The Evidence Behind Cognitive Stewardship Care
Evidence-aligned brain health for families who won't wait for decline
A new era in brain health has arrived. For the first time in history, we can detect Alzheimer's disease years before symptoms appear, access treatments that slow its progression when caught early, and prevent nearly half of dementia cases through lifestyle modification. Yet our healthcare system remains reactive. Cognitive Stewardship creates proactive brain health.
Why Now? The Convergence of Three Scientific Breakthroughs
The Problem: A Closing Window
- Early intervention works best. Disease-modifying therapies are targeted at the mild cognitive impairment/dementia stages.
- Those who wait until early dementia significantly reduce eligibility and may not benefit from other key interventions.
- Healthcare system and diagnostic delays can delay eligibility up to 20 months.
By the time traditional care pathways identify cognitive concerns, many individuals have already progressed beyond the window where interventions work best.
Source: Nakashima S, et al. Therapeutic time window of disease‐modifying therapy for early Alzheimer's disease. Alzheimer's & Dementia: Translational Research & Clinical Interventions 2025; DOI:10.1002/trc2.70102.
The Cognitive Stewardship Solution
Our evidence-aligned model shifts from reactive diagnosis to proactive brain health care:
- Longitudinal Monitoring – Regular cognitive assessment using validated instruments to detect subtle changes years before conventional medical attention
- Personalized Intervention – Evidence-aligned protocols for proactive brain health care
- Treatment Navigation – Immediate coordination with specialists for time-sensitive access to validated biomarker tests and FDA-approved therapies or clinical trials when needed
- Advance Planning – Structured conversations during periods of preserved capacity about values, preferences, and future care wishes
Aligned with American Academy of Neurology Guidelines
Treasure Coast Cognition's Cognitive Stewardship model aligns with the American Academy of Neurology's 2023 Position Statement on Brain Health and Preventive Neurology.
AAN Definition of Brain Health: "A continuous state of attaining and maintaining the optimal neurologic function that best supports one's physical, mental, and social well-being through every stage of life."
Source: Rost NS, Salinas J, Jordan JT, et al. The Brain Health Imperative in the 21st Century—A Call to Action: The AAN Brain Health Platform and Position Statement. Neurology. 2023;101(13):570-579.
Recent Scientific Evidence
Blood Biomarkers Transform Early Detection
A 2024 Nature Medicine study across five European centers demonstrated plasma p-tau217 achieved 89-91% diagnostic accuracy for Alzheimer's pathology. Longitudinal data from 2,148 dementia-free older adults showed this biomarker predicts dementia onset up to 10 years before symptoms.
Disease-Modifying Treatments Show Efficacy
Two FDA-approved medications (lecanemab, donanemab) demonstrate 22-35% slowing of cognitive decline in early-stage disease. Critically, 46-51% of patients with low disease burden at baseline showed improvement or no decline—suggesting early intervention may stabilize rather than merely slow progression.
Lifestyle Interventions Deliver Results
The US-POINTER trial (JAMA, July 2025) enrolled 2,111 adults in a comprehensive program combining physical activity, cognitive training, nutritional optimization, and vascular risk management. Results showed cognitive improvement equivalent to 1-2 years of delayed aging, with benefits consistent across genetic risk levels and baseline health status.
Prevention Works at Scale
The 2024 Lancet Commission identified 14 modifiable risk factors accounting for 45% of potentially preventable dementia cases—up from 40% in their 2020 analysis.
Our Ethical Framework
Avoiding Premature Pathologizing
With cognitive impairment reversion rates reaching 10-40%, we emphasize iterative reassessment rather than definitive labeling, present results within probabilistic frameworks, and commit to evidence-informed communication.
Psychological Support
We provide comprehensive pre-test counseling, optional pacing of evaluation, connection to mental health resources, and ongoing emotional support throughout the journey.
Access Commitment
We're developing access pathways, program adaptations, and community partnerships to ensure benefits extend beyond our initial Founding Families.
Join the Movement
Cognitive Stewardship emerges at a pivotal moment. For the first time, we possess the tools to detect problems early, effective treatments that work when applied promptly, and validated prevention strategies. Yet our healthcare system remains reactive.
Families seeking proactive brain health have nowhere to turn—until now.