What is a neuropsychological consultation?
Individuals are typically referred for neuropsychological evaluations when they begin experiencing problems with memory, concentration and attention, speech and language function, perception, mood/behavior/personality change, organization/planning/follow-through, changes in independent functioning, apathy, impulsivity, or any other symptom that affects their feeling and acting in their best, usual and normal ways of functioning in their world -- at home, in relationships with others, or at work.
It is typical for referring doctors (and patients) to seek neuropsychological consulations and examinations to better understand whether difficulties or changes in functioning have to do with normal aging, the side effects of medication, the effects of a sleep disorder or pain condition, the effects of some other medical or neurological condition that requires treatment or intervention, the effects of life stressors, or a combination of these factors.
A good neuropsychologist not only documents a person's current level of cognitive function, but also will offer diagnostic impressions as well as treatment recommendations and sometimes intervention, to improve both a person's cognitive function but also overall quality of life.
It is typical for referring doctors (and patients) to seek neuropsychological consulations and examinations to better understand whether difficulties or changes in functioning have to do with normal aging, the side effects of medication, the effects of a sleep disorder or pain condition, the effects of some other medical or neurological condition that requires treatment or intervention, the effects of life stressors, or a combination of these factors.
A good neuropsychologist not only documents a person's current level of cognitive function, but also will offer diagnostic impressions as well as treatment recommendations and sometimes intervention, to improve both a person's cognitive function but also overall quality of life.
What an exam involves...
Nothing painful or invasive occurs...(We don't poke or prod in this office!)
Dr. Schneiders realizes his patients are struggling with often uncomfortable, worrisome and sometimes even scary and upsetting changes and difficulties, and he practices in such a way as to try to minimize as much as possible, any anxiety, nervousness or other psychological discomfort his patients may feel coming in for, or may experience during formal testing.
While some neuropsychologists prefer to use technicians to examine patients, Dr. Schneiders' training emphasized the personal nature of the doctor-patient relationship and interaction, and he believes that it is not only the scores or numbers resulting from cognitive testing that tell a person's medical tale best and most accurately. (This is not to say that there aren't, of course, some truly excellent psychometrician/technicians practicing.)
A thoughtful and clear understanding of a patient's personal approach, cognitive and personality style, and other individual factors that emerge while working on test materials, also importantly illuminate (and helps him understand) each individual person's particular concerns and unique set of issues. For that reason, Dr. Schneiders administers all procedures and instruments with his patients himself personally.
While Dr. Schneiders employs a rigorous, evidence-based, scientific neuropsychological analysis to the data he obtains, he approaches each evaluation not so much as a "testing", but rather as a clinical opportunity to explore different areas of a person's brain and behavioral function in some depth -- and he feels strongly that strengths and capabilities are as important to understand and to assess, as are problems and impairments, even when the latter exist.
Because Dr. Schneiders himself personally administers all procedures and instruments (as opposed to using a technician to do so), he can often perform briefer examinations, and make tailored adjustments along the way in the number and kind of instruments he employs to understand a person's difficulties.
It is frequently possible to complete an assessment in half a day's time, though all patients should be aware that this is not always the case, and sometimes assessments require more time than that, or even another additional meeting.
REPORTS
After your evaluation/"testing" session with Dr. Schneiders, he will analyze your test data using both computer-based and other clinical methods for diagnostic purposes, and to try to assist you with any difficulties in your functioning, your treatment and your care. This process of analysis (and writing it into complex reports that may be as long as 10-15 pages at times, as they must integrate all the various, and often many, neurologic, medical, psychological/personality/stress, medication and substance use factors that can cause or contribute to cognitive and/or neurobehavioral problems), typically takes hours following the testing session visit.
Some neuropsychologists use a predominantly test score/"numbers-based" approach to case analysis. While Dr. Schneiders practices rigorously evidence-based scientific neuropsychology, and looks carefully and hard at test data in traditional ways, his training and years of experience with difficult cases lead him to believe that people -- and the problems their brains may be experiencing -- are usually far more complex than a quick or simple matter of reporting (or even interpreting) test scores alone and predominantly can fully account for.
Our office realizes you want your report and findings as quickly as possible, and while we will strive to get your final report out as quickly as we can, we are committed to looking at each and every patient and his or her problems in the greatest possible depth and detail. A rapid report, even when it is a long one, is not always the most accurate or helpful kind, particularly if your problems are complex and complicated, and have to this date left your other doctors somewhat unclear or unsure about what is going on given your symptoms, or how best to proceed in your case.
That is in large part why Dr. Schneiders himself performs the entire examination and evaluation personally with you (rather than having you seen for most of it by a psychometric technician). While a technician-based approach certainly permits many more individuals to be evaluated in a doctor's practice on any given day or at a given time, again, Dr. Schneiders was trained to understand that neuropsychological analysis involves subtleties and nuances that cannot always be captured adequately by primary reliance on simple test scores.
Because Dr. Schneiders is evaluating several people a week in this comprehensive way, please don't expect a full formal written report to be finalized for roughly 3-4 weeks following your testing session. (That means you generally don't pre-schedule your follow-up appointment with the doctor who referred you to Dr. Schneiders within that time frame, unless it is for other necessary medical or psychological care and does not require the formal report to be completed by the earlier date of that visit.) We are told by patients that many other neuropsychologists are scheduling 6-12 months out; in order to accommodate people who cannot wait that long, our office has added a number of weekly appointment times to get people in earlier. In order to do so, however, we have had to extend the time in which typical reports are completed to closer to 4 weeks after testing, than our previous 2-3 week time frame.
Finally, it is Dr. Schneiders' practice to provide you with a copy of his report, and to offer a follow-up appointment to review your results and findings (that may include your spouse, partner, family or any other significant person in your life you may wish). Again, our office will do everything possible to get you in for this review session as quickly as possible, but unless there is an unexpected urgent need, a few weeks are often necessary to coordinate very busy (and sometimes 'dueling') schedules.
