SXSW helped Austin become a gathering place for the people building the next generation of culture and technology. Now Texas itself is recognizing the importance of brain health, with billions of dollars in proposed investment into brain and mental health research.

There is a nice symmetry to that.

A city whose modern identity was shaped by bringing together music, creativity, technology and entrepreneurship could now become one of the places where the next era of brain health takes shape.

This is no longer a niche conversation about Alzheimer’s disease.

It is becoming a conversation about the infrastructure of human flourishing.

For TruNeura, this is exactly the future we have been building toward.

Our work started with cognitive decline because Alzheimer’s is perhaps the clearest example of what happens when the healthcare system waits too long. By the time someone receives a diagnosis, the biological processes driving that decline may have been developing for decades.

But the opportunity is much larger than Alzheimer’s.

The next era of medicine will increasingly be about protecting cognitive function before it disappears, measuring the factors that influence it, identifying risk earlier and helping people participate actively in improving their own brain health.

That requires better diagnostics. It requires AI. It requires functional and precision medicine. It requires health coaches, nutritionists and families. It requires communities. And increasingly, it requires technology capable of bringing all of those pieces together around the individual.

The science has been building for years. The technology has been building for years. The functional medicine community has been building the clinical model for years.

Now the culture is catching up.

And if South by Southwest really is one of our best windows into what is coming next, the proposals for 2027 are sending a pretty clear signal.

The Year of the Brain may only be the beginning.

And we would love to make sure the precision medicine approach to cognitive decline is part of that conversation in Austin.

Please take a minute to vote for Dr. Kristine Burke and Dr. Dale Bredesen’s panel for SXSW 2027.

Vote for the panel here

What if someone comes to you worried about memory loss, but their memory is actually working relatively well?

That was one of the most compelling clinical lessons from this month’s TruNeura Mastermind, featuring Garland Glenn, DC, PhD and Michelle Eads, MD.

The conversation explored what happens when clinicians look beyond the obvious symptoms of cognitive decline and start asking a different question: What is actually preventing the brain from functioning well?

Look beyond the symptom

Dr. Glenn shared a case that illustrated this beautifully.

A 72-year-old woman came to him convinced she was developing a memory problem. Her CNS Vital Signs testing told a different story. Her memory scores were relatively strong, while other areas, including processing speed and cognitive flexibility, raised more questions.

Her volumetric MRI added another piece to the puzzle.

Rather than showing significant problems in the areas typically associated with memory, the imaging pointed toward dysfunction involving the thalamus and deeper brain structures.

Dr. Glenn described it as a switching and encoding problem.

She could remember information from her past. The challenge was getting new information routed and encoded effectively enough to become a memory.

That distinction matters because it changes what you do next.

Instead of simply treating “memory,” Dr. Glenn uses the assessment data to identify which functional pathways may need support, then builds targeted cognitive exercises around those findings.

The brain can learn new pathways

This is where functional neurology adds another layer to root-cause cognitive care.

Dr. Glenn’s approach combines precision medicine with assessments such as CNS Vital Signs, volumetric MRI and eye movement testing to identify areas of dysfunction. From there, patients can work on targeted drills designed to repeatedly engage specific pathways.

His analogy was simple: if you lose the ability to write with your dominant hand, you can learn to write with the other one.

The goal isn’t simply to understand what isn’t working. It’s to give the nervous system opportunities to build new pathways.

But there’s an important caveat: more isn’t always better.

Dr. Glenn emphasized that a brain struggling with energy production cannot necessarily tolerate long cognitive training sessions. Short, frequent sessions may be more appropriate than pushing through a lengthy workout.

That same principle came up throughout the conversation: cognitive care has to be individualized.

Compliance is part of the clinical picture

Both clinicians also spoke candidly about one of the hardest parts of cognitive care: getting patients to consistently implement what they know they need to do.

Dr. Eads has spent the past decade refining a largely telemedicine-based practice focused exclusively on cognitive health. Her practice has evolved from highly labor-intensive patient education to a more streamlined model that uses education platforms, wearables and simplified resources to help patients stay engaged.

Dr. Glenn has built a larger team around his practice, including a nutritionist, RN and staff dedicated to cognitive exercises.

One of his biggest lessons?

Touch points matter.

Frequent follow-ups, nutrition support, cognitive drills and tools like continuous glucose monitors can create ongoing feedback instead of leaving patients to navigate a complex protocol on their own.

The goal is not simply to give someone a plan. It’s to build a system that helps them actually follow it.

CGM can reveal a different story

Continuous glucose monitoring came up repeatedly throughout the discussion, particularly around sleep.

Dr. Glenn shared a case where a patient was waking around 3 a.m. He initially suspected reactive hypoglycemia. Her CGM showed otherwise.

Her glucose remained relatively stable, followed by a sharp rise.

That observation shifted the clinical thinking toward a different possibility: a stress response and cortisol surge rather than a blood sugar crash.

The discussion opened into a broader conversation about trauma, hypervigilance and disrupted sleep, with several clinicians contributing perspectives on how these patterns can show up in practice.

It was a good reminder that even familiar symptoms can have very different underlying drivers.

Another layer: plasmalogens

Dr. Eads also introduced the group to plasmalogens, a specialized area of cognitive health that she has incorporated into her practice over the past several years.

Plasmalogens are specialized phospholipids found in high concentrations in tissues including the brain. Dr. Eads discussed their role in cellular membranes, oxidative stress, mitochondrial function and neurological health, as well as emerging research into their relationship with cognitive decline.

Her point wasn’t that plasmalogens replace the foundational work of cognitive care.

Rather, they represent another potential layer to investigate as clinicians continue looking for ways to support patients, particularly those with significant symptoms or those focused on prevention.

The bigger takeaway

Perhaps the most important theme from this Mastermind was that cognitive decline cannot be reduced to a single symptom or a single intervention.

Two patients can both say, “I’m having memory problems,” while having very different underlying issues.

One may need deeper investigation into metabolic or inflammatory drivers. Another may need to address sleep, glucose regulation or trauma. Another may have relatively preserved memory but difficulty with processing, switching or encoding.

And another may need to address the brain’s ability to actually use the pathways that remain available.

The more precisely we can understand those differences, the more precisely we can intervene.

That is ultimately what makes this work so exciting: we’re moving beyond asking whether someone is declining and toward asking why, where and what can we do about it?

This week, Microsoft released one of the most fascinating studies I’ve read in a long time. Using 304 exceptionally complex cases from the New England Journal of Medicine, their new AI diagnostic system, MAI-DxO, correctly diagnosed 85.5% of cases, while a group of experienced physicians achieved just 19.9% accuracy. The physicians had between five and twenty years of clinical experience, and the AI reached its conclusions while ordering roughly 20% fewer diagnostic tests.

Before anyone concludes that AI is about to replace physicians, it’s worth understanding what this study actually measured. These weren’t everyday primary care visits. They were some of the most diagnostically challenging cases published in one of the world’s leading medical journals. The participating physicians weren’t allowed to consult colleagues, references, or AI tools as they normally would, and the system has not yet been validated in routine clinical practice.

Even with those important caveats, I don’t think the most interesting question is whether AI will replace doctors. The more important question is what this tells us about the future of diagnosing and treating complex chronic illness.

If experienced physicians correctly identified fewer than one in five of these extraordinarily difficult cases, it should remind us just how challenging complex disease has become. We have created a healthcare system built around specialization, but the patients who struggle the most rarely fit neatly into a single specialty. They move from neurologist to endocrinologist, rheumatologist to gastroenterologist, collecting diagnoses along the way while no one is responsible for putting the entire picture together.

This is particularly true in cognitive decline. Alzheimer’s disease, Lewy body dementia, vascular dementia, Parkinson’s disease dementia—these are useful diagnostic labels, but they are often descriptions of where the patient has arrived rather than explanations of how they got there. Behind those labels lie interacting networks of vascular dysfunction, chronic inflammation, metabolic disease, immune dysregulation, environmental toxicity, infections, hormonal changes, sleep disruption, nutritional deficiencies, and much more. The challenge isn’t simply identifying one of these contributors. It’s understanding how they interact to create disease in a particular individual.

A perfect example came just a few weeks ago at the IntelliXDNA Conference, where one of the physicians in the TruNeura community, Dr. Jessica Knape, presented an extraordinary case of reversing Lewy body dementia. What struck me wasn’t simply the outcome. It was the way she framed the problem. Rather than treating the patient as “a case of Lewy body dementia,” she described it as a case of toxic neuroinflammation. That shift in thinking changed everything. Once the underlying drivers of inflammation were identified and addressed, the patient’s neurological symptoms resolved.

That is systems medicine.

Instead of asking, “What disease does this patient have?” the question becomes, “What biological processes are creating this disease?” Those are very different questions, and they lead to very different treatment strategies.

When I look at Microsoft’s AI system, I don’t see a machine that is replacing physicians. I see a system that excels at holding complexity. It asks follow-up questions, orders additional tests, revises its hypotheses as new information becomes available, and continues reasoning until it has enough confidence to reach a conclusion. In many ways, it behaves less like a single physician and more like an experienced multidisciplinary team working together to solve a difficult case.

The Microsoft study also reinforces something I’ve believed for a long time: the future of medicine will not be organized around specialties. It will be organized around systems.

