Short answer: more people than you might think. Neural Effects in particular sees not only people with noticeable memory or thinking changes, but also those who want a second opinion after an initial diagnosis, people managing medical conditions that raise lifetime risk for dementia, and “worried‑well” adults who feel fine but have questions because of family history or recent science (for example, the long‑term effects after COVID‑19). Evidence shows that earlier evaluation and risk management can meaningfully lower your lifetime dementia risk, especially when it targets hearing, vascular health, head‑injury prevention, sleep, and other modifiable factors.
Five reasons you may benefit from a Neural Effects Consult
- You’ve noticed changes.
Memory lapses, word‑finding trouble, slowed thinking, new disorganization, or getting lost in familiar places. A structured evaluation can clarify whether changes reflect normal aging, mild cognitive impairment (MCI), depression or anxiety, sleep or thyroid problems, medication effects, or a neurodegenerative condition. - You already have an initial diagnosis and want more in-depth answers, a plan, and options for slowing down cognitive decline.
Primary care or urgent‑care teams may reasonably start with “possible MCI” or “possible Alzheimer’s.” A memory clinic adds longer neurocognitive testing, differential diagnosis (e.g., Alzheimer’s, vascular, Lewy body, frontotemporal, mixed), and a practical care plan. Additionally, Neural Effects offers opportunities for education, community, and Cognitive Stimulation Therapy for individuals with mild to moderate dementia. - You’re among the “worried‑well.”
You feel fine but want to understand your personal risk because a parent, grandparent, or sibling had dementia; you’ve had multiple concussions; your blood pressure or cholesterol runs high; you’ve noticed hearing loss or poor sleep; or you’re simply proactive. The latest Lancet Commission says 14 modifiable factors (including hearing and vision loss, hypertension, diabetes, air pollution, head injury, smoking, depression, inactivity, obesity, social isolation, heavy alcohol use, and high LDL cholesterol) account for nearly half of worldwide dementia cases1—meaning action now matters. - You live with neurological or medical conditions linked to cognitive risk.
Examples: Parkinson’s disease, REM sleep behavior disorder (acting out dreams), significant sleep apnea, stroke or TIA, autoimmune disease, or HIV. Parkinson’s carries a meaningful risk for later dementia; genetics (e.g., GBA, LRRK2) and disease duration influence that risk.2 - You’re concerned about the cognitive effects of COVID-19.
Large cohort studies and meta‑analyses report higher rates of later cognitive disorders after SARS‑CoV‑2 infection (though size and persistence of risk vary by study). An individualized baseline and follow‑up can help track and manage your cognition, sleep, mood, and vascular risks post‑infection.3
What happens when I have a Neural Effects Memory Clinic consultation and evaluation?
During your initial consultation, we take a detailed history, talk about your medications, your family, and your concerns. Next, we develop a plan to evaluate your cognitive function. We may order a neuropsychological evaluation alone or in addition to other testing. Sometimes we will also ask to interview someone close to you, like a friend or family member, to gather their observations as well.
The evaluation plan will be tailored to you, but could include:
- Labs: Labs to check B12, thyroid-stimulating hormone (TSH), metabolic profile, and others based on your history to look for treatable contributors to your cognitive changes.
- Imaging: MRI (or CT) is often used to rule out strokes, tumors, hydrocephalus, or other structural causes.
- Neuropsychological Testing: Pen and paper testing using proven measures gives us detailed information about your cognitive function.
- Other Specialized Scans & Tests:
- Sleep, hearing, and vision screening. We routinely consider sleep apnea, REM sleep behavior disorder (RBD), hearing loss, and vision loss, which are increasingly recognized as important (and treatable) levers for brain health.
- Advanced biomarkers: Amyloid or tau PET Scans can confirm Alzheimer’s‑type pathology in the right scenarios, but few facilities offer these scans.
- Blood‑based biomarkers (BBMs): Beta Amyloid 42/40 Ratio; Phosphorylated Tau 181 (pTau-181); Neurofilament Light Chain (NfL), are used to determine the presence or absence of key biological changes that are consistent with Alzheimer’s disease. These are not screening tests for people without symptoms.
- Genetic Counseling or Testing:
- Most dementia is not caused by a single gene. That said, certain autosomal‑dominant mutations (APP, PSEN1, PSEN2) cause early‑onset Alzheimer’s in some families; testing is typically considered when there’s a strong, young‑onset family history and should include genetic counseling. Routine APOE testing is not recommended to predict risk in the general population because having the APOE gene does not always mean you will later have Alzheimer’s disease. A genetic counselor will need to help you understand what having the gene means for you.
- For frontotemporal dementia (FTD) families, genes such as MAPT, GRN, and C9orf72 may be relevant; again, genetic counseling is essential.