We take getting reports out to you and your doctor(s) very seriously indeed, and Dr. Schneiders is continuously working to generate these for his patients throughout each week. Please let him and/or Laura know at the earliest possible opportunity should there ever be a need for a "rushed" report -- while all such requests cannot realistically be met, we will always do our very best to be as helpful in this regard as possible in specific situations.
DIET, DEMENTIA AND COGNITIVE HEALTH
Recently, a number of patients have asked me whether there are any dietary changes they might make to improve their cognitive health, or even to lessen their dementia risk and their risk of cognitive decline with aging.
I always begin by informing them I am not formally trained in either nutritional studies or in medicine (though most physicians have zero or next to zero training in nutrition per se during their medical training). I do, however, try to keep myself familiarized with the scientific literature on this topic as well as I can coming from a different specialty. I always counsel people to check with their own medical doctors about any unusual or special dietary issues or needs they may have (there typically are few to none) but after that, I do think that research is burgeoning around certain particular dietary guidelines for better health, including brain health, that involve shifting to a plant-based (that is, no animal products consumed) diet.
However, having said that (and offering what follows), I must say clearly that no diet or dietary regimen has yet been scientifically, conclusively shown fully to prevent, or treat and cure dementia (except, perhaps, B12 supplementation for the reversible severe B12 deficiency cognitive syndrome). But can diet significantly improve your brain health, making it more resilient and robust in the face of the adverse effects of aging, and in regard to dementia risk? That's a different question, and one I think a great deal of research appears to be converging in consensus about...
In recent years, a fair amount of research (to my reading of it, anyway), has begun increasingly to, and solidly to show that movement away from a diet comprised of saturated fats, meats, dairy and eggs, and toward a plant-based diet, not only demonstrably and significantly improves cardiovascular health (i.e., reduces the risk of heart attack and stroke, and frequently lowers serum cholesterol, sometimes dramatically), but also appears to positively influence brain health. I have appended a number of article abstracts from PubMed below for those wishing to review some of that literature themselves -- enormously more studies than the ones I have listed exist, of course.
People are often surprised (I know I was) to find that plants of various sorts are wonderful sources rich in dietary protein as well as calcium, and to discover that countless people (including infants raised under such dietary conditions) positively thrive without animal fats, animal protein or calcium from dairy intake in their diets, with often extremely significant secondary weight loss (if it is desired and needed) that has seemed impossible for them to manage to obtain otherwise, no matter which "fad" diet the person has tried before.
The medical literature (reflected in the selection below) is beginning to suggest that it may well be possible to improve cognitive function, and -- the evidence is still out for certain, but does appear suggestive to date -- perhaps to delay the onset of, and even reduce the risk of acquiring, a dementing disease like Alzheimer's, in part by changing one's diet from the "typical" American diet, to a predominantly plant-based (again: no animal products) diet. The "Mediterranean" Diet has been studied far more frequently to date than an entirely plant-based diet has been so far, but recent studies suggest fairly clearly that a fully plant-based or vegan diet is significantly more beneficial to overall health than the MD*.
Recently, the American Hospital Association has recommended all hospitals move toward plant-based dietary alternatives:
“RESOLVED, That our American Medical Association hereby call on US hospitals to improve the health of patients, staff, and visitors by (1) providing a variety of healthful food, including plant-based meals and meals that are low in fat, sodium, and added sugars, (2) eliminating processed meats from menus, and (3) providing and promoting healthful beverages.”
The Physicians Committee—a nonprofit of 12,000 doctors—commends the AMA on its leadership in improving hospital food environments. Numerous scientific studies show that healthful, plant-based meals can prevent and even reverse heart disease, diabetes and obesity. The AMA’s second recommendation, to remove processed meat from menus, is also supported by strong scientific evidence. The World Health Organization warns that processed meats, including hot dogs, and bacon, are “carcinogenic to humans” and there is no amount safe for consumption.
“Hospitals that provide and promote fruits, vegetables, whole grains, and beans are likely to reduce readmissions, speed recovery times, and measurably improve the long-term health of visitors, patients, and staff,” says James Loomis, M.D., M.B.A., medical director of the Barnard Medical Center.
The major dietary and nutrition organizations in America and elsewhere have also endorsed a plant-based diet in strong terms. As an example:
Position of the Academy of Nutrition and Dietetics: Vegetarian Diets.Melina V, et al. J Acad Nutr Diet. 2016.
Melina V1, Craig W2, Levin S3.J Acad Nutr Diet. 2016 Dec;116(12):1970-1980. doi: 10.1016/j.jand.2016.09.025.
'It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that produce lower total and low-density lipoprotein cholesterol levels and better serum glucose control. These factors contribute to reduction of chronic disease. Vegans need reliable sources of vitamin B-12, such as fortified foods or supplements.'
In Canada, it was just recently announced that proposed dietary guidelines for the entire country may end up going so far as deleting dairy as a recommended food group altogether, and may substitute plant-based foods as one of the primary preferred dietary food groups.
And Kaiser Permanente now recommends a plant-based diet be advocated on the part of their physicians and health-care providers for all Kaiser patients (https://www.azumio.com/blog/nutrition/kaiser-permanente-recommends-a-plant-based-diet). In their Spring 2013 Journal, America’s largest managed care company and hospital system has taken a bold stand on the superiority of plant-based nutrition to promote health:
“Physicians should consider recommending a plant-based diet to all their patients…encouraging whole, plant-based foods and discouraging meats, dairy products, and eggs as well as all refined and processed foods.”
Recent research published in Neurology (the pre-eminent journal for Neurology) reported the following [adapted from Medscape review]:
For the first time, dietary flavonols, which are components of many fruits, vegetables, and tea, have been linked to a significantly lower risk of developing Alzheimer disease (AD). However, some experts are calling for healthy skepticism when interpreting the findings.