For over a century we’ve divided medicine into silos because that’s how we’ve divided medical education. We have neurologists for the brain, cardiologists for the heart, gastroenterologists for the gut, endocrinologists for hormones, and rheumatologists for the immune system. That structure has been incredibly successful for acute disease, but it struggles when patients develop chronic illness that emerges from the interaction of all of these systems at once.

The body, of course, doesn’t recognize those specialties. It functions as one interconnected network.

That is why I believe functional medicine is the strongest candidate to become the operating system for the age of artificial intelligence. Functional medicine isn’t simply another specialty. It is a framework for understanding biological complexity. It begins with the premise that physiology is interconnected, that disease emerges from disturbed networks rather than isolated organs, and that restoring function usually requires improving many systems simultaneously rather than fixing one thing in isolation.

In many ways, AI and functional medicine are arriving at the same conclusion from opposite directions. AI succeeds because it can process extraordinary complexity without becoming overwhelmed. Functional medicine succeeds because it was built around the idea that complexity is the true nature of biology. As these technologies mature, combining AI with a systems biology framework has the potential to fundamentally change how we diagnose and understand chronic disease.

But diagnosis is only the beginning.

One of the biggest lessons from every successful cognitive decline reversal program is that insight alone doesn’t change outcomes. Patients don’t improve because they receive a brilliant diagnosis. They improve because someone helps them translate that diagnosis into hundreds of small actions that become sustainable habits over months and years.

This is where physicians trained in functional medicine have another enormous advantage. Their role extends well beyond diagnosis and prescribing. They help patients understand why they became ill, prioritize interventions, build motivation, and empower them to become active participants in their own recovery. The goal isn’t compliance. It’s ownership.

Even then, no physician can do this alone.

The only programs that have consistently demonstrated meaningful reversal of cognitive decline are multidisciplinary. They combine physicians with health coaches, dietitians, care partners, and families who work together over many months to implement complex lifestyle and medical interventions. That’s because reversing Alzheimer’s disease isn’t a prescription. It’s an episode of care.

AI may become extraordinarily good at recognizing patterns. It may even become better than any individual physician at generating differential diagnoses. But it cannot build trust with a frightened family. It cannot coach someone through changing decades of eating habits. It cannot help a spouse navigate caregiver burnout or celebrate the small victories that keep patients moving forward.

Those are profoundly human skills.

Perhaps that is what the future really looks like. AI becomes the world’s best clinical reasoning partner. Functional medicine provides the biological framework for understanding complex chronic disease. Multidisciplinary teams empower patients to implement the changes that restore function. Together, they create something more powerful than any one of them could achieve alone.

At TruNeura, this has always been our philosophy. We don’t see Alzheimer’s disease as a diagnosis to be managed. We see it as the manifestation of a network of biological dysfunctions that can often be identified, measured, and addressed. AI doesn’t change that philosophy. If anything, it strengthens it.

The future of medicine isn’t AI versus the clinician. It’s AI, systems biology, clinical experience, and human relationships working together in service of the patient. If we get that balance right, AI won’t make the best physicians obsolete. It will make them more effective than they’ve ever been.

For decades, cognitive decline has often been treated as though it begins and ends in the brain.

But what if memory loss, brain fog, and neurodegeneration are actually the downstream result of dysfunction occurring throughout the body?

That was the central theme of TruNeura’s latest educational session featuring Christopher Shade, PhD, Founder & CEO of Quicksilver Scientific. Dr. Shade presented a systems-based framework that organizes cognitive decline into six major root cause categories, giving clinicians a strategic way to identify what’s driving dysfunction and where treatment should begin.

The takeaway: meaningful cognitive recovery often depends on recognizing which biological systems have become disrupted and how they interact.

A Better Way to Assess Cognitive Decline

One of the most compelling ideas from the session was that the brain is often the last place dysfunction becomes visible, not the first place it begins.

Patients may present with memory concerns, executive dysfunction, or slowed processing speed, but the biological drivers frequently begin elsewhere:

• Chronic inflammation

• Metabolic dysfunction

• Environmental toxins

• Hormonal imbalance

• Vascular dysfunction

• Chronic infections

• Mitochondrial decline

Rather than asking, “What’s wrong with the brain?” Dr. Shade encouraged clinicians to ask:

“Which systems are preventing the brain from functioning optimally?”

That subtle shift reframes cognitive decline from a neurological diagnosis into a systems biology problem.

The Six Root Cause Categories

Throughout the presentation, Dr. Shade organized cognitive decline around six interconnected biological domains that practitioners should evaluate together rather than in isolation.

1. Metabolic Dysfunction & Inflammation

Insulin resistance, impaired metabolic flexibility, chronic inflammation, and disrupted autophagy create an environment where the brain struggles to generate and efficiently use energy.

Supporting healthy metabolism isn’t simply about glucose control. It may also influence neuroinflammation, mitochondrial performance, and cellular repair.

2. Nutrient Deficiencies & Mitochondrial Dysfunction

Healthy cognition depends on efficient energy production.

Dr. Shade emphasized the importance of restoring nutrient status while supporting mitochondrial function, the cellular engines responsible for producing ATP and maintaining neuronal resilience.

When mitochondria become impaired, virtually every aspect of brain performance begins to suffer.

3. Hormonal & Neurotrophic Support

Hormones influence far more than reproductive health.

They regulate neuroplasticity, brain-derived neurotrophic factor (BDNF), mitochondrial activity, and communication between neurons.

Age-related hormonal decline may contribute to cognitive changes that extend well beyond traditional endocrine symptoms.

4. Cardiovascular Health

If blood flow is compromised, nutrient delivery is compromised.

Supporting vascular integrity, endothelial function, and cerebral circulation plays a critical role in maintaining cognitive performance and reducing vascular contributions to dementia.

5. Chronic Infections & Biotoxins

Persistent infections and microbial dysbiosis can drive ongoing immune activation and inflammation.

Rather than viewing gut health, Lyme disease, mold exposure, and immune dysfunction as separate conversations, Dr. Shade highlighted how they often converge to influence brain health.

6. Environmental Toxins & Detoxification

One of the session’s strongest messages centered on detoxification.

Dr. Shade revisited a landmark case from his early work with Dr. Dale Bredesen in which significant cognitive improvement occurred after identifying and addressing severe mercury retention.

The broader lesson wasn’t simply about mercury. It was about recognizing that impaired detoxification may allow environmental toxins to perpetuate inflammation, mitochondrial dysfunction, and metabolic imbalance.

For many patients, removing biological obstacles may prove just as important as replacing nutritional deficiencies.

The Common Thread: Everything Is Connected

Rather than treating these six categories as separate checklists, Dr. Shade repeatedly demonstrated how each influences the others.

Inflammation slows detoxification.

Environmental toxins impair mitochondria.

Hormonal changes affect neuroplasticity.

Poor vascular health limits nutrient delivery.

Metabolic dysfunction reduces autophagy and cellular repair.

The result is a reinforcing cycle that can gradually push the brain toward dysfunction.

Understanding those relationships allows clinicians to prioritize interventions based on physiology rather than symptoms alone.

Why This Matters for Precision Medicine

Perhaps the most valuable takeaway from the session wasn’t a specific protocol.

It was the reminder that cognitive decline is rarely driven by a single cause.

Instead of searching for one missing nutrient or one breakthrough therapy, clinicians can use a systems-based framework to identify the dominant biological drivers for each patient.

That’s the essence of precision medicine, and one of the guiding principles behind TruNeura’s clinical approach.

Looking Toward the Future

The session also offered a glimpse into where integrative medicine is heading.

From advances in peptide therapies and improved nutrient delivery systems to deeper insights into neurovascular health, mitochondrial signaling, and personalized treatment strategies, cognitive care is becoming increasingly individualized and systems-oriented.

As research continues to evolve, clinicians are gaining better tools to understand not just what is happening in the brain, but why it’s happening in the first place.

Continue the Conversation at QSX 2026

Many of the concepts explored during this session will be examined in greater depth at QSX: Becoming the Future Human, Quicksilver Scientific’s annual educational conference.

📍 Aurora, Colorado | October 2–4

Hosted by James Maskell, QSX brings together leading voices in integrative medicine, including Chris Shade, PhD, John Sansei, Dr. Chris Turnpaugh, Dr. Lauren Bramley, Dr. Marc Estes, Dr. Davis Brockenshire, Mansoor Mohammed, PhD, and more.

Together, they’ll explore the future of precision therapeutics, from longevity science and detoxification to hormonal intelligence, AI, advanced diagnostics, and the next generation of personalized care.

If this session reinforced the importance of addressing the root causes of cognitive decline, QSX is the natural next step for clinicians looking to stay at the forefront of integrative medicine.

For years, functional and precision medicine has centered on one foundational idea: heal the gut to improve health. But according to functional medicine pioneer Dr. Jeffrey Bland, the next evolution of medicine may begin somewhere even more fundamental.

The immune system.

In a recent TruNeura Mastermind session, members reviewed Dr. Bland’s keynote from the Personalized Lifestyle Medicine Institute (PLMI) 2025 conference, followed by a discussion with James Maskell and Kristine Burke about what these emerging discoveries mean for clinicians working to reverse cognitive decline.

The takeaway was clear. Understanding immune function is becoming essential for delivering precision brain health care.

