A specialist to measure and monitor for your clients and patients
Treasure Coast Cognition provides neuropsychological evaluation and structured cognitive stewardship for families on the Treasure Coast. Direct-pay, low-volume by design, founded and run by a neuropsychologist with two decades of academic-medicine training.
When a patient arrives with an Alzheimer's blood test result
Patients are already walking in with these, ordered elsewhere or ordered by themselves. Here is what the result can and cannot tell you.
The result alone...is complicated
Many of these tests have been cleared by the FDA (e.g., Elecsys® pTau217 for primary and specialty care), and the specialty guidelines written, for people who already have measured cognitive impairment (not subjective report alone) include evaluation by a clinician trained in memory disorders. However, these tests are now available direct-to-consumer or in primary care. Primary care clinicians likely do not have memory disorders training. Run on someone with no measured impairment, a positive result is a probability statement about brain biology — not a diagnosis.
Neither does what the patient tells you
This is the part that surprises people. How someone rates their own memory is among the least reliable information in the room. A care partner can also provide "collateral" information, but many people walk in that don't have someone who can accurately report.
Worry about memory tracks mood, sleep, and temperament at least as closely as it tracks cognition. Many of the most worried patients perform entirely normally. And the pattern runs the other direction as well: insight into cognitive change tends to fade as the change advances, so the people with the most to find are often the ones reporting that nothing is wrong. A spouse or an adult daughter usually notices well before the patient does.
So the two pieces of information most available in a fifteen-minute visit — the test result and the patient's own account — are the two weakest signals available. What makes either one mean anything is measurement: performance on the right cognitive tests (not a screen) against what this particular person should be able to do, plus history from someone who sees them every day.
A brief office screen does not settle it either. Patients with substantial education and demanding careers routinely score in the normal range on short screens while something real is underway. Reserve hides it. That is a measurement problem, not a judgment problem, and it is not solvable in the time you have.
The three situations you will actually face
Measured impairment, positive test. The biology likely explains the picture. Contributors still worth clearing: anticholinergics and benzodiazepines, untreated sleep apnea, thyroid, B12, alcohol, depression, vascular burden. Then specialty referral for staging and treatment eligibility.
Symptoms, negative test. The most useful thing these tests do. They are built to be highly sensitive, so a negative meaningfully argues against Alzheimer's pathology — which redirects the workup rather than ending it. Vascular, Lewy body, medication effect, mood, sleep, thyroid.
No measured impairment, positive test. Not a diagnosis, and no treatment indication. What this patient needs is a documented baseline and a stated interval for re-measurement, so that a change three years from now is compared against data instead of recollection. Without that, the result is an anxiety generator with nothing attached to it and close to have the people who have this result will not go on to develop cognitive impairment.
A positive result is a starting point, not a verdict
Brain pathology and daily function come apart more than most people expect. Two patients with similar biology can look nothing alike five years on, and the difference is partly in what gets managed in between — vascular risk, sleep, hearing, medications, activity, and the timing of decisions about driving, finances, and legal documents.
That is the conversation this result opens. It should be scheduled and it should include the family. What patients do in the month after an unexplained positive result — sell a house, change a will, stop driving, or tell no one — is the risk most worth managing.
One practical note worth passing along: long-term care and disability underwriting can consider these results. Genetic nondiscrimination protections do not extend to them.
What a referral gets you
A baseline evaluation in the patient's home. Objective performance measured against that person's own expected level, plus structured history from a family member who sees them daily.
You receive a written report, with the family's authorization: what was measured, what the pattern is consistent with, and a specific recommended next step. Plain language, no score appendix.
The baseline evaluation is $3,000, direct-pay — a one-time specialist evaluation, closer to a cardiac workup than a subscription. Many families continue with quarterly monitoring afterward; that is arranged together after the baseline, with no automatic renewal. If a family wants a smaller first step, we offer a consultation that is credited in full toward the baseline if they continue.
Call (772) 202-0486. You reach Dr. Stoeckel directly and hear back the same day.
What a referral gets
A comprehensive baseline evaluation in the family's home; a written report you receive with the family's authorization; and — if the family continues — six months of stewardship with structured change detection against their own baseline, not repeat screenings. You stay in the loop throughout.
What we don't do
We provide neuropsychological services and cognitive care. No medical treatment, no medication management, no medical diagnosis. We work alongside the family's physicians, not in place of them. Cases needing acute workup, psychiatric care, or rehabilitation are referred out — including cases referred to us.
Fees — so you can quote them
$3,000 for the baseline evaluation. $12,000 for six months of Cognitive Stewardship, or $9,000 if the baseline is already done. Paid directly by the family; direct-pay, not billed to insurance. No fees to or from referring professionals, ever.
When to refer
When you are not sure how to interpret the result from the person who already ordered the test. Give me a call. When a client is close to making a significant decision and you want to know if they may have cognitive impairment that impacts their decision-making. When a family member raises concerns you can't evaluate. When someone's decisions have changed in ways you notice but can't name. You don't need to be sure — that's what the evaluation is for.
For significant decisions
When clients make significant decisions, it is important to know they are unimpaired. This is part of any engagement and is tailored and timed to the significant decision.
How to refer
Two options, your choice: a closed-loop referral (you introduce us, we report back to you at each stage, with the family's authorization) or an open one (you hand the family our information and step back). The simplest start is a three-way email introduction — or call me directly.