Kaempferol, isorhamnetin, and myricetin may not be household names, but investigators at Rush University Medical Center in Chicago, Illinois, found that for those who reported diets highest in these flavonols, the rate of incident AD was 48% lower than that of their counterparts who consumed the lowest levels of these dietary compounds.
Kale, beans, spinach, apples, olive oil, and tomato sauce are among the sources richest of these flavonols.
"Eat your fruits and vegetables, particularly dark leafy greens, and drink some tea every now and again. A healthy diet that contains various fruits and vegetables is critical for continued health, especially brain health," study investigator Thomas M. Holland, MD, Rush Institute for Healthy Aging, told Medscape Medical News.
A number of flavonoid classes, including flavonols, are known to have antioxidant and anti-inflammatory properties.
Kale, beans, tea, spinach, and broccoli were the top food sources for kaempferol. Tea, wine, kale, oranges, and tomatoes led the list for myricetin. Pears, olive oil, wine, and tomato sauce were associated with the highest intake of isorhamnetin. Top sources of quercetin included tomatoes, kale, apples, and tea.
"However, this list is not exhaustive," Holland said. Total flavonol sources include more than 30 various fruits, vegetables, and beverages such as tea that contribute to the beneficial association with risk for AD dementia, he added.
"In our study, due to its overall consumption, black teas' flavonoid profile was used. Nevertheless, green tea also has a robust flavonol concentration," he said.
The investigators ran a series of adjustments to rule out other potential contributors to their findings.
The current findings build on a previous study, also conducted by Rush University investigators, that linked kaempferol in leafy green vegetables to a slower rate of cognitive decline, as previously reported by Medscape Medical News.
For example, they found that intake of vitamin E, saturated fat, folate, leutin, and omega-3 fatty acids did not materially change AD risk estimates.
The above study was published online January 29 in Neurology.
While there are many other excellent reasons to switch to a plant-based diet these days (including diminishing the all-too-frightening and emerging global effects of climate change and global warming, increasing the sustainability of our dwindling planetary resources, and of course, diminishing dramatically the terrible suffering of animals in all aspects of the food-based industry [particularly dairy, but also meat and fish 'farming']), improving brain and cardiovascular health, and reducing the risks of developing various serious medical disorders and diseases, appear to be among the most serious and important of reasons to consider making a shift to plant-based eating.
The one thing those of us who have made the complete shift to plant-based diet need to keep in mind, is the need to stay on top of our vitamin B12 levels. Most people who move to an entirely plant-based diet should take a daily B12 supplement (easy to do, of course), and should have their B12 and sometimes a test called an MMA done about once a year (or more often, if their physician recommends that). Otherwise, plant-based diets provide what almost all of us need -- more than enough protein, calcium, etc. -- across the board.
While many people fear that a plant-based or 'vegan' diet means they will be consigned to eating boring, repetitive meals of plain vegetables and nothing else, nothing could be farther from the truth...
On a plant based diet, you can eat your fill of pasta, pizza, mac and cheese, and all sorts of plant-based burgers, tacos, sausage, cold cuts, cakes, meatballs, donuts, ice cream, yoghurt, cheese, potato chips, and on and on. [Of course, a truly healthy diet means very much limiting processed foods and foods high in sugar and simple carbohydrates, particularly if you have a medical condition or risk for one such as diabetes, hypertension, high cholesterol, cancer, liver disease, etc.] My point here is that a plant-based diet not only can and should improve your health, perhaps considerably, but also need not keep you from enjoying [one hopes in a reasonable manner!] your favorite types of snacks and the many enjoyable kinds of food you do now.
And if you think a plant-based diet lacks sufficient protein or calcium necessary for keeping your strength up and for maintaining optimal, robust health, just go to Netflix and watch the new documentary "Game Changers" -- if you do, prepare to be not only informed, but also very likely amazed (and at the same time entertained). Many other superb documentaries are available that discuss plant-based eating and living, coming to this issue from different directions.
The number of plant-based products now available to substitute for meat and dairy-based ones is astonishing, and the taste difference (depending on a person's personal preferences, of course) can now be un-detectable.
In my own experience, the following are some of the most delicious and easy-to-substitute options when making first steps in such a dietary health shift. (Your own taste preferences may be different from mine, so should you decide to experiment with a plant-based diet, or to move in that direction, certainly plan to experiment among options within each area yourself.)
Butter: EarthBalance 'butter' and/or Miyoko's are simply wonderful. (They have shortening sticks for baking, if
desired, as well.)
Mayonaise: Hampton Creek Mayonaise, JustMayo, and Veganaise brands are excellent to my taste.
(Garlic, Chipotle, Regular, and many other flavors available.)
Salad Dressing: Hampton Creek varieties, Follow Your Heart varieties (Blue Cheese, Caesar, Ranch, Thousand
Island, Creamy Garlic, 'Honey' Mustard, Miso), Daiya brands, and many other delicious choices
are readily found in King Soopers and Safeway and Sprouts.
Cheese: Chao cheese; Dayia Cheese; Follow Your Heart Cheese. (Many delicious, specialty artisanal/flavored cheeses like vegan Brie, burgundy-infused Camembert, etc., are also available from specialty stores such as Nooch.) "Follow Your Heart" shredded "parmesan" and feta are superb, and you can also now get vegan Ricotta at places like Sprouts.
Cream Cheese: Tofutti brand, Trader Joe's cream cheese, Daiya, Kite Hill and other brands are plentiful, including Follow Your Heart, some with berries, with onion, and with even Miyoko's vegan cream cheese with 'lox' are available.
Sour Cream: Tofutti Sour Cream (identical in flavor and texture to dairy-based); Follow Your Heart brand and
several other brands are available as well.