A Nobel Prize That Could Reshape Clinical Practice

Dr. Bland opened his presentation by explaining why the recent Nobel Prize in Physiology or Medicine represents a major milestone for clinicians.

The award recognized discoveries surrounding regulatory T cells (Tregs) and the FOXP3 transcription factor, which helps regulate immune balance by influencing the expression of more than 1,000 genes.

Even more compelling, emerging research suggests that FOXP3 activity may be influenced by nutrition and lifestyle factors, including:

• Vitamin D

• Omega-3 fatty acids

• Vitamin C

• Vitamin A

• Dietary polyphenols

For clinicians practicing precision medicine, this reinforces an important concept. Lifestyle interventions are not simply supportive care. They may directly influence the biological systems responsible for regulating inflammation and immune resilience.

Why This Matters for Cognitive Decline

Alzheimer’s disease and other neurodegenerative conditions are increasingly understood through the lens of chronic inflammation, immune dysregulation, and metabolic dysfunction.

As James Maskell pointed out during the discussion, many of today’s leading experts in cognitive decline, including Dr. Dale Bredesen, Dr. David Perlmutter, and Dr. Robert Lustig, are converging around the role of immunometabolism.

Rather than viewing cognitive decline solely as a neurological condition, clinicians are beginning to recognize it as a systems biology problem involving:

• Immune regulation

• Metabolic health

• Environmental exposures

• Mitochondrial function

• Lifestyle factors

This systems approach aligns closely with TruNeura’s precision medicine framework.

Looking Beyond Traditional Inflammatory Markers

One of the most practical sections of Dr. Bland’s presentation focused on inexpensive, accessible tools that may provide deeper insight into immune function.

Among them were two indices calculated directly from a standard CBC with differential:

Systemic Immune-Inflammation Index (SII)

SII combines platelet, neutrophil, and lymphocyte counts into a single value that reflects systemic inflammatory tone.

Research suggests SII may correlate with:

• Cardiometabolic disease

• Autoimmune conditions

• Chronic inflammation

• Overall health status

Because it requires no additional laboratory testing, it can be incorporated into routine patient evaluations.

Systemic Inflammation Response Index (SIRI)

SIRI uses neutrophils, monocytes, and lymphocytes to evaluate a different aspect of immune activation.

Together, SII and SIRI provide clinicians with complementary perspectives on immune balance using laboratory data they may already collect.

Introducing suPAR

Perhaps the newest biomarker discussed during the Mastermind was soluble urokinase plasminogen activator receptor, commonly known as suPAR.

Unlike highly reactive markers such as hs-CRP, suPAR appears to remain relatively stable over time and may better reflect chronic immune activation rather than short-term inflammatory changes.

According to Dr. Bland, suPAR has shown associations with:

• Cardiovascular disease

• Chronic kidney disease

• Diabetes

• Frailty

• Mortality risk

James Maskell noted that one of suPAR’s most interesting characteristics is that meaningful improvements appear to require sustained lifestyle changes over time, making it a potentially valuable tool for monitoring long-term patient engagement and biological progress.

Although suPAR remains an emerging biomarker in functional medicine, many clinicians are watching its development with great interest.

Building a Better Patient Journey

The Mastermind discussion also explored how these biomarkers may eventually reshape patient onboarding and care pathways.

Rather than jumping immediately into comprehensive cognitive decline programs, practices may eventually create staged evaluations that help patients better understand what’s driving their symptoms before committing to more extensive care.

This type of structured journey can improve patient education while reinforcing the value of precision diagnostics.

As James Maskell emphasized, the future of cognitive decline care will depend not only on advanced interventions but also on helping patients understand why those interventions are needed.

Precision Medicine Requires Precision Measurement

One of Dr. Bland’s strongest messages was that clinicians need objective ways to measure immune function over time.

He highlighted a broader framework that includes metrics such as:

• Waist-to-hip ratio

• Grip strength

• Heart rate variability (HRV)

• Sleep metrics

• Body temperature

• Daily movement

• Cognitive assessments

• Immune biomarkers

Together, these measurements create a more complete picture of biological resilience than any single laboratory value alone.

The Future of Brain Health Is Systems Biology

The field of cognitive decline is moving beyond isolated diagnoses toward understanding the interconnected biology driving disease progression.

Immune function, metabolism, environmental factors, mitochondrial health, and lifestyle are increasingly recognized as part of the same conversation.

For clinicians committed to reversing cognitive decline, staying current with these emerging models will become increasingly important.

TruNeura Mastermind sessions are designed to bring these evolving concepts into practical clinical discussion, helping providers translate cutting-edge research into better patient care.

Interested in Offering suPAR Testing?

As interest in immunometabolism and precision biomarkers continues to grow, suPAR is emerging as a valuable tool for assessing chronic immune activation and tracking long-term lifestyle interventions. If you’re a clinician interested in incorporating suPAR into your practice, you can now apply to become one of the first partners in the US.

👉 Learn more about becoming a suPAR provider

Ready to Build Your Cognitive Decline Program?

If you’re ready to strengthen your cognitive decline program with structured implementation support, precision medicine tools, and a collaborative clinical community, book a TruNeura Success Planning Session to explore how we can help you build and grow your practice.

Launching a cognitive decline reversal program can feel overwhelming. Questions about staffing, pricing, workflows, technology, patient education, and confidence often stop practitioners before they begin.

In this TruNeura Mastermind, Anna Sattah, MD, IFMCP shared exactly how she built her cognitive decline program, from opening a brand-new functional medicine practice in 2024 to creating a comprehensive, high-value precision brain health program. Along the way, she discussed the operational lessons, clinical systems, and mindset shifts that helped her grow with confidence.

Joined by Kristine Burke, MD, James Maskell, and Seth Conger, COO of Freedom Practice Coaching, the conversation offered a practical roadmap for clinicians who want to launch or expand cognitive decline programs without waiting until everything is perfect.

Start Before Everything Is Perfect

When Dr. Sattah joined the TruNeura Mastermind in January 2025, her practice was only six months old. Her entire team consisted of herself, two virtual assistants, and a contracted health coach.

Instead of waiting until every workflow was polished, she began caring for patients using the resources she had while continuously improving the experience.

Her advice was simple:

• Start with the best program you can deliver today.

• Record educational content as you create it.

• Refine your systems with every patient.

• Let experience build confidence over time.

The first version of your program is not meant to be the final version. Growth comes through repetition and continuous improvement.

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Focus on Systems Before Scaling

One of the biggest lessons Dr. Sattah shared was identifying the rate-limiting step in your practice.

For many clinicians, the instinct is to invest heavily in marketing first. Instead, she focused on making sure she could consistently deliver excellent care before increasing patient volume.

That meant investing time in:

• AI scribes to reduce documentation

• CRM software for patient communication and automation

• Virtual assistants to manage logistics

• Standardized workflows

• Dedicated administrative time for improving processes

Strong systems create the foundation for sustainable growth. Marketing becomes much easier when your practice is prepared to deliver an exceptional patient experience.

Build a Team That Supports the Patient Journey

Comprehensive cognitive decline care requires far more than physician visits.

Dr. Sattah described building a collaborative care model that includes:

• Virtual assistants

• Health coaches

• Patient Success Advisors

• Group education

• Caregiver support groups

• Weekly multidisciplinary patient review meetings

Each team member plays a specific role, allowing the physician to focus on clinical decision making while patients receive consistent support throughout their program.

One particularly valuable addition was the Patient Success Advisor, a role dedicated to helping patients navigate technology, laboratory testing, supplement ordering, remote cognitive assessments, and educational resources. Removing logistical barriers keeps patients engaged and improves the overall care experience.

Education Creates Better Outcomes

Rather than repeating the same educational conversations during every appointment, Dr. Sattah began creating short educational videos covering topics such as sleep, nutrition, detoxification, hormones, and mitochondrial health.

Over time, these recordings became a growing educational library that benefits both patients and the practice.

The education library helps:

• Reinforce physician recommendations

• Improve patient understanding

• Create consistency across the care team

• Build long-term clinical credibility

Patients also benefit from regular group coaching sessions and educational webinars, creating a sense of community that reduces the isolation many families experience during cognitive decline.

AI Is Becoming an Essential Clinical Tool

Artificial intelligence has become an important part of Dr. Sattah’s workflow.

She described using AI to:

• Organize presentations and educational materials

• Summarize scientific literature

• Support research using NotebookLM

• Improve patient communications

• Streamline documentation with AI scribe technology

Rather than replacing clinical expertise, AI allows physicians to spend less time on administrative work and more time focusing on patient care.

Overcoming Imposter Syndrome

One of the most relatable parts of the discussion centered on confidence.

Many practitioners hesitate to offer comprehensive cognitive decline care because they feel they need more experience before they are ready.

Dr. Sattah offered a different perspective.

You do not have to know everything. You simply need to provide care that is better than the current standard of care.

That mindset shift allowed her to confidently offer comprehensive, evidence-informed programs while continuing to learn alongside a collaborative community of practitioners.

Price Programs Based on Outcomes

The conversation also explored one of the biggest challenges practitioners face: pricing.

Seth explained that pricing should reflect the cost of delivering exceptional patient outcomes, not a clinician’s discomfort with discussing money.

Dr. Sattah shared that she initially tried to reduce laboratory testing and program costs because the numbers felt too high. Eventually, she realized that removing essential components meant compromising the quality of care she wanted to provide.

