I am often asked by patients: what exactly is precision medicine, and how will it help me? This term is being used more and more in relation to mild cognitive impairment, integrative medicine, and brain health, so it is important to make it clear and practical.
What we mean by precision medicine
At Rezilir, precision medicine is an approach where the clinician uses a patient’s individual biomarkers to create a personalized group of interventions, with the goal of changing meaningful outcomes of the disease within a defined period of time. It is a way of practicing medicine, not a single protocol or supplement plan. We will discuss each of the bolded words further and in more depth.
Approach, not a one-size-fits-all protocol
Precision medicine is an approach, not a fixed protocol. Simple protocols can sometimes help with very specific problems, such as intestinal permeability, but for mild cognitive impairment and overall brain health it is clear that multiple interventions need to be done at the same time to see improvement. This requires significant clinical judgment about which interventions to use, in what sequence, and at what dosage for each individual patient.
Using your individual biomarkers
In our initial assessment, we measure a broad set of individual biomarkers to get a complete picture of your brain and body. These include anatomy, brain networks, genomics, neurodegenerative markers, cognitive performance, personal and partner assessments of symptoms, body composition, metabolic function, micronutrients, hormones, inflammatory markers, vascular health, gut health, microbiome, chronic infections, and environmental toxicants.
Early on, we try to get key markers of disease severity and prognosis, such as neuroimaging, brain network metrics, and cognitive performance, so that we can have a more precise and realistic discussion about your situation. We work with you to get as much of this testing covered by insurance as possible; encouragingly, insurance is now covering much more of this than it did five years ago.
Many popular “annual lab subscription” panels are not designed for brain health and can be more expensive than what is actually needed, so we encourage you to talk with us before signing up for those.
Personalized plan and a group of interventions
We personalize your interventions in two main ways. First, we use your specific biomarkers to decide exactly which interventions are needed; second, we have detailed conversations with you to understand your values, preferences, and capacity for change, while being honest about the level of work required to achieve success.
Our approach almost always involves a group of interventions rather than just one or two. For mild cognitive impairment, the research supports using multiple interventions together, and we organize these into three main categories: life essentials, root causes, and intensive neuromodulatory therapy.
- Life essentials: We help you change activities you are already doing—food, movement and exercise, sleep, brain exercises, stress management, air and water quality, and sense of purpose—so they better support brain health. Our team, including a health coach, dietitian, and physical therapist, plays a critical role here.
- Root causes: We use an integrative and functional approach to address roughly 40 potential contributors to cognitive decline, all of which we assess in the initial biomarker testing. The sequence in which we address these issues matters; while there is limited clinical trial data to dictate the exact order, clinical judgment and experience clearly influence outcomes.
- Intensive neuromodulatory therapy: For patients with more significant atrophy and lower cognitive scores, we may add a more intensive program that includes hyperbaric oxygen therapy at 2 atmospheres, frequent QEEG monitoring, neurofeedback, and photobiomodulation therapy using an Aspen laser.
Outcomes and timeframe
After your initial evaluation, we define a set of custom outcomes that are clinically relevant and personally important to you. These typically include improvement in cognitive performance, changes in specific biomarkers (including neurodegenerative markers), and changes in brain networks measured by QEEG.
From our experience, a 6 month window is a realistic timeframe to see measurable changes in these outcomes. Because the interventions require significant effort, it is psychologically important for you and your family to see positive change around this milestone. Published research shows that many patients can notice improvements within 2–3 months, but some root-cause interventions will take longer to fully express their benefits.
If you are interested in a concrete example of how this looks in real life, we invite you to read our preprint describing a patient with corticobasal syndrome treated with this precision medicine approach.
