Managing Cognitive Decline

An Integrated Programme for Memory, Cognition and Brain Health

Changes in memory or thinking can be worrying—for the person experiencing them and for family members who may have noticed a difference.

Memory difficulties do not always indicate dementia. They may be influenced by sleep disturbance, stress, depression, medication, alcohol, nutritional deficiency, thyroid dysfunction, impaired hearing or vision, cardiovascular disease, diabetes and other potentially treatable factors.

The Health Equation provides a structured diagnostic and six-month intervention programme for people concerned about memory, cognition or age-related cognitive change.

The programme does not diagnose or treat dementia and does not replace assessment by a GP, neurologist, geriatrician or NHS memory service. Its purpose is to identify and address clinically relevant, potentially modifiable factors while supporting appropriate medical investigation and ongoing care.

Medical Assessment Comes First

New, progressive or functionally significant changes in memory, thinking, language, behaviour or everyday capability require appropriate medical assessment.

You should consult your GP if cognitive symptoms:

• Persist or progressively worsen
• Interfere with work, finances, medication, driving or daily activities
• Are noticed by family members or colleagues
• Are accompanied by changes in personality, behaviour, speech or movement
• Develop alongside neurological or other unexplained physical symptoms

A GP may review medication, arrange blood tests, undertake cognitive screening and refer to a memory clinic or specialist where appropriate. Brain imaging or other investigations may also be required.

Sudden confusion or an abrupt change in cognition can represent an acute medical problem and requires urgent assessment.

The Health Equation programme can complement this process, but it should not delay or replace it. NHS guidance recommends consulting a GP when persistent memory problems affect everyday life.

Cognitive Decline Is Multifactorial

There is rarely one single explanation for cognitive decline. Genetic susceptibility, ageing, medical conditions, sensory impairment, lifestyle, psychological health and environmental exposure may all influence risk.

The 2024 Lancet Commission identified 14 potentially modifiable factors associated with dementia risk:

• High blood pressure
• High LDL cholesterol
• Diabetes
• Obesity
• Smoking
• Excessive alcohol consumption
• Physical inactivity
• Depression
• Social isolation
• Hearing loss
• Untreated visual impairment
• Traumatic brain injury
• Air pollution
• Limited access to education earlier in life

The Commission estimated that addressing these factors could potentially prevent or delay approximately 45% of dementia cases at population level. This does not mean that dementia can always be prevented, nor does it predict an individual person’s outcome.

It does, however, provide a strong rationale for identifying modifiable risks and supporting brain health throughout life. Read the 2024 Lancet Commission report.

Who May Benefit from the Programme?

The programme may be suitable for adults who:

• Have noticed changes in memory, concentration or mental clarity
• Are concerned about maintaining cognitive health as they age
• Have a family history of dementia or Alzheimer’s disease
• Have cardiovascular, metabolic or lifestyle risk factors
• Have already received medical assessment but want broader evaluation of potentially modifiable contributors
• Wish to take a structured and proactive approach to brain health
• Would benefit from support implementing sustainable changes in nutrition, exercise, sleep, breathing or other health behaviours

It may also be helpful for someone with mild cognitive impairment or an established diagnosis, provided they remain under appropriate medical care and the aims of the programme are realistic and clearly agreed.

Where possible, patients are encouraged to involve a partner, relative or trusted supporter, particularly if memory difficulties affect the accuracy of the clinical history or the practical implementation of recommendations.

An Integrated Approach to Brain Health

Cognitive function depends upon more than the brain in isolation. It is influenced by the interaction of neural, circulatory, respiratory, endocrine, immune and inflammatory, metabolic and musculoskeletal regulation.

Assessment therefore considers factors such as:

• Blood pressure and cardiovascular risk
• Glucose regulation and metabolic health
• Sleep quality and possible sleep-disordered breathing
• Medication and alcohol exposure
• Hearing, vision and sense of smell
• Mood, stress and social connection
• Physical activity, balance and mobility
• Breathing behaviour and respiratory physiology
• Nutritional adequacy and relevant deficiencies
• Inflammation and existing medical conditions
• Previous head injury
• Family history and genetic susceptibility

The purpose is to build an individual clinical picture, identify potentially modifiable contributors and establish priorities that are proportionate, realistic and compatible with existing medical care.

The Diagnostic Package

The diagnostic phase establishes an individual baseline and examines potentially modifiable factors that may influence memory, cognition and wider brain health.

