Let’s talk about early cognitive decline, one of the most feared issues for patients.

Case #9 – The Worried Executive

Patient: Michael, 62-year-old executive
Chief complaint: Increasing forgetfulness, losing words, fear of dementia
Duration: 2–3 years

His primary care doctor says, “It’s normal aging,” but he’s not convinced.

1. What we knew on Day One

Forgets names more often

Loses track of tasks, feels overwhelmed more easily

Sleep is short and interrupted

High stress, long career of overwork

Metabolic markers not ideal (borderline BP, weight, lipids)

Pause:
Is this “aging”… or brain as downstream of whole terrain?

2. The upstream view

We evaluated:

• Sleep quality (including risk of apnea)
• Metabolic health (insulin resistance, lipids, BP)
• Inflammation (hs-CRP and others as appropriate)
• Nutrient status (B12, D, etc.)
• Activity level, cognitive and social engagement

We explained:

“Your brain is downstream of your heart, metabolism, sleep, and environment. We can’t change age, but we can change those.”

3. Plan and outcome

Plan:

• Improve sleep (timing, environment; consider sleep study if indicated)
• Address metabolic markers (see earlier cases)
• Encourage regular exercise (especially cardio + resistance)
• Nutrient optimization and brain-supportive lifestyle
• Cognitive engagement and social connection

Outcome:

• Reduced “slips,” more mental clarity
• Improved confidence and sense of agency
• Slowed or stabilized decline

4. Takeaways for your practice

Pearl #1: Early cognitive decline is often a multisystem metabolic issue.

Pearl #2: Sleep (especially apnea) is a major, often ignored driver.

Pearl #3: Patients are highly motivated when you show modifiable levers.

Action step:
With your next “memory” patient, ask:

“How well do you really sleep, and has anyone ever evaluated your breathing at night?”

FM 2.0 Lens

FMU builds on this with:

• Genomics related to lipids, inflammation, and brain resilience
• Expanded lab patterns for brain terrain
• Multi-domain intervention frameworks (metabolic, cognitive, emotional, environmental)

Clinical Rounds gives you the language to start that conversation.

Take care,

Ron Grisanti, D.C., D.A.B.C.O., D.A.C.B.N., M.S., DIANM, CFMP

P.S. If these Clinical Rounds are resonating and you’d like a step-by-step path to practice this level of upstream, terrain-based thinking with support and structure, the next FMU Fellowship cohort is now forming. You can hold your seat with a $150 deposit so you don’t miss the enrollment window. To learn more or reserve your seat, click here.

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