When she built a program around what patients truly needed instead of what felt comfortable to charge, patients said yes, and she was able to practice medicine with greater confidence.

Dr. Burke also emphasized the importance of understanding your true cost of care by calculating annual practice expenses against available clinical hours. Knowing your real numbers creates confidence in pricing because those prices are based on the actual cost of delivering excellent care and credited Seth from FPC for giving her that insight.

Every Patient Helps Advance Precision Brain Health

James Maskell highlighted another important theme from the discussion.

Collecting comprehensive clinical data today helps improve cognitive decline care for the future.

As more practitioners contribute standardized clinical data through TruNeura, patterns become easier to identify, allowing future protocols to become more efficient and increasingly personalized.

Today’s work lays the foundation for tomorrow’s standard of care.

Continue Learning with Cognitive Decline Reversal at Scale

If this Mastermind resonated with you, the next step is to watch Cognitive Decline Reversal at Scale, presented by Seth.

In this on-demand training, Seth breaks down exactly how to build and scale an outcome-based cognitive decline program inside your practice.

When you access the replay, you’ll also receive an exclusive asset that maps out the structure of a comprehensive 9-12 month cognitive decline program.

👉 Watch the replay and download the brain health journey map

Ready to See TruNeura in Action?

Whether you’re building your first cognitive decline program or refining an established practice, TruNeura helps clinicians deliver precision brain health through standardized workflows, clinical intelligence, and data-driven care.

When I started the Functional Forum in 2014, I chose the name very deliberately.

I believed functional medicine had the potential to become the universal language of the new era of healthcare.

For years before that, I had spent time with chiropractors, naturopathic doctors, Chinese medicine practitioners, Ayurvedic physicians, osteopaths, nutritionists, and functional medicine doctors. Although they came from very different traditions, I was struck by how often they reached the same conclusion.

Health is created.

The body is an interconnected system. Lifestyle matters. Environment matters. Relationships matter. Human beings are dynamic, adaptive networks rather than collections of isolated organs.

In other words, salutogenesis, the creation of health, was the foundation.

The challenge was that everyone described this reality differently.

One practitioner talked about qi. Another talked about mitochondrial function. Another focused on nervous system regulation. Someone else described terrain, subluxation, doshas, or methylation.

Different words.

The same patient.

The same underlying reality.

The consequence was that collaboration became incredibly difficult. Every practitioner was looking at the same mountain from a different side, but there was no common map.

When I first encountered the Institute for Functional Medicine’s systems model, I thought I had found the answer.

Antecedents. Triggers. Mediators. Systems biology. The Matrix.

This was a language that could organize complexity and allow practitioners from different backgrounds to communicate with one another.

That belief became one of the inspirations behind the Functional Forum. I wanted to create a place where practitioners from every discipline could come together around a shared vision of healthcare.

In many ways, it succeeded.

But over time I realized something I hadn’t appreciated at the beginning.

Healthcare is influenced by economics.

Economics rewards differentiation.

Every organization eventually develops its own terminology, its own conferences, its own certifications, and its own identity.

Functional medicine became one movement.

Longevity medicine became another.

Regenerative medicine created its own category.

Precision medicine developed its own language.

Naturopathic medicine maintained its own traditions.

Everyone had good reasons for doing so, but the unintended consequence was further fragmentation.

Ironically, by calling it the Functional Forum, I had unintentionally picked a side.

What I wanted was unity.

What I got was another tribe.

For years that frustrated me because I still believe our movement needs a common operating system if we are ever going to deliver truly collaborative care.

Building TruNeura forced me to rethink the problem.

The universal language isn’t functional medicine.

It isn’t antecedents, triggers, and mediators.

It isn’t even biology.

The universal language is numbers. Base 10.

Numbers work in every country. We’ve already agreed on this.

Numbers work in every medical tradition.

Numbers work in every language.

A laboratory marker can become a score out of 100 no matter the units.

A wearable metric can become a score out of 100 no matter the gadget.

Lifestyle participation can become a score out of 100 no matter the modality.

Sleep can become a score out of 100 no matter the side of the bed.

Inflammation can become a score out of 100 by combining all the other scores.

Every measurement can be normalized into a common framework where 100 represents optimal function and progressively lower scores reflect increasing dysfunction.

Imagine looking at a laboratory marker. Instead of simply being told whether it is “normal” or “abnormal,” it is translated into a score from 0 to 100. At the center of the optimal range, the score is 100. As the marker drifts away from optimal, the score gradually declines. Far outside the optimal range, it approaches zero.

Every laboratory marker can be translated this way. Every wearable metric. Every lifestyle behavior. Every functional assessment.

Once everything speaks the same language, practitioners no longer have to agree on philosophy before they can collaborate.

Imagine a patient with cognitive decline.

Around the table sits an acupuncturist, a functional neurology chiropractor, a functional medicine physician, a psychotherapist, a health coach, and a nutritionist.

Each practitioner sees something different.

The acupuncturist wants to improve bioenergetic flow.

The chiropractor wants to restore structural and neurological function.

The functional medicine physician focuses on inflammation, toxins, hormones, or metabolism.

The psychotherapist sees unresolved trauma and social isolation.

The health coach recognizes that implementation is the missing piece.

Who is right?

Perhaps all of them. A team of practitioners working to orchestrate an episode of care is the only intervention that has ever reversed cognitive decline successfully.

The human body is a complex adaptive network. Different interventions can improve the function of that network through entirely different mechanisms.

Historically, practitioners have spent enormous energy defending their philosophy because there has never been a shared scoreboard.

But imagine something different.

Every intervention is prescribed.

Every intervention is measured.

Every patient is rescored.

Now we can begin to understand which interventions improve cognition most rapidly for patients with inflammatory drivers.

Which approaches work best for patients with vascular disease.

Which patients benefit most from bioenergetic therapies.

Which interventions consistently improve sleep, resilience, metabolism, executive function, or quality of life.

Nobody has to lose.

Nobody has to prove that their philosophy is the only correct one.

Reality becomes the teacher.

The data begins to reveal which interventions work best, for which phenotype of patient, under which circumstances.

The system learns.

The practitioners learn.

Medicine evolves.

This is the vision behind TruNeura.

Every laboratory marker becomes a score.

Every lifestyle behavior becomes a score.

Every wearable metric becomes a score.

Those scores are then combined into higher-order indices that reveal patterns no single biomarker could ever show on its own. They identify the dominant drivers of dysfunction, quantify progress over time, and help practitioners prioritize the interventions that are most likely to improve the health of the entire network.

The score itself belongs to no profession.

It belongs to the patient.

I have spent much of my career trying to create unity across functional medicine and the many disciplines that share its vision of health.

Today, I believe that unity will not come from asking everyone to use the same terminology.

It will come from giving everyone the same way to measure reality.

That is the true universal language of medicine.

At TruNeura, we are bringing together leaders from functional medicine, neurology, naturopathic medicine, chiropractic, nutrition, health coaching, psychology, bioenergetics, and many other healing traditions to build something that is larger than any one profession.

Our goal is not to replace these disciplines. It is to connect them.

To create a shared operating system that allows every practitioner to contribute their unique gifts while learning, together, what creates the greatest improvements in human health.

This is bigger than software.

It is bigger than any one company.

It is an opportunity to build a legacy that extends beyond all of our individual careers. A healing system that continues to learn, continues to improve, and continues to evolve long after we are gone.

If salutogenesis truly is the future of medicine, then it deserves infrastructure that can scale. It deserves a common operating system. It deserves a universal language that every practitioner can understand, regardless of their training or philosophy.

That is the future we are building at TruNeura.

A future where data creates unity instead of division. Where every patient interaction helps the system become wiser. Where the collective intelligence of thousands of practitioners becomes a living, learning network in service of human health.

Because the future of medicine will not be built by one profession.

It will be built by all of us, together.

Complex chronic illness rarely unfolds under ideal circumstances. Sometimes the biggest obstacle isn’t diagnosis, it’s helping patients make progress while ongoing exposures remain

That was the focus of a recent TruNeura Mastermind case discussion, where Julie Helm, NP-C, IFMCP, presented the case of a 55-year-old woman experiencing subjective cognitive impairment, chronic fatigue, autoimmune disease, and persistent inflammatory signaling driven by long-term biotoxin exposure.

Her case sparked an important conversation: How do we support patients when the ideal intervention isn’t immediately possible?

A Case That Reflects Real Clinical Practice

This patient had many of the hallmarks clinicians see in complex chronic illness:

• Subjective cognitive decline despite a normal MoCA

• Autoimmune conditions including Hashimoto’s thyroiditis and psoriasis

• Chronic fatigue and reduced cognitive stamina

• Persistent inflammatory biomarkers

• Evidence of biotoxin exposure

• Multiple immune system stressors developing over time

The greatest challenge wasn’t identifying what was driving her illness, it was that she couldn’t immediately leave the environment contributing to it.

As Julie explained, many patients face financial, family, housing, or logistical barriers that delay removal from ongoing exposure. That reality forces clinicians to answer a difficult question:

How can we reduce the physiologic consequences while patients work toward eliminating the root cause?

Precision Medicine Requires Looking Beyond One Diagnosis

Throughout the discussion, Dr. Kristine Burke highlighted an important pattern seen repeatedly in complex brain health cases: recovery rarely depends on addressing a single issue.