Ice Cream & Yoghurt: Countless varieties of delicious flavors, including a number offered by Ben and Jerry and by Hagen Daz. Usually several vegan flavors are available fresh at better ice cream parlors, such as Sweet Action on Broadway or Bonnie Brae Ice Cream Parlour, if you ask.
Meat alternatives: Gardein products include delicious hamburgers, "turkey" cutlets, "chicken", "beef", "meatloaf", "pork" and bbq, as well as battered "fish" filets -- all extremely tasty, and made without any animal products (and suffering) at all. Specialty stores (and now even King Soopers) have plant-based "crab" cakes, "fish", and other kinds of meat alternatives made by Gardein, Boca and many other companies. "Beyond Meat" and Impossible Burgers make superb hamburgers and sausage (again, without meat, though you probably won't believe it when you taste them), and now King Soopers and Safeway carry many plant-based hamburgers, sausages, etc. which can be found in the meat area. You can get also several brands of "meatballs", link sausage, many kinds of pizza, and vegan 'bacon' (I like both LiteLife 'bacon' and BenevolentBacon though there are many other brands -- again, all animal/cruelty-free and delicious). Veggie burgers of an enormous number of types (that are not made to mimic hamburger, but are delicious in their own right) are available everywhere now.
The Herbiferous Butcher (online) ships made-to-order 'ribs', 'steaks', 'pastrami', 'turkey' that are absolutely delicious. There are a number of other excellent online vegan "butchers" and companies that ship pre-made vegan meals out (check out Veestro).
Egg substitutes: I was amazed (and pleased) to find that eggs are not necessary for almost any kind of cooking and baking -- Google "egg substitutes" for yourself to see the many different alternatives and uses… JustEgg is now available and makes wonderful omelettes and scrambled eggs. VegEgg is another product that makes scrambled "eggs" and omelettes, that to my tastebuds at least, are indistinguishable from chicken's egg products. Again, without any animal-based cholesterol, fat or ingredients whatsoever.
Milk substitutes and coffee creamers: Almost everyone has seen the wide variety of non-dairy milks now available: an enormous number of different brands of soy, almond, coconut, oat (and yes, even pea or flax) based alternatives exist, and the number of taste choices seems to increase by the week. I personally prefer the unsweetened Chobani Creamy Oat Milk or OATLY Oat Milk myself, which to someone who in the past enjoyed cow's milk, tastes virtually the same but absent cruelty and beneficial to our planet (and I don't get any kickback from the companies for saying that…). The different brands and types all taste a little different from each other, and come in sweetened or unsweetened, regular, chocolate, barista style coffee-creamer (many flavors), as well as espresso and latte-based drinks, so it's important to try a few and find your own favorite over time.
Where to get these products? While places like Whole Foods, Sprouts or GNC may have the largest selection across types and kinds of plant based alternatives and while the most unusual and interesting of specialty-based products will be found in small stores like Nooch (on Ellsworth, just east off Broadway in Denver) or sometimes online, King Soopers, Safeway, and Target and Trader Joes all have good-sized plant-based selections, especially in the larger stores.
And if you want to dine out on a plant-based diet? Try the amazing number of breakfast and lunch selections at City O' City downtown, dinner at Watercourse restaurant on 17th Avenue, gourmet meals at Leaf restaurant in Boulder, or the many plant-based gourmet options at places like Root Down (with its romantic view of the City from the Highlands), and the incredible bakeries like Make Believe Bakery next to City O' City (try their incredible HoHos) or the many kinds of amazing vegan donuts at Denver's Zombie Donuts, or the spectacular selection of cakes, donuts, muffins, cookies and tarts at Beet Box Cafe, which also truly makes among the most delicious lunches in town.
There are always two changing and delicious plant-based ice cream options at Sweet Action (on Broadway), and many pizza parlors now offer plant-based cheese on their regular pizzas. Most good restaurants offer plant-based options now, and I've had friends tell me they envied my meals over theirs at Elway's (call ahead!), and on airplanes, too. New vegan restaurants and restaurant offerings abound and seem to open all the time around the Denver area (and beyond).
I should probably also mention that plant-based burgers and breakfast sausages are also now available at fast food places such as Carl's Jr., Burger King, Dunkin' Donuts, White Castle, at DIA terminal restaurants, and a very large number of other fast food (and other) restaurants. (These are sometimes called "Beyond Burger" or "Impossible Burger"). Del Taco even sells a vegan taco made with Beyond Meat "beef".
Virtually every major airport in America have restaurants that offer vegan meals now, as well, so brain and heart-healthy, plant-based, (and yes, cruelty-free) eating is easy when traveling these days, too.
I will update this section of the website as scientific/medical/nutritional/neurologic evidence becomes available for patients who are interested in making the shift over to plant-based eating options. Again, speak to your own doctor if you have special medical needs, doubts or concerns.
Here are some articles you may want to look over as a start -- searching PubMed is virtually always a better place to look for a scientific perspective on such matters, than a general Google, Bing or Yelp search:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327363/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956662/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315380/
https://www.ncbi.nlm.nih.gov/pubmed/11516224
https://www.ncbi.nlm.nih.gov/pubmed/27787891
https://www.ncbi.nlm.nih.gov/pubmed/28035345
https://www.ncbi.nlm.nih.gov/pubmed/28456717
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485368/
https://www.ncbi.nlm.nih.gov/pubmed/8327020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437154/
https://www.ncbi.nlm.nih.gov/pubmed/27355990
https://www.ncbi.nlm.nih.gov/pubmed/28655926
https://www.ncbi.nlm.nih.gov/pubmed/28440854
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662288/
https://www.ncbi.nlm.nih.gov/pubmed/26976087
https://www.ncbi.nlm.nih.gov/pubmed/27633105
https://www.ncbi.nlm.nih.gov/pubmed/27645350
http://www.medicalnewstoday.com/releases/271681.php
https://www.ncbi.nlm.nih.gov/pubmed/28710144
http://www.mdpi.com/2072-6643/9/7/674
https://www.ncbi.nlm.nih.gov/pubmed/27890688
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967195/
https://www.ncbi.nlm.nih.gov/pubmed/28710142
http://content.iospress.com/articles/journal-of-alzheimers-disease/jad130179
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410624/
https://www.ncbi.nlm.nih.gov/pubmed/28697569
https://www.azumio.com/blog/nutrition/kaiser-permanente-recommends-a-plant-based-diet
Dr. Schneiders realizes his patients are struggling with often uncomfortable, worrisome and sometimes even scary and upsetting changes and difficulties, and he practices in such a way as to try to minimize as much as possible, any anxiety, nervousness or other psychological discomfort his patients may feel coming in for, or may experience during formal testing.