- In Parkinson’s disease, most cases are not considered to be genetic; however, select patients may discuss GBA or LRRK2 testing; these gene variants can influence risk and disease course, including cognitive complications.4
“Worried-Well”: What we can do now (before you notice any cognitive changes)
Coming to a memory clinic as a healthy person without any memory symptoms isn’t overkill or paranoia; it’s smart preventive care. Here’s what a proactive visit can include:
- Personal risk mapping
We review your family history, vascular risks (blood pressure, A1c, LDL), sleep, hearing, vision, head‑injury history, physical activity, alcohol use, mood, stress, and social support system to determine your personal risks and what you can do now to protect your brain. - Baseline cognitive profile
An objective baseline allows your healthcare team to compare apples to apples as time goes by. If future concerns arise, we know your personal starting point. - Hearing & vision Check
Treating hearing loss slowed cognitive decline by approximately 50% over three years in high‑risk older adults in the NIH‑funded ACHIEVE trial, and the 2024 Lancet update adds untreated vision loss as a modifiable risk. If you’ve been “putting off” hearing aids or new lenses, now is the time to address these needs. - Vascular tune‑up
Just 30 minutes of exercise a day, managing your blood pressure, and following the rest of the American Heart Association’s checklist for Life’s Essential 8 can significantly reduce your risk of vascular dementia. - Sleep evaluations
We screen for sleep apnea and REM Sleep Behavior Disorder (RBD). Sleep apnea is linked to cognitive decline; treating it is associated with better cognition and lower dementia diagnoses. RBD can precede Lewy body disorders by years, and treating it may have protective effects.5 - Head‑injury prevention
We review sports and work risks and fall prevention. Traumatic brain injury (including repeated head impacts) is associated with higher dementia risk; prevention and safe return‑to‑play strategies matter. - Talk about when not to test
We avoid tests that don’t help people without symptoms, for example, DaTscan, a test that helps determine the cause of tremors, is helpful when Parkinsonian symptoms are present, but it isn’t a screening test for healthy people.
Major dementia types & what raises risk
- Alzheimer’s disease (AD)
Age is the biggest factor. Genetics play a role: the APOE ε4 gene raises risk but doesn’t guarantee disease; rare APP/PSEN1/PSEN2 gene mutations cause familial early‑onset Alzheimer’s disease. Vascular, hearing, sleep, and lifestyle factors remain crucial for risk reduction across the lifespan. - Vascular cognitive impairment and vascular dementia
Strongly tied to blood pressure, diabetes, atrial fibrillation, cholesterol or lipids, smoking, and inactivity. Managing these is central to prevention. - Lewy body dementia (LBD)
Shares features with Parkinson’s; REM Sleep Behavior Disorder and loss of smell can be early signals. - Frontotemporal dementia (FTD)
More common under in individuals under 65; MAPT/GRN/C9orf72 genes account for many inherited cases. - Parkinson’s disease dementia (PDD)
Dementia risk rises with Parkinson’s disease duration and in certain genotypes. A tailored plan to reduce risk targets sleep, mood, exercise, cognition, and medication side effects.
A note on Parkinson’s and “pre-Parkinson’s” concerns
If you (or a parent or sibling) have Parkinson’s, or you’ve been told you have REM sleep behavior disorder, it’s reasonable to ask about cognition now, even if your thinking feels normal. REM sleep behavior disorder (RBD) in particular is a recognized prodrome, or early symptom, of Lewy body conditions. Simple strategies (sleep safety, exercise, mood treatment, vascular control, hearing and vision correction) add protective value over time. DaTscan may help clarify diagnosis when motor symptoms are present, but it’s not a prevention or screening test.
COVID-19 and later cognitive risk: what we know
Multiple large studies report increased rates of new‑onset cognitive disorders or measurable brain changes after COVID‑19, likely via a mix of vascular, inflammatory, and indirect effects. The magnitude and duration of risk differ by age, severity, and variant, and research is ongoing. At baseline, controlling vascular risks, optimizing sleep, good mental health care, and gradual return to exercise are sensible steps if you’re concerned about COVID-19’s lasting effects.
Frequently Asked Questions
“Should I get a brain scan even if I’m fine?”
Usually, no. We start by reviewing your history, cognitive testing, and risk review. Structural imaging (MRI/CT) is reserved for specific indications, and advanced PET scans are used selectively under updated appropriate‑use criteria.
“What about the new blood tests for Alzheimer’s?”
A 2025 FDA‑cleared plasma test (p‑tau217/Aβ42 ratio) can help evaluate symptomatic adults when AD is suspected. It is not a general screening test for healthy people. We discuss pros/cons, insurance, and how results would change your care.
“Should I check my APOE status with genetic testing?”
APOE influences risk but doesn’t make or rule out a diagnosis. Predictive APOE testing should only be performed in conjunction with genetic counseling because results can be misunderstood and rarely change management by themselves. If you have an early‑onset family pattern, different, gene‑specific testing may be appropriate—again, with counseling.
“I have sleep apnea. Does treating it help my brain?”
Treating obstructive sleep apnea improves sleep and is associated with better cognition and lower incidents of dementia, some trials show cognitive benefits with sustained CPAP use. We’ll help you navigate the treatment process.
“Do my medications matter?”
We review medicines that can fog thinking (e.g., strong anticholinergics) and discuss safer substitutes when possible.
What to bring to your first visit
- A trusted family member or friend (they notice things you may not).
- A medication list (including over‑the‑counter and supplements).
- Glasses or hearing aids, if you use them.
What you will leave with
- A clear summary of where you are today or a plan for a more complete evaluation.
- A personalized Brain Health Plan (hearing/vision, BP/A1c/LDL goals, sleep, activity, nutrition, alcohol/smoking, head‑injury prevention, mood/social connection).
- Recommendations about when (or whether) to pursue imaging, labs, sleep studies, hearing aids, biomarker, or genetic screenings, with orders and referrals coordinated as needed.
Five dementia prevention moves to remember
- Treat hearing and vision loss.
- Know your numbers (BP, A1c, LDL) and target heart‑healthy ranges.
- Move most days and build strength/balance; protect your head.
- Sleep well and get screened for sleep apnea or RBD if you snore, gasp, or act out dreams.
- Stay connected (family, friends, community, purpose). Social isolation is a modifiable risk.
Medical note: This article is educational and not a substitute for individual medical advice. If you’re having sudden or rapidly worsening symptoms (new confusion, stroke‑like symptoms, severe headache, head trauma, severe sleep behaviors with injury risk), seek urgent care.
- Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission
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