Instead, clinicians must evaluate how multiple systems interact simultaneously, including:

• Environmental biotoxins

• Immune dysregulation

• Neuroinflammation

• Mitochondrial dysfunction

• Hormonal resilience

• Vascular health

• Nutrient status

• Viral reactivation

• Gut and autoimmune contributors

Rather than treating these as isolated problems, the group discussed how layered physiologic stress can eventually overwhelm resilience, and why restoring that resilience requires an equally comprehensive strategy.

The Value of Objective Data

One of the strengths of the discussion was how objective biomarkers helped organize a highly complex clinical picture.

The case incorporated multiple data sources, including:

• Inflammatory biomarkers

• Immune function testing

• Nutrient and hormone panels

• Environmental exposure markers

• Brain imaging

• Cognitive assessments

• Functional laboratory testing

Reviewing these results together allowed participants to prioritize interventions, identify evolving patterns over time, and evaluate which therapies were making meaningful clinical impact.

Recovery Happened When the Root Cause Was Finally Addressed

The patient trialed numerous supportive therapies over several years to improve resilience and reduce the downstream effects of chronic inflammation.

While many interventions helped stabilize her condition, one clinical turning point stood out.

Meaningful improvement accelerated only after she was finally able to leave the contaminated environment and later return to a properly remediated home.

For everyone participating in the discussion, it reinforced a principle that functional and precision medicine clinicians know well:

Supportive therapies matter, but they cannot fully compensate for ongoing exposure to an active root cause.

Why These Conversations Matter

Cases like this are exactly why the TruNeura Mastermind exists.

Complex patients rarely fit into neat diagnostic categories. They require clinicians who can integrate biomarkers, clinical history, imaging, environmental medicine, and systems biology into a coherent treatment strategy.

Each Mastermind session gives practitioners the opportunity to learn from real cases, explore emerging clinical evidence, and hear how experienced clinicians approach difficult decision-making when there are no simple answers.

As James Maskell noted in closing, these are the kinds of multi-system, multi-causal cases clinicians are seeing every day—and collaborative learning is essential to improving patient outcomes.

What if one of the most powerful tools for protecting cognitive health wasn’t developed for the brain at all?

Continuous glucose monitors (CGMs) have long been associated with diabetes management. Today, a growing number of precision medicine clinicians are using them for something much bigger: understanding how an individual’s metabolism responds to food, stress, sleep, exercise, and daily habits before chronic disease takes hold.

That was the focus of this week’s Mastermind, where Dr. Ryan Arnold delivered a masterclass on the expanding role of continuous glucose monitoring in cognitive health. But as with every Mastermind, the presentation was only the beginning.

Following Dr. Arnold’s talk, clinicians from across the community shared how they’re implementing CGMs in real-world practice, offering practical insights into patient education, care coordination, and precision medicine that attendees could immediately take back to their own clinics.

Looking Upstream at Cognitive Decline

One of Dr. Arnold’s central messages was that Alzheimer’s disease and other forms of cognitive decline cannot be understood through a single lens.

Research continues to strengthen the connection between metabolic dysfunction and brain health, leading many researchers to describe Alzheimer’s disease as “Type 3 Diabetes.” While the term remains debated, the underlying concept is becoming increasingly difficult to ignore.

Patients with Type 2 diabetes have a significantly higher risk of developing Alzheimer’s disease and vascular dementia. More importantly, insulin resistance may begin affecting brain function years before cognitive symptoms appear.

Dr. Arnold explained that the issue isn’t simply elevated blood sugar.

When insulin signaling becomes impaired, brain cells lose efficient access to the fuel they need. Even when glucose is circulating in the bloodstream, the brain can experience an energy deficit that contributes to inflammation, impaired cellular function, and the processes associated with neurodegeneration.

Instead of focusing solely on downstream findings like amyloid plaques, Dr. Arnold encouraged clinicians to think further upstream.

He offered a memorable analogy.

Imagine a neighborhood on fire.

The fire trucks arrive in response to the emergency.

Removing the fire trucks doesn’t stop the fire.

Likewise, targeting the brain’s protective response without addressing the metabolic dysfunction that may be driving it risks treating the consequence rather than the underlying problem.

Why Continuous Data Changes the Conversation

Traditional laboratory testing provides valuable information, but it captures only isolated moments in time.

Continuous glucose monitoring tells an entirely different story.

A patient may have a normal HbA1c, normal fasting glucose, and still experience significant glucose variability throughout the metaday that routine lab work never detects.

Those fluctuations can be influenced by far more than food alone.

Stress.

Sleep quality.

Exercise.

Meal timing.

Hormonal changes.

All can dramatically influence metabolic health, and CGMs allow both clinicians and patients to see those relationships in real time.

Dr. Arnold emphasized that this continuous stream of data helps identify dysfunction long before traditional diagnostic thresholds are crossed, creating opportunities for earlier intervention rather than waiting until disease is established.

Turning Data Into Patient Empowerment

One of the strongest themes throughout the session was that CGMs are more than monitoring devices.

They’re educational tools.

When patients can see exactly how their own bodies respond to everyday choices, lifestyle recommendations become personal instead of theoretical.

Rather than being told what they should eat, they discover how specific foods affect them.

Rather than hearing that exercise improves metabolism, they watch a walk after dinner lower a glucose spike.

Rather than assuming stress is only emotional, they can observe its physiological effects in real time.

That immediate feedback often becomes one of the most powerful motivators for lasting behavior change.

The Conversation Expanded Beyond One Presentation

As valuable as Dr. Arnold’s presentation was, one of the defining strengths of the Mastermind is the expertise that emerges when clinicians begin sharing their own experiences.

Kristine Burke, MD described how her practice has built continuous glucose monitoring into a structured clinical workflow. Rather than simply prescribing a CGM, patients first receive education from a dietitian before beginning monitoring. They initially maintain their normal routines to establish a baseline, then return for follow-up visits where the data is reviewed together and targeted lifestyle interventions are introduced. This staged approach transforms glucose monitoring into an active learning process rather than a passive collection of numbers.

Registered dietitian Ishbel Cavaleri highlighted another powerful application: group care. By combining individualized CGM data with group education, patients learn how to interpret their own patterns while benefiting from shared discussion and coaching. The model allows practices to deliver personalized care while scaling education more efficiently.

Anna Sattah, MD expanded the conversation to team-based care, sharing how platforms like Dexcom Clarity allow clinicians to review patient glucose data together and improve coordination across the care team. Rather than relying solely on office visits, providers can identify patterns, monitor progress, and guide interventions using objective data collected between appointments.

Lori Calabrese, MD added one of the session’s most relatable perspectives by describing her own experience wearing a continuous glucose monitor. Although she believed she was calmly moving through busy clinic days, her glucose data revealed a different physiological reality. Even while fasting, periods she perceived as routine were producing significant stress responses. Seeing that objective data prompted her to reorganize her daily schedule and reinforced how valuable CGMs can be, not only for patients, but for clinicians seeking a deeper understanding of their own physiology.

Together, these experiences illustrated an important point.

Continuous glucose monitoring is not simply another diagnostic tool.

It becomes far more valuable when it is integrated into an interdisciplinary model of care where physicians, dietitians, health coaches, and patients all learn from the same objective information.

A Shift Toward Earlier Intervention

Perhaps the biggest takeaway from this Mastermind was that precision medicine is moving away from waiting for disease and toward identifying dysfunction.

Instead of waiting for diabetes.

Instead of waiting for cognitive decline.

Instead of waiting until laboratory values finally become abnormal.

Clinicians can begin recognizing subtle metabolic changes much earlier and help patients make meaningful lifestyle adjustments before those changes become chronic disease.

Continuous glucose monitoring is helping make that shift possible.

As Dr. Arnold’s presentation demonstrated, and as the discussion that followed reinforced, CGMs are becoming much more than diabetes technology. They are emerging as one of the most practical tools available for delivering personalized, preventive, precision medicine.

The science continues to evolve, but one thing is already clear: when clinicians can see more, patients can do more.

One of the themes that keeps emerging inside the TruNeura Mastermind is that clinical excellence has surprisingly little to do with knowing one more supplement or ordering one more lab test.

It has everything to do with being willing to hold the line.

Last week, we welcomed Lori Cardellino, DMD back to the Mastermind after an extraordinary first session. As she answered questions from clinicians, it became obvious that she approaches dentistry in exactly the same way that Dr. Kristine Burke approaches cognitive medicine.

Both are willing to have conversations that many practitioners avoid.

For the past eighteen months, our community has become increasingly confident in what Dr. Burke teaches so consistently. What Dr. Dale Bredesen later called “Burke’s Law” is actually a very simple principle. You cannot recover while the thing making you sick is still there.

Lifestyle interventions matter. Nutrition matters. Exercise matters. Sleep matters.

But if the body is still being exposed to a significant source of inflammation, toxicity, or infection, there is only so far that healing can go.

That principle sounds obvious.

Living it out in practice is much harder.

Because holding the line means being willing to tell a patient that the mold in their home needs to be addressed, even when another physician has told them it is irrelevant.

It means discussing whether chronic infections in the mouth could be contributing to neurological symptoms, even if that means questioning long-held assumptions about conventional dentistry.

It means asking difficult questions about toxic exposures, metals, medications, environmental factors, and lifestyle patterns that have become completely normalized in modern healthcare.