It includes:

• A 60-minute Diagnostic Consultation
• Detailed medical, cognitive, family and lifestyle history
• Appropriate physical, neurological, cardiovascular and functional examination
• Capnometry and heart rate variability assessment
• MMSE and/or GPCOG cognitive screening
• Burghart 12-item Sniffin’ Sticks olfactory identification test
• GAJ2 comprehensive blood profile
• Functional Blood Analysis with written interpretation
• An individualised Metabolic Balance® nutritional plan
• A structured written clinical report
• A follow-up discussion of findings and recommendations

An optional APOE E2/E3/E4 genetic susceptibility test is available at an additional cost, but is undertaken only after appropriate discussion of its limitations and possible implications.

Cognitive Screening: MMSE and GPCOG

The programme uses the Mini-Mental State Examination (MMSE) and/or the General Practitioner Assessment of Cognition (GPCOG) to establish a cognitive baseline.

These questionnaires examine areas such as:

• Orientation
• Attention and concentration
• Memory and recall
• Language
• Visual-spatial ability
• Performance of simple cognitive tasks
• The effect of cognitive change on everyday function

Results must be interpreted carefully. Scores may be influenced by education, language, sensory impairment, anxiety, fatigue and other clinical factors.

These questionnaires do not diagnose dementia and a normal score does not necessarily exclude early cognitive change. Where findings or symptoms cause concern, appropriate GP, memory-clinic or specialist assessment will be recommended.

Repeating the same or an appropriate comparable questionnaire at six and 12 months can help monitor change, although small score differences must not automatically be interpreted as clinical improvement or deterioration. NHS guidance confirms that cognitive assessments may identify difficulties requiring further investigation but cannot diagnose dementia by themselves.

Olfactory Assessment: Sniffin’ Sticks

Changes in the sense of smell can occur with ageing, nasal or sinus disease, respiratory infection, smoking, medication, head injury and some neurological conditions.

The programme includes the Burghart 12-item Sniffin’ Sticks identification test. This provides a standardised assessment of the ability to recognise a series of familiar odours and establishes an olfactory baseline.

The result may help identify reduced smell function and determine whether further medical or ENT assessment should be considered. However, an abnormal result is not specific to Alzheimer’s disease or any other neurodegenerative condition, and a normal result does not exclude cognitive impairment.

Testing may be repeated during follow-up to monitor change. Any difference is interpreted alongside the wider clinical picture rather than as a standalone marker of cognitive improvement or decline.

Blood Testing and Functional Blood Analysis

The diagnostic package includes the GAJ2 blood profile, providing a broad assessment of factors that may be relevant to cognitive and general health.

The profile includes:

• Haematology
• Kidney and liver function
• Blood glucose and HbA1c
• Lipid profile
• ESR and CRP inflammatory markers
• Thyroid function, including TSH and free T4
• Pancreatic enzymes
• Vitamin D
• Additional routine biochemical markers

Depending upon the clinical history and previous results, further tests may be recommended—for example vitamin B12, folate or other targeted investigations. These are not automatically included and may involve an additional charge.

Results are interpreted through a Functional Blood Analysis, which considers patterns and relationships across the complete profile rather than relying solely upon whether individual markers fall inside or outside the laboratory reference range.

This interpretation does not replace conventional medical diagnosis. Significant abnormalities are communicated clearly, and GP or specialist review is recommended where appropriate.

Breathing, Capnometry and Heart Rate Variability

Breathing behaviour can influence carbon dioxide regulation, cerebral blood flow, oxygen delivery, sleep, anxiety and the wider physiological response to stress.

The diagnostic assessment may therefore include:

• Observation of breathing pattern
• Respiratory rate
• End-tidal carbon dioxide measured by capnometry
• Heart rate and heart rate variability
• Response to guided breathing or relaxation
• Assessment of relevant ribcage and respiratory mechanics

These measurements do not diagnose cognitive decline or dementia. They help identify potentially modifiable respiratory or neural-regulatory patterns that may be relevant to symptoms, sleep, stress tolerance or wider physiological function.

Where appropriate, breathing retraining may form part of the six-month programme, with progress reviewed through symptoms, clinical findings and repeat physiological measurement.

The Glymphatic System, Sleep and Brain Health

The glymphatic system describes a network of fluid pathways surrounding blood vessels within the brain. It supports exchange between cerebrospinal fluid and interstitial fluid and is being investigated for its role in clearing metabolic waste products from brain tissue.

This includes proteins such as beta-amyloid and tau, which are associated with neurodegenerative disease when abnormally accumulated. Sleep appears to influence glymphatic function, although the mechanisms and their clinical significance in humans remain under active investigation.

The assessment therefore considers factors that may affect sleep and brain-fluid regulation, including:

• Sleep duration, quality and regularity
• Possible obstructive sleep apnoea or sleep fragmentation
• Blood pressure and vascular health
• Respiratory physiology
• Physical activity
• Metabolic health
• Alcohol and medication
• Previous head injury

The Health Equation does not claim to measure the glymphatic system directly or to “detoxify” the brain through treatment. Its relevance is that it provides an additional physiological reason to identify sleep disturbance and address modifiable respiratory, cardiovascular, metabolic and behavioural factors.