While some neuropsychologists prefer to use technicians to examine patients, Dr. Schneiders' training emphasized the personal nature of the doctor-patient relationship and interaction, and he believes that it is not only the scores or numbers resulting from cognitive testing that tell a person's medical tale best and most accurately. (This is not to say that there aren't, of course, some truly excellent psychometrician/technicians practicing.)
A thoughtful and clear understanding of a patient's personal approach, cognitive and personality style, and other individual factors that emerge while working on test materials, also importantly illuminate (and helps him understand) each individual person's particular concerns and unique set of issues. For that reason, Dr. Schneiders administers all procedures and instruments with his patients himself personally.
While Dr. Schneiders employs a rigorous, evidence-based, scientific neuropsychological analysis to the data he obtains, he approaches each evaluation not so much as a "testing", but rather as a clinical opportunity to explore different areas of a person's brain and behavioral function in some depth -- and he feels strongly that strengths and capabilities are as important to understand and to assess, as are problems and impairments, even when the latter exist.
Because Dr. Schneiders himself personally administers all procedures and instruments (as opposed to using a technician to do so), he can often perform briefer examinations, and make tailored adjustments along the way in the number and kind of instruments he employs to understand a person's difficulties.
It is frequently possible to complete an assessment in half a day's time, though all patients should be aware that this is not always the case, and sometimes assessments require more time than that, or even another additional meeting.
REPORTS
After your evaluation/"testing" session with Dr. Schneiders, he will analyze your test data using both computer-based and other clinical methods for diagnostic purposes, and to try to assist you with any difficulties in your functioning, your treatment and your care. This process of analysis (and writing it into complex reports that may be as long as 10-15 pages at times, as they must integrate all the various, and often many, neurologic, medical, psychological/personality/stress, medication and substance use factors that can cause or contribute to cognitive and/or neurobehavioral problems), typically takes hours following the testing session visit.
Some neuropsychologists use a predominantly test score/"numbers-based" approach to case analysis. While Dr. Schneiders practices rigorously evidence-based scientific neuropsychology, and looks carefully and hard at test data in traditional ways, his training and years of experience with difficult cases lead him to believe that people -- and the problems their brains may be experiencing -- are usually far more complex than a quick or simple matter of reporting (or even interpreting) test scores alone and predominantly can fully account for.
Our office realizes you want your report and findings as quickly as possible, and while we will strive to get your final report out as quickly as we can, we are committed to looking at each and every patient and his or her problems in the greatest possible depth and detail. A rapid report, even when it is a long one, is not always the most accurate or helpful kind, particularly if your problems are complex and complicated, and have to this date left your other doctors somewhat unclear or unsure about what is going on given your symptoms, or how best to proceed in your case.
That is in large part why Dr. Schneiders himself performs the entire examination and evaluation personally with you (rather than having you seen for most of it by a psychometric technician). While a technician-based approach certainly permits many more individuals to be evaluated in a doctor's practice on any given day or at a given time, again, Dr. Schneiders was trained to understand that neuropsychological analysis involves subtleties and nuances that cannot always be captured adequately by primary reliance on simple test scores.
Because Dr. Schneiders is evaluating several people a week in this comprehensive way, please don't expect a full formal written report to be finalized for roughly 3-4 weeks following your testing session. (That means you generally don't pre-schedule your follow-up appointment with the doctor who referred you to Dr. Schneiders within that time frame, unless it is for other necessary medical or psychological care and does not require the formal report to be completed by the earlier date of that visit.) We are told by patients that many other neuropsychologists are scheduling 6-12 months out; in order to accommodate people who cannot wait that long, our office has added a number of weekly appointment times to get people in earlier. In order to do so, however, we have had to extend the time in which typical reports are completed to closer to 4 weeks after testing, than our previous 2-3 week time frame.
Finally, it is Dr. Schneiders' practice to provide you with a copy of his report, and to offer a follow-up appointment to review your results and findings (that may include your spouse, partner, family or any other significant person in your life you may wish). Again, our office will do everything possible to get you in for this review session as quickly as possible, but unless there is an unexpected urgent need, a few weeks are often necessary to coordinate very busy (and sometimes 'dueling') schedules.
We take getting reports out to you and your doctor(s) very seriously indeed, and Dr. Schneiders is continuously working to generate these for his patients throughout each week. Please let him and/or Laura know at the earliest possible opportunity should there ever be a need for a "rushed" report -- while all such requests cannot realistically be met, we will always do our very best to be as helpful in this regard as possible in specific situations.
DIET, DEMENTIA AND COGNITIVE HEALTH
Recently, a number of patients have asked me whether there are any dietary changes they might make to improve their cognitive health, or even to lessen their dementia risk and their risk of cognitive decline with aging.
