Overview
What It Is Dr. Heather Sandison’s approach is a personalized, multi-factorial lifestyle and clinical protocol for people with cognitive decline and early Alzheimer’s disease. It builds on Bredesen-style systems medicine: comprehensive assessment of metabolic, infectious, toxic, hormonal, and lifestyle contributors, followed by a plan that typically includes a ketogenic or low-carb diet, exercise, sleep optimization, stress reduction, targeted supplements, and medical management of identified contributors.
How It Works Cognitive decline is treated as the result of multiple interacting imbalances rather than a single pathway. By improving the biological environment (metabolism, inflammation, toxins, hormones, activity, sleep), the protocol aims to support remaining neural networks and create conditions in which adaptive plasticity and better function are more possible. A 2023 pragmatic trial led by Sandison reported cognitive improvements on MoCA and computerized testing over six months.
Conditions - Primary use: objective cognitive impairment and early Alzheimer’s-type cognitive decline. - Note: Evidence includes published pragmatic and related multi-modal trials; larger randomized controlled trials are still limited. This is not an FDA-approved disease-modifying drug therapy. Cost and complexity are significant.
How it is administered
Begins with comprehensive clinical and laboratory assessment (in-clinic or structured remote programs). Follow-up includes dietary and lifestyle coaching, supplements, and medical management of identified contributors. In-person and at-home/coaching formats exist (including Marama residential and home programs).
Conditions connected in the NPA database
The NPA Treatment Database lists this treatment in connection with 1 condition record. A database relationship does not establish effectiveness, safety, or suitability for an individual.
Related questions
These controlled question pages reference this treatment through stored condition relationships.
Symptoms connected in the NPA database
The current record associates this treatment with the following symptom information. This is not a claim that the treatment will improve these symptoms.
Cognition & Memory
- confusion with time/place
- difficulty with familiar tasks
- Memory loss (especially recent events)
- trouble planning or problem-solving
Emotion & Behavior
- apathy
- irritability
- Mood and personality changes
- withdrawal from activities
Sleep & Fatigue
- restlessness at night
- Sleep disturbances
Practical information
Insurance coverage
Labs and some medical visits may be partially covered; much of the program (coaching, supplements, specialized testing) is typically out-of-pocket.
Cost information
Initial evaluation and testing often thousands of dollars; ongoing monthly costs for supplements, coaching, and follow-up vary widely.
Results and outcomes described in the source record
Cognitive changes in published work were assessed over months (e.g., 6-month primary endpoint in the 2023 study).
Side effects and risks
Dietary change side effects (e.g., adaptation to ketogenic eating) possible; supplement and medication effects depend on the individual plan. Medical supervision is important.
Research context in the NPA database
This section reproduces the current database's research summary and detail. Structured citation metadata has not been supplied, so it should not be read as an independently verified literature review.
Research summary
Evidence Level: Emerging What the research shows: Sandison et al. (Journal of Alzheimer’s Disease, 2023) reported improved MoCA and Cambridge Brain Sciences scores over six months in a pragmatic multi-modal intervention. Related Bredesen-protocol research includes small trials and case series. Key takeaway: A comprehensive lifestyle-and-systems approach with encouraging pragmatic trial data and ongoing need for larger RCTs.
Research detail
Overview Dr. Heather Sandison applies a personalized multi-modal protocol (diet, lifestyle, targeted therapeutics) for cognitive decline, with published pragmatic outcomes.
Evidence Base and Published Work • Sandison et al., Journal of Alzheimer’s Disease (2023): pragmatic trial with improved MoCA and CBS cognitive measures at 6 months. • Related multi-modal / Bredesen-protocol publications (including Toups et al. and case series) report cognitive improvements in some participants. • Larger independent randomized trials remain limited.
Outcomes Outcomes most frequently described include improvements on cognitive screening and computerized testing for some participants over months of sustained multi-modal intervention.
Questions to ask a provider
1. Is a multi-modal Sandison/Bredesen-style protocol appropriate for my stage of cognitive decline? 2. What laboratory and cognitive testing is required, and what is the total cost? 3. What dietary, exercise, sleep, and supplement changes will be expected? 4. What cognitive improvements were seen in published pragmatic trials, and over what timeframe? 5. How will this plan be coordinated with my neurologist or primary care physician?
Website and contact information
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