Recent human research supports an association between sleep quality, glymphatic function and memory, while recognising that the evidence is still developing. Research in Molecular Psychiatry and a recent human crossover study in Nature Communications provide useful emerging evidence.

Nutrition and Metabolic Health

The brain depends upon stable energy regulation, adequate nutrient availability and healthy vascular function. The programme therefore considers dietary pattern alongside blood glucose, lipid profile, blood pressure, body composition and relevant laboratory findings.

The diagnostic package includes an individualised Metabolic Balance® nutritional plan, which is modified according to the patient’s cognitive-health priorities, medical needs and practical circumstances.

Nutritional recommendations may aim to support:

• Stable blood glucose regulation
• Cardiovascular and metabolic health
• Adequate protein, fibre and micronutrient intake
• Weight management where appropriate
• Reduced reliance upon highly processed foods
• Sustainable and enjoyable eating patterns
• Correction of an identified nutritional deficiency

Supplements may be recommended selectively where there is a clear clinical rationale. However, no supplement, food or dietary programme can presently be claimed to prevent Alzheimer’s disease or other forms of dementia.

Nutrition forms one part of a multidomain strategy and does not replace appropriate medical investigation or prescribed treatment.

Optional APOE Genetic Susceptibility Testing

The APOE E2, E3 and E4 test is available as an optional blood test at an additional cost.

APOE is involved in lipid transport and other aspects of brain and cardiovascular physiology. Certain variants—particularly APOE ε4—are associated with an increased statistical risk of developing Alzheimer’s disease. However:

• APOE ε4 does not mean that a person has Alzheimer’s disease
• Many people with APOE ε4 never develop dementia
• Alzheimer’s disease can occur without APOE ε4
• The result cannot predict whether or when an individual will develop cognitive decline
• The test does not diagnose or exclude dementia

Testing is therefore undertaken only after discussion of its limitations, potential psychological impact and possible implications for family members, insurance or future decision-making.

Where genetic counselling would be more appropriate, this will be recommended before testing proceeds. The decision not to undertake APOE testing does not prevent participation in the programme.

Understanding Your Diagnostic Findings

Following completion of the diagnostic phase, the findings are integrated into a structured written report.

This brings together:

• The clinical history and cognitive concerns
• Physical and neurological examination findings
• Cognitive screening results
• Olfactory assessment
• Capnometry and heart rate variability
• Blood-test findings and Functional Blood Analysis
• Cardiovascular and metabolic risk factors
• Sleep, mood, sensory and lifestyle considerations
• Existing diagnoses, medication and specialist care
• Prioritised recommendations and appropriate referrals

The report explains which findings appear clinically important, which require medical follow-up and which may be amenable to practical intervention.

Where the patient gives consent, the report can be shared with their GP, memory clinic, neurologist or other healthcare professional to support continuity of care and avoid unnecessary duplication.

The Six-Month Treatment and Intervention Programme

Following the diagnostic phase, patients may choose to undertake a structured six-month programme addressing the priorities identified during assessment.

The programme includes five standard 45-minute consultations:

• Three consultations incorporating osteopathic treatment and/or breathing re-education, as clinically appropriate
• Two consultations providing nutritional and behavioural-change support

The wider programme may include:

• A modified Metabolic Balance® nutritional plan
• Selective nutritional supplementation where justified
• Individualised physical-activity and exercise strategies
• Sleep and recovery recommendations
• Breathing exercises and stress-management techniques
• Support for cardiovascular and metabolic risk reduction
• Advice concerning hearing, vision and social engagement
• Olfactory training or smell-enrichment advice
• Liaison with medical or allied healthcare professionals where appropriate

The programme is personalised. Not every intervention is required by every patient, and recommendations are adapted to clinical need, ability, preference and existing medical care.

Review at Six Months (additional add on)

At the end of the six-month programme, progress is reviewed using the same broad clinical framework established at baseline.

The review includes:

• Repeat GAJ2 blood profile
• Updated Functional Blood Analysis
• Repeat MMSE and/or GPCOG cognitive screening
• Repeat Sniffin’ Sticks olfactory assessment
• Review of symptoms, daily function and quality of life
• Review of nutrition, exercise, sleep and behavioural changes
• Repeat relevant clinical or physiological measurements
• A final standard 45-minute consultation
• Recommendations for ongoing care, medical follow-up or further investigation

Changes are interpreted cautiously. Improvements in an individual result or questionnaire score do not prove that cognitive decline has been prevented or reversed, while a stable score does not exclude clinically important change.