None of these are easy conversations.

In many cases, they mean disagreeing, respectfully but confidently, with the recommendations of a neurologist, a primary care physician, a dentist, or another specialist who genuinely believes they are practicing good medicine.

That can feel uncomfortable.

But discomfort is often where great medicine begins.

The standard of care is built on today’s evidence. Functional medicine has always been about recognizing tomorrow’s evidence before it becomes universally accepted. Every meaningful advance in medicine has required clinicians who were willing to question prevailing assumptions while remaining grounded in science, clinical observation, and the best interests of their patients.

That is what holding the line really means.

It means refusing to normalize things that you believe are contributing to illness simply because they have become socially or medically acceptable.

It means having the confidence to continue asking deeper questions when the easy answer is to prescribe another medication or simply monitor the decline.

It means remembering that our responsibility is not to defend the status quo. Our responsibility is to help patients recover.

This is why community matters so much.

Holding the line is difficult when you are practicing alone. Every clinician has moments when they wonder whether they are the one who is wrong. Every clinician has patients who come back from another appointment confused because someone else dismissed mold, ignored oral health, overlooked environmental toxicity, or suggested that symptoms should simply be managed rather than understood.

Confidence grows in community.

When you hear dozens of experienced clinicians discussing similar cases, reaching similar conclusions, and seeing similar outcomes, it becomes much easier to stand behind your clinical judgment. You develop the confidence to have the conversations that your patients need, even when those conversations are awkward.

That, more than anything else, is what we are building at TruNeura.

Yes, we are building technology that helps clinicians identify contributors such as mycotoxins, toxic metals, chronic infections, and other drivers of cognitive decline. But technology is only part of the equation.

The real work is building a community of practitioners who are committed to addressing root causes and who are willing to hold the line when it matters most.

Holding the line might seem radical today. But it’s the foundation of healing and might be tomorrow’s standard of care.

The TruNeura Mastermind two weeks ago challenged clinicians to think differently about the relationship between oral health and cognitive decline. For many practitioners, it fundamentally changed how they viewed some of their most difficult neurological cases.

Last week, the conversation shifted from why biological dentistry matters to an even more important question:

How do clinicians actually put these ideas into practice?

Returning for Part 2, biological dentist Lori Cardellino, DMD spent more than an hour answering the questions that illuminated for practitioners after last week’s discussion. The result was an honest, thought-provoking conversation about patient communication, referrals, treatment philosophy, and what it will take to build a healthcare system where medicine and dentistry truly work together.

When New Knowledge Changes the Way You Practice

Opening the session, James Maskell reflected on the response from the previous Mastermind.

Many clinicians admitted they had spent the week mentally revisiting complex patient cases.

Patients with cognitive decline.

Patients who plateaued despite comprehensive care.

Patients whose oral health history had never been fully explored.

The questions had changed.

Instead of asking whether biological dentistry belonged in neurological care, practitioners were now asking how to integrate it into everyday clinical practice.

Dr. Lori Cardellino Answers the Questions Every Practitioner Is Thinking

As the discussion opened, clinicians brought forward the practical challenges they were already encountering.

How do you help patients understand why a biological dental evaluation matters?

How do you identify a dentist whose philosophy truly aligns with whole-person care?

What role should CBCT imaging play?

How should clinicians think about root canals, chronic infections, and existing implants?

Rather than offering simple checklists, Dr. Cardellino encouraged practitioners to rethink the entire relationship between oral health and systemic disease.

Her central message was clear.

If clinicians believe chronic inflammation, toxic burden, and hidden infections contribute to neurological disease, then oral health cannot remain an afterthought. It must become part of the clinical investigation from the very beginning.

The conversation challenged attendees to think beyond isolated symptoms and consider the mouth as part of an interconnected biological system.

The Referral Gap Every Clinician Faces

One of the strongest moments of the Mastermind came as practitioners voiced a common frustration.

Even when they recognize oral health as an important piece of the puzzle, many simply do not know where to send patients.

Finding a biological dentist is one challenge.

Finding one whose clinical philosophy aligns with root cause medicine is another.

Dr. Cardellino acknowledged that reality openly, emphasizing that meaningful collaboration depends on shared principles rather than labels alone.

That honesty resonated throughout the discussion.

It also highlighted why building trusted professional relationships may be just as important as learning new clinical concepts.

From Individual Experts to an Integrated Network

Throughout the session, James Maskell repeatedly returned to a larger vision.

The future is not about creating isolated experts.

It is about creating connected practitioners.

As he described it, TrueNeura is becoming more than a clinical platform. It is evolving into a growing network where physicians, biological dentists, health coaches, and specialists collaborate around the same patient, sharing expertise instead of working in silos.

Dr. Cardellino echoed that vision.

Rather than expecting every clinician to become an expert in biological dentistry, she emphasized building relationships with practitioners who are committed to learning together and advancing patient care collaboratively.

That model transforms referrals into partnerships.

Confidence Is Built Together

One insight surfaced repeatedly throughout the conversation.

Having these discussions with patients requires confidence.

James compared the learning curve to conversations around mold exposure and environmental illness. At first, the evidence may feel unfamiliar, and the conversations can feel uncomfortable.

Confidence develops through experience.

It grows by reviewing cases, asking questions, hearing different perspectives, and learning alongside colleagues who are navigating the same challenges.

That is precisely what the TrueNeura Mastermind was created to provide.

The Future of Cognitive Care Depends on Collaboration

This week’s Mastermind was not about delivering another lecture on biological dentistry.

It was about building something larger.

A community where physicians know who to call when oral health becomes clinically relevant.

Where biological dentists work alongside neurologically focused practitioners instead of independently.

Where difficult cases become opportunities for collaboration rather than frustration.

Dr. Lori Cardellino brought decades of clinical experience and an unapologetic perspective that challenged attendees to think differently about the role of oral health in chronic disease.

James Maskell brought the vision for connecting those clinicians into a network capable of changing how complex neurological care is delivered.

Together, they illustrated something increasingly clear.

The future of brain health will not be built by one specialty alone.

It will be built by practitioners willing to learn from one another, challenge conventional thinking, and collaborate around the patients who need them most.

One of the most exciting aspects of the TruNeura community is not the technology itself. It’s what happens when practitioners from different disciplines begin working together to solve complex cognitive decline cases.

This week’s TruNeura Mastermind offered a powerful example.

Functional medicine physician Dr. Ryan Arnold invited biologic dentist Lori Cardellino, DMD to share real-world cases demonstrating how oral health can become a critical consideration in patients struggling with cognitive concerns, chronic inflammation, neurological symptoms, and unexplained health challenges.

More importantly, the session highlighted something bigger: what becomes possible when clinicians collaborate instead of working in silos.

Why Biological Dentistry Matters in Cognitive Decline

When evaluating cognitive decline, practitioners often investigate toxins, inflammation, infections, metabolic dysfunction, hormones, genetics, and lifestyle factors.

The mouth is not always part of that conversation.

Yet oral health sits at the intersection of many of these same systems.

Chronic infections, inflammatory burden, historical dental work, recurring sinus issues, and exposure to certain materials may all represent factors worth exploring in complex cases.

For practitioners focused on root causes, the question is not whether every cognitive decline patient has a dental issue.

The question is whether we are asking enough questions about oral health when patients fail to improve.

That was a recurring theme throughout the mastermind.

A Real Example of Collaborative Care

Dr. Arnold shared the story of a patient who initially sought care for hormone optimization and general wellness concerns.

As the evaluation progressed, a more complex picture emerged.

The patient reported years of anxiety and panic attacks that seemed to come out of nowhere. She was also experiencing brain fog, difficulty multitasking, elevated inflammatory markers, and recurring sinus infections.

Despite extensive investigation, there was no obvious explanation.

Through Dr. Arnold’s collaboration with Dr. Cardellino, the patient’s dental history became part of the conversation.

Advanced imaging revealed issues that warranted further evaluation, leading to treatment that addressed previously overlooked oral health concerns.

What stood out most was not any single intervention.

It was the process.

A functional medicine physician recognized that another specialist might see something he could not. A biologic dentist brought a different lens to the case. Together, they uncovered potential contributors that had not previously been addressed.

That kind of collaboration is exactly what the TruNeura Network is designed to foster.

The Case That Captured Everyone’s Attention

While several cases sparked discussion, one in particular resonated deeply with the group.

The patient had been experiencing significant cognitive decline and neurological symptoms. As Dr. Cardellino reviewed the case, she highlighted the patient’s extensive dental history, including multiple implants, restorations, and significant exposure to metal-containing dental materials accumulated over many years.

For a room full of practitioners focused on cognitive decline, the discussion quickly connected to a familiar concept: toxic burden.

One of the foundational principles of the TruNeura methodology is evaluating the many factors that may contribute to cognitive dysfunction. Environmental exposures and chemical toxins are among those considerations.

As the patient’s dental history was reviewed, attendees were shown the extensive list of metals present in various dental materials throughout the mouth. The case raised important questions about the role oral health may play when evaluating total toxic burden and neurological health.

Following treatment, the patient’s family reported meaningful changes in symptoms, function, and quality of life.

The story served as a reminder that even in complex neurological cases, important clues can sometimes be hiding in unexpected places.

Looking Beyond the Tooth

One of the most valuable takeaways from the session was that biological dentistry is not really about teeth.