I always begin by informing them I am not formally trained in either nutritional studies or in medicine (though most physicians have zero or next to zero training in nutrition per se during their medical training). I do, however, try to keep myself familiarized with the scientific literature on this topic as well as I can coming from a different specialty. I always counsel people to check with their own medical doctors about any unusual or special dietary issues or needs they may have (there typically are few to none) but after that, I do think that research is burgeoning around certain particular dietary guidelines for better health, including brain health, that involve shifting to a plant-based (that is, no animal products consumed) diet.
However, having said that (and offering what follows), I must say clearly that no diet or dietary regimen has yet been scientifically, conclusively shown fully to prevent, or treat and cure dementia (except, perhaps, B12 supplementation for the reversible severe B12 deficiency cognitive syndrome). But can diet significantly improve your brain health, making it more resilient and robust in the face of the adverse effects of aging, and in regard to dementia risk? That's a different question, and one I think a great deal of research appears to be converging in consensus about...
In recent years, a fair amount of research (to my reading of it, anyway), has begun increasingly to, and solidly to show that movement away from a diet comprised of saturated fats, meats, dairy and eggs, and toward a plant-based diet, not only demonstrably and significantly improves cardiovascular health (i.e., reduces the risk of heart attack and stroke, and frequently lowers serum cholesterol, sometimes dramatically), but also appears to positively influence brain health. I have appended a number of article abstracts from PubMed below for those wishing to review some of that literature themselves -- enormously more studies than the ones I have listed exist, of course.
People are often surprised (I know I was) to find that plants of various sorts are wonderful sources rich in dietary protein as well as calcium, and to discover that countless people (including infants raised under such dietary conditions) positively thrive without animal fats, animal protein or calcium from dairy intake in their diets, with often extremely significant secondary weight loss (if it is desired and needed) that has seemed impossible for them to manage to obtain otherwise, no matter which "fad" diet the person has tried before.
The medical literature (reflected in the selection below) is beginning to suggest that it may well be possible to improve cognitive function, and -- the evidence is still out for certain, but does appear suggestive to date -- perhaps to delay the onset of, and even reduce the risk of acquiring, a dementing disease like Alzheimer's, in part by changing one's diet from the "typical" American diet, to a predominantly plant-based (again: no animal products) diet. The "Mediterranean" Diet has been studied far more frequently to date than an entirely plant-based diet has been so far, but recent studies suggest fairly clearly that a fully plant-based or vegan diet is significantly more beneficial to overall health than the MD*.
Recently, the American Hospital Association has recommended all hospitals move toward plant-based dietary alternatives:
“RESOLVED, That our American Medical Association hereby call on US hospitals to improve the health of patients, staff, and visitors by (1) providing a variety of healthful food, including plant-based meals and meals that are low in fat, sodium, and added sugars, (2) eliminating processed meats from menus, and (3) providing and promoting healthful beverages.”
The Physicians Committee—a nonprofit of 12,000 doctors—commends the AMA on its leadership in improving hospital food environments. Numerous scientific studies show that healthful, plant-based meals can prevent and even reverse heart disease, diabetes and obesity. The AMA’s second recommendation, to remove processed meat from menus, is also supported by strong scientific evidence. The World Health Organization warns that processed meats, including hot dogs, and bacon, are “carcinogenic to humans” and there is no amount safe for consumption.
“Hospitals that provide and promote fruits, vegetables, whole grains, and beans are likely to reduce readmissions, speed recovery times, and measurably improve the long-term health of visitors, patients, and staff,” says James Loomis, M.D., M.B.A., medical director of the Barnard Medical Center.
The major dietary and nutrition organizations in America and elsewhere have also endorsed a plant-based diet in strong terms. As an example:
Position of the Academy of Nutrition and Dietetics: Vegetarian Diets.Melina V, et al. J Acad Nutr Diet. 2016.
Melina V1, Craig W2, Levin S3.J Acad Nutr Diet. 2016 Dec;116(12):1970-1980. doi: 10.1016/j.jand.2016.09.025.
'It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes. Plant-based diets are more environmentally sustainable than diets rich in animal products because they use fewer natural resources and are associated with much less environmental damage. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity. Low intake of saturated fat and high intakes of vegetables, fruits, whole grains, legumes, soy products, nuts, and seeds (all rich in fiber and phytochemicals) are characteristics of vegetarian and vegan diets that produce lower total and low-density lipoprotein cholesterol levels and better serum glucose control. These factors contribute to reduction of chronic disease. Vegans need reliable sources of vitamin B-12, such as fortified foods or supplements.'
In Canada, it was just recently announced that proposed dietary guidelines for the entire country may end up going so far as deleting dairy as a recommended food group altogether, and may substitute plant-based foods as one of the primary preferred dietary food groups.
And Kaiser Permanente now recommends a plant-based diet be advocated on the part of their physicians and health-care providers for all Kaiser patients (https://www.azumio.com/blog/nutrition/kaiser-permanente-recommends-a-plant-based-diet). In their Spring 2013 Journal, America’s largest managed care company and hospital system has taken a bold stand on the superiority of plant-based nutrition to promote health:
“Physicians should consider recommending a plant-based diet to all their patients…encouraging whole, plant-based foods and discouraging meats, dairy products, and eggs as well as all refined and processed foods.”
Recent research published in Neurology (the pre-eminent journal for Neurology) reported the following [adapted from Medscape review]:
For the first time, dietary flavonols, which are components of many fruits, vegetables, and tea, have been linked to a significantly lower risk of developing Alzheimer disease (AD). However, some experts are calling for healthy skepticism when interpreting the findings.
Kaempferol, isorhamnetin, and myricetin may not be household names, but investigators at Rush University Medical Center in Chicago, Illinois, found that for those who reported diets highest in these flavonols, the rate of incident AD was 48% lower than that of their counterparts who consumed the lowest levels of these dietary compounds.
Kale, beans, spinach, apples, olive oil, and tomato sauce are among the sources richest of these flavonols.
