How do I know Cognitive Stewardship is right for us?

Cognitive Stewardship works best during what I call the "early window"— when changes are noticeable but capacity remains largely intact. This is typically early stages of cognitive decline: subtle memory changes, mild confusion, family members starting to notice or compensate. Our initial consultation determines if you're in this window.

We're not sure if this is serious enough yet.

That's exactly what the consultation is for. I'll help you determine if a full evaluation is appropriate or if it's too early. Either answer has value.

Is Cognitive Stewardship the same as Direct Cognitive Care?

The Cognitive Stewardship model is aligned with Direct Cognitive Care. This is a new healthcare model where you pay directly for cognitive health services, rather than going through insurance. This approach allows us to focus entirely on what's best for you and your family—not what insurance will reimburse. You get longer appointments, easier access, and a true partnership in managing cognitive health over time.

How is this different from traditional healthcare?

In traditional healthcare, insurance dictates how much time doctors can spend with you, what tests can be ordered, and how often you can be seen. Cognitive Stewardship or Direct Cognitive Care removes these restrictions. We spend as much time as needed in appointments, respond to questions between visits, coordinate with your other providers, and design a care plan based on your family's actual needs—not what fits into billing codes.

Why don't you accept insurance?

Insurance wasn't designed for the kind of care families need when facing cognitive changes. Insurance typically covers brief, episodic visits focused on diagnosis and medication management. It doesn't cover the things that matter most: extended assessment time, family education, care coordination with attorneys and financial advisors, quarterly monitoring, or the ongoing guidance that prevents crises. By staying out of the insurance system, we can provide the comprehensive, longitudinal care your family actually needs. However, specific components (such as specialist visits, certain lab tests, or imaging studies) may be billable to your insurance.

How do we know if this model is better for us?

Cognitive decline doesn't follow insurance's schedule or categories.

Families need someone who can:

• Spend 2-3 hours on initial assessment

• Evaluate financial capacity

• Attend to the family's emotional journey, not just diagnose symptoms

• Coordinate care across multiple professionals

• Provide guidance over the 7-10 year window when planning is still possible

Insurance doesn't reimburse for this. Cognitive Stewardship makes it possible.

Cognitive Stewardship is ideal if:

• You're noticing cognitive changes but not sure what they mean

• You want comprehensive assessment, not just a diagnosis

• You need help with financial or legal capacity questions

• You're concerned about making important decisions (driving, finances, healthcare)

• You want a long-term partner, not just a one-time consultation

• You value having direct access to expert guidance

• You can afford to invest in preventing cognitive decline crises

If you're looking for a brief evaluation to check a box, this isn't the right fit. If you want genuine partnership in navigating cognitive changes, this is exactly what we've built.

Don't most neuropsychologists work this way?

No. Most neuropsychologists work within insurance systems, which means:

• Service is limited to testing and a report, written mostly for the referring physician

• There is a focus on diagnosis, not ongoing management

• There is limited time to coordinate care or answer family questions

• There is limited availability between appointments

Cognitive Stewardship is designed specifically for families who need more than a one-time evaluation—they need a committed partner across the entire journey of cognitive change. This is rare, which is exactly why I created this practice model.

Why only 5 Founding Families?

Each family requires significant time, attention, and coordination. As a solo practice launching this model, I'm intentionally limiting initial capacity to ensure exceptional outcomes. This is a service that requires deep relationships. Once established, we plan to offer services to a limited number of additional families.

What happens after 6 months?

Families can continue with ongoing stewardship as new decisions need to be made. The first 6 months establishes whether ongoing support is appropriate and valuable for your situation. There's no obligation to continue. What happens if I develop concerning cognitive changes?

This is exactly when Cognitive Stewardship proves most valuable. You receive immediate evaluation, priority access to Cognitive Stewardship services, specialist coordination, and ongoing navigation—precisely when you need it most. Unlike traditional care where families wait weeks or months for responses, families receive same-week consultation and coordinated action within days.

What is Major Neurocognitive Disorder? How is that different than Mild Cognitive Impairment and Dementia?

Major Neurocognitive Disorder means cognitive decline interferes with independence in everyday activities. The person needs help with tasks they previously managed on their own—like finances, medications, or household management. "Major Neurocognitive Disorder" is the DSM-5 clinical term; "dementia" is what most people still call it. They mean the same thing. It's a syndrome caused by various conditions: Alzheimer's disease (most common), vascular disease, Lewy body disease, frontotemporal degeneration, Parkinson's disease, and others.

How is that different from Mild Neurocognitive Disorder?

If someone has noticeable cognitive decline beyond normal aging, but they remain functionally independent. Changes are evident on testing and noticed by the person or family, but don't significantly interfere with daily activities. It’s the same thing as Mild Cognitive Impairment.

Is this just for people with family history of dementia?

No. While family history is one risk factor, Cognitive Stewardship benefits anyone who values proactive brain health. Many founding families will have no family history but understand that dementia is potentially preventable—and want expert guidance for evidence-aligned prevention. Others have watched friends or colleagues decline and don't want to wait for symptoms themselves.

What if testing shows I have early biomarker changes?

Most people will receive reassurance that dementia risk is normal. If testing suggests elevated risk or early pathology, we discuss results in your specific context, provide support, discuss early intervention strategies and potential referrals, and create a proactive monitoring and planning strategy. Early knowledge enables early action—which is exactly when interventions work best.

I'm only in my 40s or 50s. Am I too young for this?

Not necessarily. Midlife is an ideal time for lifestyle modification for cognitive health. Many modifiable risk factors begin affecting brain health in your 40s and 50s. Cardiovascular health, diet, physical activity, hearing preservation, and sleep quality all have cumulative effects over decades. Early optimization has the greatest long-term impact. Additionally, blood biomarkers can detect pathology 10+ years before symptoms—starting in midlife means catching changes at the earliest possible stage when intervention works best.

I spend winters in Florida. Can I participate?

Yes. Founding Families can be snowbirds or part-time Florida residents. We can accommodate flexible scheduling with in-person visits during your time in Florida and virtual check-ins when you're away. Quarterly monitoring can be done via telemedicine, with annual comprehensive evaluations scheduled during your Florida residence.

Can I include my spouse and adult children?

Absolutely. Founding Families include multiple generations—both for individual cognitive health optimization and to facilitate family planning conversations.

Do you prescribe medications?

Dr. Stoeckel is not a prescribing physician. For medication management, we coordinate directly with your primary care physician and specialists. However, we provide evidence-based guidance on medical options, facilitate access to FDA-approved disease-modifying treatments when indicated, and coordinate care.

What if I already see a neurologist?

Excellent. Cognitive Stewardship complements rather than replaces specialist care. We provide proactive monitoring, lifestyle optimization, and care navigation that traditional neurology doesn't offer. If you develop concerning changes, we coordinate directly with your neurologist—or help you find one if you don't have established care. Many founding families have existing relationships with neurologists for other conditions and Cognitive Stewardship integrates seamlessly.