It is about systems.

The conversation touched on chronic inflammation, recurring sinus issues, hidden infections, toxic burden, structural health, and the relationship between oral health and the rest of the body.

Whether practitioners ultimately agree with every philosophy discussed, the larger lesson remains highly relevant:

The mouth should not be separated from the rest of the patient.

For clinicians treating cognitive decline, that perspective can open entirely new avenues of investigation when patients plateau or fail to respond as expected.

The Future of Cognitive Care Is Collaborative

Throughout the session, James Maskell emphasized that the goal is not to send every patient to a single specialist.

The goal is to build a network.

A network where cognitive decline practitioners, functional medicine clinicians, health coaches, biological dentists, and other specialists can collaborate around difficult cases.

A network where practitioners know who to call when a patient presents with unanswered questions.

A network where expertise is shared instead of isolated.

The relationship between Dr. Arnold and Dr. Cardellino offers a glimpse of what that future looks like.

One practitioner recognized a potential blind spot.

Another practitioner helped investigate it.

The patient benefited.

As TruNeura continues expanding its practitioner community, these collaborative relationships may become one of the most important tools available for helping patients navigate cognitive decline.

Because sometimes the breakthrough isn’t a new supplement, a new protocol, or a new test – It’s having the right practitioner in your network.

For most of modern economic history, wealth has been measured through physical assets and financial assets.

We measure factories, roads, ports, energy production, real estate, GDP, stock markets, and labor productivity. We spend enormous amounts of time tracking the performance of these assets because we understand that they are essential to economic growth.

What we have never been particularly good at measuring is the asset that drives all the others: the human brain.

That may be beginning to change.

A new commission published in Nature Medicine is proposing a fundamental shift in how governments, economists, and policymakers think about prosperity. The Brain Health for Economic Resilience Commission argues that brain health should be viewed as a form of capital, one that is just as important to economic success as physical infrastructure, financial markets, or technological innovation.

The commission uses the term “brain capital” to describe the collective cognitive resources that allow societies to function and flourish. This includes our ability to learn, create, solve problems, adapt to change, collaborate with others, and remain resilient in the face of uncertainty.

These capabilities have always mattered, but they have become increasingly important in an economy that is being reshaped by artificial intelligence, automation, and digital technologies.

In an industrial economy, economic value was often created through physical labor. In a knowledge economy, value increasingly comes from uniquely human capabilities. Creativity. Judgment. Emotional intelligence. Complex decision making. Systems thinking. The ability to navigate ambiguity and build trust.

These are all products of healthy brains.

Yet despite their importance, we rarely measure them. We do not track brain capital with the same rigor that we track financial capital. We do not build economic policy around protecting and growing it. And we certainly do not invest in it at the scale its importance would suggest.

The authors of the commission argue that this is becoming a serious problem.

Countries across the world are simultaneously confronting aging populations, rising rates of neurological and mental health conditions, increasing economic uncertainty, and rapid technological change. At precisely the moment when cognitive performance is becoming one of society’s most valuable assets, the systems responsible for protecting it remain fragmented and underdeveloped.

The result is that one of the most important forms of capital in the modern economy is largely unmanaged.

That observation immediately resonated with me as my original training was in health economics.

For years, healthcare has operated as though brain health were primarily a medical issue. If someone develops Alzheimer’s disease, depression, anxiety, or another neurological condition, the healthcare system responds. But what if we have been asking the wrong question?

What if brain health is not simply a healthcare issue?

What if it is an economic issue?

Viewed through this lens, investments in sleep, mental health, social connection, environmental health, education, cognitive training, prevention, and precision medicine become more than healthcare interventions. They become investments in national productivity, workforce resilience, innovation, and long-term prosperity.

This is one reason why the conversation around cognitive decline is changing so rapidly.

The cost of dementia is certainly enormous, but the larger issue is the loss of human potential. Every year that a person remains cognitively healthy, engaged, productive, and connected creates value not only for that individual but for everyone around them. Families benefit. Employers benefit. Communities benefit. Economies benefit.

That idea sits at the heart of another initiative that we have been helping to advance, the Declaration of Cognitive Interdependence.

The declaration recognizes a simple truth. Our brains do not operate in isolation. Human cognition exists within networks of relationships, families, workplaces, and communities. The health of one person’s brain affects the wellbeing and productivity of countless others.

The emerging Brain Health Economy framework and the concept of Cognitive Interdependence are ultimately describing the same reality from different angles.

One is economic.

The other is social.

Both recognize that human cognitive capacity is one of the most valuable resources society possesses.

The significance of this commission is not simply that it appears in Nature Medicine. It is that it signals the arrival of a new way of thinking.

For decades, economists have talked about physical capital, financial capital, and human capital.

The next chapter may be defined by brain capital.

The countries, communities, organizations, and healthcare systems that learn how to protect, measure, and grow that capital will be better positioned to thrive in a future that increasingly rewards human creativity, adaptability, and resilience.

The future economy will not be built solely on artificial intelligence.

It will be built on the quality of human intelligence.

And that makes brain health one of the most important economic issues of our time.

To learn more about the Declaration of Cognitive Interdependence, or to add your name in support, visit www.CognitiveDeclaration.org.

One of the biggest challenges in cognitive decline is that by the time memory symptoms appear, the disease process has often been unfolding for years.

This is one of the central lessons from our movement. Cognitive decline does not begin when someone forgets a name, misses an appointment, or gets lost driving home. Those symptoms are often the final stage of a process that has been quietly developing for a decade or more.

That is why I am always interested in early signals.

A fascinating study published in Alzheimer’s & Dementia in 2022 followed 287 adults for 15 years. All participants had normal cognition when the study began. Researchers measured their walking speed over time and tracked who eventually developed cognitive decline.

The results were striking.

The people who later developed dementia were already walking more slowly up to nine years before their first cognitive symptoms appeared. Their slower gait was also associated with the biological changes seen in Alzheimer’s disease, suggesting that the disease process was already developing while they still appeared completely healthy.

A second study using data from the UK Biobank examined more than 47,000 adults and found something similar. Across the entire dataset, slower walking speed emerged as the strongest gait-related predictor of future dementia.

These studies are observational, so they do not prove that slower walking causes dementia. But they do reinforce an important idea that is becoming increasingly difficult to ignore.

The brain often reveals its struggles through movement long before it reveals them through memory.

Walking may seem simple, but it is actually one of the most complex things we do. Every step requires coordination between multiple brain networks. Balance, attention, sensory processing, motor planning, visual input, and executive function must all work together seamlessly.

When those networks begin to lose efficiency, the first sign may not be a forgotten word. It may be a slower pace.

Reduced arm swing. A slight hesitation when turning. A loss of fluidity. A subtle change that would be easy to dismiss as normal aging.

To me, walking speed is not really about the legs. It is a window into the health of the brain.

This is one reason why experienced clinicians often pay close attention to how a patient walks into the room. Long before a cognitive assessment begins, there may already be clues present in the way someone moves.

Historically, these observations have been subjective. One practitioner notices something. Another does not. But that is beginning to change.

Today’s wearable technologies can continuously measure cadence, walking speed, stride length, variability, balance, and movement patterns. For the first time, we have the ability to monitor changes in movement over years rather than relying on a snapshot from a single office visit.

That is exciting because it aligns perfectly with where the field needs to go.

At TruNeura, we spend a lot of time thinking about how to identify cognitive decline earlier. The reality is that memory loss is often a late-stage symptom. By the time someone notices that they are forgetting things, the process may have been underway for years.

What makes these studies so interesting is that they suggest the brain is giving us signals much earlier. Not through memory, but through movement.

I am excited about a future where wearable devices can track walking speed, cadence, balance, and other markers continuously over time. Not because walking speed itself is the problem, but because it may be another window into how well the brain’s networks are functioning.

The more we learn about cognitive decline, the more it becomes clear that there is no single test that will tell us everything. Instead, we need to start paying attention to patterns. Changes in biomarkers. Changes in sleep. Changes in social engagement. Changes in movement.

Walking speed may be one more piece of that puzzle.

The lesson here is not that everyone should start obsessing over how fast they walk.

The lesson is that cognitive decline leaves clues.

There are many ways to spot the early signs of Alzheimer’s disease and other forms of dementia. Some people notice changes in memory. Others notice changes in mood, attention, executive function, or social engagement. Increasingly, research suggests that changes in movement may be part of that picture too.

Looking back, my own father’s walking speed and shuffling gait became much more obvious in the summer before he was diagnosed. At the time, it was easy to explain away as aging. Only later did it become clear that it was part of a much bigger story.

For decades, we have waited for memory symptoms to tell us that something is wrong. Increasingly, the science suggests that the brain has been telling us for years. We just have not been listening.

The opportunity now is to build systems that can recognize those signals earlier and intervene while there is still plenty of brain function left to protect.

Because when it comes to cognitive decline, the goal is not to diagnose it earlier.

The new goal is to prevent it from becoming a diagnosis in the first place.

Reversing cognitive decline is often framed around root causes, lab markers, protocols, and progress tracking. Those conversations are critical.

But what happens when a patient continues to decline? What happens when caregivers are exhausted? What happens when families are carrying guilt, grief, uncertainty, and impossible decisions?

These are the conversations that too often go unspoken.