"Eat your fruits and vegetables, particularly dark leafy greens, and drink some tea every now and again. A healthy diet that contains various fruits and vegetables is critical for continued health, especially brain health," study investigator Thomas M. Holland, MD, Rush Institute for Healthy Aging, told Medscape Medical News.
A number of flavonoid classes, including flavonols, are known to have antioxidant and anti-inflammatory properties.
Kale, beans, tea, spinach, and broccoli were the top food sources for kaempferol. Tea, wine, kale, oranges, and tomatoes led the list for myricetin. Pears, olive oil, wine, and tomato sauce were associated with the highest intake of isorhamnetin. Top sources of quercetin included tomatoes, kale, apples, and tea.
"However, this list is not exhaustive," Holland said. Total flavonol sources include more than 30 various fruits, vegetables, and beverages such as tea that contribute to the beneficial association with risk for AD dementia, he added.
"In our study, due to its overall consumption, black teas' flavonoid profile was used. Nevertheless, green tea also has a robust flavonol concentration," he said.
The investigators ran a series of adjustments to rule out other potential contributors to their findings.
The current findings build on a previous study, also conducted by Rush University investigators, that linked kaempferol in leafy green vegetables to a slower rate of cognitive decline, as previously reported by Medscape Medical News.
For example, they found that intake of vitamin E, saturated fat, folate, leutin, and omega-3 fatty acids did not materially change AD risk estimates.
The above study was published online January 29 in Neurology.
While there are many other excellent reasons to switch to a plant-based diet these days (including diminishing the all-too-frightening and emerging global effects of climate change and global warming, increasing the sustainability of our dwindling planetary resources, and of course, diminishing dramatically the terrible suffering of animals in all aspects of the food-based industry [particularly dairy, but also meat and fish 'farming']), improving brain and cardiovascular health, and reducing the risks of developing various serious medical disorders and diseases, appear to be among the most serious and important of reasons to consider making a shift to plant-based eating.
The one thing those of us who have made the complete shift to plant-based diet need to keep in mind, is the need to stay on top of our vitamin B12 levels. Most people who move to an entirely plant-based diet should take a daily B12 supplement (easy to do, of course), and should have their B12 and sometimes a test called an MMA done about once a year (or more often, if their physician recommends that). Otherwise, plant-based diets provide what almost all of us need -- more than enough protein, calcium, etc. -- across the board.
While many people fear that a plant-based or 'vegan' diet means they will be consigned to eating boring, repetitive meals of plain vegetables and nothing else, nothing could be farther from the truth...
On a plant based diet, you can eat your fill of pasta, pizza, mac and cheese, and all sorts of plant-based burgers, tacos, sausage, cold cuts, cakes, meatballs, donuts, ice cream, yoghurt, cheese, potato chips, and on and on. [Of course, a truly healthy diet means very much limiting processed foods and foods high in sugar and simple carbohydrates, particularly if you have a medical condition or risk for one such as diabetes, hypertension, high cholesterol, cancer, liver disease, etc.] My point here is that a plant-based diet not only can and should improve your health, perhaps considerably, but also need not keep you from enjoying [one hopes in a reasonable manner!] your favorite types of snacks and the many enjoyable kinds of food you do now.
And if you think a plant-based diet lacks sufficient protein or calcium necessary for keeping your strength up and for maintaining optimal, robust health, just go to Netflix and watch the new documentary "Game Changers" -- if you do, prepare to be not only informed, but also very likely amazed (and at the same time entertained). Many other superb documentaries are available that discuss plant-based eating and living, coming to this issue from different directions.
The number of plant-based products now available to substitute for meat and dairy-based ones is astonishing, and the taste difference (depending on a person's personal preferences, of course) can now be un-detectable.
In my own experience, the following are some of the most delicious and easy-to-substitute options when making first steps in such a dietary health shift. (Your own taste preferences may be different from mine, so should you decide to experiment with a plant-based diet, or to move in that direction, certainly plan to experiment among options within each area yourself.)
Butter: EarthBalance 'butter' and/or Miyoko's are simply wonderful. (They have shortening sticks for baking, if
desired, as well.)
Mayonaise: Hampton Creek Mayonaise, JustMayo, and Veganaise brands are excellent to my taste.
(Garlic, Chipotle, Regular, and many other flavors available.)
Salad Dressing: Hampton Creek varieties, Follow Your Heart varieties (Blue Cheese, Caesar, Ranch, Thousand
Island, Creamy Garlic, 'Honey' Mustard, Miso), Daiya brands, and many other delicious choices
are readily found in King Soopers and Safeway and Sprouts.
Cheese: Chao cheese; Dayia Cheese; Follow Your Heart Cheese. (Many delicious, specialty artisanal/flavored cheeses like vegan Brie, burgundy-infused Camembert, etc., are also available from specialty stores such as Nooch.) "Follow Your Heart" shredded "parmesan" and feta are superb, and you can also now get vegan Ricotta at places like Sprouts.
Cream Cheese: Tofutti brand, Trader Joe's cream cheese, Daiya, Kite Hill and other brands are plentiful, including Follow Your Heart, some with berries, with onion, and with even Miyoko's vegan cream cheese with 'lox' are available.
Sour Cream: Tofutti Sour Cream (identical in flavor and texture to dairy-based); Follow Your Heart brand and
several other brands are available as well.
Ice Cream & Yoghurt: Countless varieties of delicious flavors, including a number offered by Ben and Jerry and by Hagen Daz. Usually several vegan flavors are available fresh at better ice cream parlors, such as Sweet Action on Broadway or Bonnie Brae Ice Cream Parlour, if you ask.