The purpose of reassessment is to evaluate progress, identify remaining priorities and determine an appropriate longer-term plan.

Follow-Up at 12 Months (additional add on)

Patients are invited to return for a further cognitive review at approximately 12 months from the start of the programme.

This follow-up may include:

• Repeat MMSE and/or GPCOG cognitive screening
• Review of memory, thinking and everyday function
• Discussion of any changes noticed by the patient or family
• Review of medical diagnoses, medication and investigations
• Assessment of progress with agreed health and lifestyle priorities
• Recommendations for continued monitoring or onward referral

The 12-month review provides a further reference point, but cognitive screening remains only one part of the clinical picture. Any progressive or functionally significant change requires appropriate GP, memory-clinic or specialist assessment.

Why Gerry Developed the Programme

Gerry has a longstanding personal and professional interest in cognitive health, influenced in part by a strong family history of Alzheimer’s disease.

In 2019, he began bringing together research concerning cardiovascular and metabolic health, breathing physiology, sleep, nutrition, physical activity, olfactory function and behavioural change into a structured clinical framework.

He subsequently presented this integrated approach to a postgraduate osteopathic group:

“It was truly a masterclass performance… It opened our eyes to understanding blood tests, using nutritional knowledge and recognising the biochemistry of breathing and its relationship to lifestyle and good health.”

Bob Gupta
Organiser, eVeNT Postgraduate Osteopaths

The programme has continued to evolve as the evidence has developed. Its purpose is not to claim that dementia can be prevented or reversed, but to help patients identify and address clinically relevant factors within their control.

Realistic Expectations and Clinical Boundaries

The programme is designed to support brain health and address potentially modifiable clinical and lifestyle factors. It does not claim to:

• Diagnose dementia or Alzheimer’s disease
• Prevent or reverse dementia
• Guarantee improvement in memory or cognitive-test scores
• Replace a GP, memory clinic, neurologist or geriatrician
• Replace prescribed medication or established dementia care
• Provide certainty about future cognitive health
• Treat the glymphatic system directly
• Interpret APOE status as a diagnosis or prediction

Some patients may improve in particular areas of health or function, while others may remain stable or continue to experience cognitive decline.

Where symptoms progress, test findings are concerning or specialist assessment is required, appropriate medical referral will be recommended. The programme works best as part of coordinated care with realistic, individually agreed objectives.

Programme Fees

Diagnostic Package

• London: £1,276
• Marlborough: £1,188

These fees include a 20% reduction compared with purchasing the individual components separately.

Six-Month Treatment and Intervention Package

• London: £980
• Marlborough: £680

This includes five standard 45-minute consultations and represents a 20% reduction on the individual consultation fees.

Six-Month Reassessment Package

• London: £555
• Marlborough: £480

This includes the agreed repeat testing, Functional Blood Analysis, cognitive and olfactory reassessment, and final clinical review. The published fee represents a 50% reduction on the relevant individual components.

The optional APOE genetic susceptibility test, nutritional supplements and any additional investigations or specialist consultations are charged separately.

The 12-month cognitive follow-up is arranged and charged separately according to the assessment required.

Booking the Managing Cognitive Decline Programme

The programme is available at The Health Equation clinics in:

• London: 86 Harley Street, London W1G 7HP
• Wiltshire: Alton Barnes, near Marlborough

The first appointment is the Managing Cognitive Decline Diagnostic Consultation.

Before attending, patients are encouraged to provide:

• A current medication and supplement list
• Relevant GP or specialist correspondence
• Previous blood-test and imaging reports
• Details of any existing cognitive assessment
• A brief chronology of the changes that have caused concern

Where appropriate, it can be helpful to attend with a partner, relative or trusted supporter who can contribute observations and assist with the practical implementation of recommendations.

[Book a Managing Cognitive Decline Diagnostic Consultation]

Alternatively, contact the practice:

Email: info@thehealthequation.co.uk
Telephone: 020 7631 1414

Evidence and Further Reading

The programme is informed by established guidance and emerging research concerning modifiable dementia risk, cognitive assessment, sleep, metabolic health and multidomain intervention.

Useful sources include:

• The 2024 Lancet Commission on Dementia Prevention, Intervention and Care
• NHS: How to Get a Dementia Diagnosis
• NHS: Tests Used When Assessing Dementia
• Sleep, Glymphatic Function and Memory in Older Adults
• The Integrated Regulatory Systems Framework

Evidence in this field continues to develop. Research findings are used to inform clinical reasoning, but associations between a risk factor and cognitive decline should not automatically be interpreted as proof of individual causation or treatment effect.

Download the Managing Cognitive Decline Brochure

Our brochure provides a concise overview of the diagnostic package, six-month intervention programme, follow-up assessments and current fees.

Please click the image below to download the brochure.