In this week’s TruNeura Mastermind, members were joined by Sierra Campbell, an elder care expert, death doula educator, and longtime dementia caregiver whose work spans three decades supporting patients and families through advanced cognitive decline and end-of-life care.

What unfolded was one of the most heartfelt and important discussions we’ve had in the Mastermind to date.

Cognitive Decline Doesn’t Just Affect the Patient

One of the strongest themes throughout the session was a reminder that cognitive decline is never an individual diagnosis.

It affects spouses. Adult children. Siblings. Caregivers. Entire family systems.

Sierra encouraged clinicians to think beyond the patient in front of them and recognize that the person coordinating appointments, managing medications, tracking symptoms, and making difficult decisions is often carrying an enormous emotional burden. She described these family members as the “team leaders” of care and emphasized the importance of supporting them alongside the patient.

For many practitioners, this resonated deeply.

The reality is that caregiver burnout, anticipatory grief, and feelings of failure often emerge long before families openly discuss them.

From Independence to Interdependence

Sierra’s most powerful reframes centered on language.

Rather than focusing on a patient’s “loss of independence,” she encourages families to think about interdependence and the natural process of leaning into a broader circle of care as needs increase.

This subtle shift changes the conversation.

Instead of viewing additional support as failure, families can begin to see caregiving as a shared responsibility involving spouses, children, neighbors, friends, professionals, and community resources.

The discussion explored how clinicians can help patients identify and build this “care circle” before a crisis occurs.

Navigating Guilt, Grief, and Difficult Decisions

Meaningful moments came during conversations about transitions to memory care and advanced stages of disease.

Mastermind members shared experiences caring for families who felt they had somehow failed when a loved one continued to decline despite years of dedicated effort.

Sierra spoke candidly about the guilt many caregivers carry and the importance of normalizing those emotions. She emphasized that moving to memory care is not necessarily a failure, and neither is reaching a point where additional support becomes necessary.

The conversation also addressed something many clinicians encounter but may not discuss proactively enough: advanced cognitive decline can sometimes bring agitation, paranoia, aggression, sleep disruption, or behaviors that place caregivers at risk. Sierra encouraged practitioners to prepare families for these possibilities and to normalize seeking additional medical support when safety becomes a concern.

These discussions are never easy, but they are often essential.

Presence Over Perfection

Perhaps the most significant takeaway from the session was Sierra’s emphasis on presence.

She reminded attendees that caregiving is not about being the hero, fixing every problem, or carrying the entire burden alone. Instead, caregiving is often a practice of showing up consistently, creating moments of connection, and helping families feel supported through uncertainty.

Throughout the discussion, she shared examples of how simple rituals, meaningful routines, compassionate communication, and community support can help create stability for both patients and caregivers.

One quote captured the spirit of the entire conversation:

“It’s not babysitting. It’s connection.”

In a field often focused on interventions and outcomes, it was a powerful reminder that human connection remains one of the most important forms of care we can offer.

Why This Matters

At TruNeura, we’re passionate about helping clinicians identify root causes and create better outcomes for patients experiencing cognitive decline.

But we also recognize that great care extends beyond protocols.

It includes supporting caregivers, navigating difficult transitions, having honest conversations about quality of life, and helping families feel less alone during one of the most challenging journeys they may ever face.

This Mastermind session was a reminder that treating cognitive decline isn’t just about preserving cognition.

It’s about caring for the entire human experience that surrounds it.

One of the most valuable aspects of the TruNeura community is the opportunity for practitioners to bring real-world challenges directly to experts who are doing this work every day.

In a recent AMA session, TruNeura Co-Founder Kristine Burke, MD fielded a wide range of practitioner questions spanning mold exposure, patient engagement, clinical complexity, care planning, and the realities of implementing precision medicine approaches for cognitive decline.

While the discussion covered many different scenarios, a common theme emerged: successful cognitive decline care requires far more than following a protocol. It requires clinical judgment, pattern recognition, and the ability to navigate the unique circumstances of each patient.

When Mold Becomes Part of the Cognitive Decline Story

One of the most active areas of discussion centered around mold and mycotoxin exposure.

Practitioners brought forward questions involving patients with persistent symptoms despite treatment, uncertainty around interpreting test results, concerns about ongoing environmental exposures, and the challenge of helping patients make difficult decisions when mold may still be contributing to cognitive decline.

Dr. Burke emphasized that environmental contributors are rarely simple. The conversation explored how practitioners can think through these situations systematically while balancing clinical findings, patient circumstances, and evolving evidence.

The discussion reflected an important reality of precision medicine: environmental factors such as mold are often a significant piece of the puzzle and require both clinical expertise and patient-specific decision-making.

The Challenge of Patient Motivation and Follow-Through

Another recurring topic involved patient engagement.

Many practitioners encounter situations where patients understand the recommendations but struggle to implement them consistently. Whether related to lifestyle changes, treatment adherence, caregiver dynamics, or competing priorities, these barriers can significantly impact outcomes.

Rather than focusing solely on what interventions to recommend, the conversation explored how practitioners can better support patients through the behavior change process itself.

For many attendees, this highlighted an important truth: sometimes the biggest obstacle is not knowing what to do. It’s helping patients successfully do it.

Why Community-Based Learning Matters

Perhaps the biggest takeaway from the session wasn’t any single clinical topic.

It was the power of collaborative learning.

The questions raised during the AMA reflected the realities practitioners encounter every day. Complex patients. Incomplete information. Competing priorities. Unclear next steps.

By bringing these challenges into a community of clinicians focused on cognitive decline, practitioners gain access to the collective experience, perspective, and problem-solving that simply isn’t available through static courses or textbooks alone.

These conversations are a reminder that advancing cognitive decline care is not just about acquiring knowledge. It’s about learning how to apply that knowledge in the context of real patients and real clinical decisions.

For practitioners looking to build confidence in this rapidly evolving field, that kind of support can make all the difference.

As I write this, my friend Guillermo Ochoa is preparing for another World Cup.

For most football fans, that statement barely registers. We have become accustomed to seeing athletes compete at ages that would have been unimaginable a generation ago. But if you stop and think about it, it is remarkable.

Ochoa was part of Mexico’s squad at the 2006 World Cup. Twenty years later, he is still competing at the highest level of international football. Alongside players like Lionel Messi, Cristiano Ronaldo, and Luka Modrić, he represents a generation of athletes who have fundamentally changed our expectations of human performance.

When I was growing up in England, professional athletes were largely finished by their early thirties. A few exceptional players might continue beyond that, but decline was considered inevitable. Peak performance was thought to belong to youth.

Today, that assumption has been overturned.

Tom Brady won a Super Bowl at 43. LeBron James continues to perform at an elite level in his forties. Jimmy Anderson is still at the top of his game in his mid forties (He plays cricket, in case you were wondering!) Across virtually every major sport, athletes are extending careers far beyond what previous generations thought possible.

Most people look at this and see better training methods, improved nutrition, or advances in sports science. Those factors certainly matter. But underneath all of them lies a more important shift. We have moved from thinking about disease and injury to thinking about function.

The greatest athletes in the world are not simply treating problems when they arise. They are continuously investing in the systems that allow high performance to emerge. They optimize sleep, recovery, metabolic health, movement, resilience, social connection, purpose, and stress management. They understand that elite performance is not created by any single intervention. It emerges from the coordinated function of many interconnected systems.

This is precisely why their success has implications far beyond sport.

For decades, we have treated cognitive decline differently from every other form of human performance. When an athlete loses speed, we ask what has changed. When a business executive loses focus, we ask what is causing it. When someone develops cardiovascular disease, we investigate the biological factors that contributed to it.

Yet when an older adult begins losing memory or cognitive capacity, society often responds differently. We call it aging. We accept it as inevitable. We lower our expectations.

The emerging science suggests we should be far more careful about making that assumption.

The same factors that influence physical performance influence brain performance. Metabolic dysfunction, chronic inflammation, poor sleep, social isolation, toxin exposure, vascular compromise, chronic stress, and lack of cognitive engagement all affect the brain’s ability to function. The brain is not separate from the body. It is one of the most metabolically demanding organs in it.

At TruNeura, we often talk about “network insufficiency”. Cognitive decline rarely results from a single cause. Instead, it emerges when multiple systems that support brain function begin to weaken simultaneously. The solution is not to focus on one pathway, one biomarker, or one medication. The solution is to understand the network and strengthen the network.

In many ways, this is exactly what elite athletes have been teaching us for the last twenty years.

The lesson is not that everyone can become Tom Brady or Guillermo Ochoa. The lesson is that function matters. Human performance, whether physical or cognitive, is far more adaptable than we once believed. When we create the conditions for function to thrive, people can continue performing at high levels for much longer than previous generations imagined.

We have already expanded our expectations for physical performance. Nobody is shocked anymore when a world-class athlete competes in their forties.

The next frontier is cognitive performance.

What if we expected people to remain cognitively vibrant into their eighties, nineties, and beyond? What if maintaining brain function became as normal as maintaining cardiovascular fitness? What if the same commitment to lifelong optimization that has transformed elite sport was applied to brain health?

That is the future we are working toward.

Tom Brady showed us what is possible for a quarterback. Guillermo Ochoa is showing us what is possible for a goalkeeper. The challenge now is to demonstrate what is possible for the human brain.

And that may be the most important performance story of the twenty-first century.