Meat alternatives: Gardein products include delicious hamburgers, "turkey" cutlets, "chicken", "beef", "meatloaf", "pork" and bbq, as well as battered "fish" filets -- all extremely tasty, and made without any animal products (and suffering) at all. Specialty stores (and now even King Soopers) have plant-based "crab" cakes, "fish", and other kinds of meat alternatives made by Gardein, Boca and many other companies. "Beyond Meat" and Impossible Burgers make superb hamburgers and sausage (again, without meat, though you probably won't believe it when you taste them), and now King Soopers and Safeway carry many plant-based hamburgers, sausages, etc. which can be found in the meat area. You can get also several brands of "meatballs", link sausage, many kinds of pizza, and vegan 'bacon' (I like both LiteLife 'bacon' and BenevolentBacon though there are many other brands -- again, all animal/cruelty-free and delicious). Veggie burgers of an enormous number of types (that are not made to mimic hamburger, but are delicious in their own right) are available everywhere now.
The Herbiferous Butcher (online) ships made-to-order 'ribs', 'steaks', 'pastrami', 'turkey' that are absolutely delicious. There are a number of other excellent online vegan "butchers" and companies that ship pre-made vegan meals out (check out Veestro).
Egg substitutes: I was amazed (and pleased) to find that eggs are not necessary for almost any kind of cooking and baking -- Google "egg substitutes" for yourself to see the many different alternatives and uses… JustEgg is now available and makes wonderful omelettes and scrambled eggs. VegEgg is another product that makes scrambled "eggs" and omelettes, that to my tastebuds at least, are indistinguishable from chicken's egg products. Again, without any animal-based cholesterol, fat or ingredients whatsoever.
Milk substitutes and coffee creamers: Almost everyone has seen the wide variety of non-dairy milks now available: an enormous number of different brands of soy, almond, coconut, oat (and yes, even pea or flax) based alternatives exist, and the number of taste choices seems to increase by the week. I personally prefer the unsweetened Chobani Creamy Oat Milk or OATLY Oat Milk myself, which to someone who in the past enjoyed cow's milk, tastes virtually the same but absent cruelty and beneficial to our planet (and I don't get any kickback from the companies for saying that…). The different brands and types all taste a little different from each other, and come in sweetened or unsweetened, regular, chocolate, barista style coffee-creamer (many flavors), as well as espresso and latte-based drinks, so it's important to try a few and find your own favorite over time.
Where to get these products? While places like Whole Foods, Sprouts or GNC may have the largest selection across types and kinds of plant based alternatives and while the most unusual and interesting of specialty-based products will be found in small stores like Nooch (on Ellsworth, just east off Broadway in Denver) or sometimes online, King Soopers, Safeway, and Target and Trader Joes all have good-sized plant-based selections, especially in the larger stores.
And if you want to dine out on a plant-based diet? Try the amazing number of breakfast and lunch selections at City O' City downtown, dinner at Watercourse restaurant on 17th Avenue, gourmet meals at Leaf restaurant in Boulder, or the many plant-based gourmet options at places like Root Down (with its romantic view of the City from the Highlands), and the incredible bakeries like Make Believe Bakery next to City O' City (try their incredible HoHos) or the many kinds of amazing vegan donuts at Denver's Zombie Donuts, or the spectacular selection of cakes, donuts, muffins, cookies and tarts at Beet Box Cafe, which also truly makes among the most delicious lunches in town.
There are always two changing and delicious plant-based ice cream options at Sweet Action (on Broadway), and many pizza parlors now offer plant-based cheese on their regular pizzas. Most good restaurants offer plant-based options now, and I've had friends tell me they envied my meals over theirs at Elway's (call ahead!), and on airplanes, too. New vegan restaurants and restaurant offerings abound and seem to open all the time around the Denver area (and beyond).
I should probably also mention that plant-based burgers and breakfast sausages are also now available at fast food places such as Carl's Jr., Burger King, Dunkin' Donuts, White Castle, at DIA terminal restaurants, and a very large number of other fast food (and other) restaurants. (These are sometimes called "Beyond Burger" or "Impossible Burger"). Del Taco even sells a vegan taco made with Beyond Meat "beef".
Virtually every major airport in America have restaurants that offer vegan meals now, as well, so brain and heart-healthy, plant-based, (and yes, cruelty-free) eating is easy when traveling these days, too.
I will update this section of the website as scientific/medical/nutritional/neurologic evidence becomes available for patients who are interested in making the shift over to plant-based eating options. Again, speak to your own doctor if you have special medical needs, doubts or concerns.
Here are some articles you may want to look over as a start -- searching PubMed is virtually always a better place to look for a scientific perspective on such matters, than a general Google, Bing or Yelp search:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327363/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956662/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315380/
https://www.ncbi.nlm.nih.gov/pubmed/11516224
https://www.ncbi.nlm.nih.gov/pubmed/27787891
https://www.ncbi.nlm.nih.gov/pubmed/28035345
https://www.ncbi.nlm.nih.gov/pubmed/28456717
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485368/
https://www.ncbi.nlm.nih.gov/pubmed/8327020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437154/
https://www.ncbi.nlm.nih.gov/pubmed/27355990
https://www.ncbi.nlm.nih.gov/pubmed/28655926
https://www.ncbi.nlm.nih.gov/pubmed/28440854
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662288/
https://www.ncbi.nlm.nih.gov/pubmed/26976087
https://www.ncbi.nlm.nih.gov/pubmed/27633105
https://www.ncbi.nlm.nih.gov/pubmed/27645350
http://www.medicalnewstoday.com/releases/271681.php
https://www.ncbi.nlm.nih.gov/pubmed/28710144
http://www.mdpi.com/2072-6643/9/7/674
https://www.ncbi.nlm.nih.gov/pubmed/27890688
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967195/
https://www.ncbi.nlm.nih.gov/pubmed/28710142
http://content.iospress.com/articles/journal-of-alzheimers-disease/jad130179
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410624/
https://www.ncbi.nlm.nih.gov/pubmed/28697569
https://www.azumio.com/blog/nutrition/kaiser-permanente-recommends-a-plant-based-diet
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