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Integrative Psychiatry

An Integrative Approach to Cognitive Decline and Dementia Part 2 of 2

By April 12, 2024No Comments

Preventative Care

An interesting feature of dementia is that measurable pathology begins to manifest years before cognitive symptoms are present. Even more complicated is the fact that biomarkers we consider “pathological” do not always correlate to cognitive decline, suggesting there may be protective factors also involved. Thus, preventative care is essential in mitigating the risk of cognitive decline and dementia. 

An integrative approach to dementia prevention emphasizes lifestyle interventions and personalized treatment strategies tailored to address underlying contributors to cognitive impairment. Moderating nutrient intake, including omega-3 fatty acids, fiber, and antioxidants, while limiting processed foods and added sugars can support cognitive function. Adequate sleep is also vital for brain health; practicing good sleep hygiene (see here for more) can improve memory, concentration, and overall cognitive performance. Exercise has also been shown to enhance brain health by promoting cardiovascular health, regulating the nervous system, moderating inflammatory responses, and increasing neuroplasticity. Stress mitigation through mindfulness practices is suggested to boost cognitive healthspan through similar mechanisms. Finally, but perhaps most importantly, stress and isolation, often coexisting together, are some of the biggest contributors to cognition throughout the lifespan. Engaging in meaningful social activities, maintaining strong social connections, and accessing adequate healthcare resources can positively impact cognitive function and mitigate the risk of dementia.

While well-designed studies are only beginning to be published, the Bredesen Protocol is one structured approach to the integrative and personalized treatment of dementia. The goal of this approach is to target multiple underlying contributors to neurodegeneration, including inflammation, insulin resistance, nutrient deficiencies, and mitochondrial dysfunction as outlined above. The protocol emphasizes a plant-based, high fiber, ketogenic diet, nutraceutical supplementation, stress management, and brain training.1

Emphasizing Care and Comfort

While preventative measures may be helpful in delaying the onset and progression of dementia, it is essential to prioritize compassionate care and comfort for individuals living with cognitive decline. In the medicalized world of cognitive decline, it is important to remember that some of the greatest healing is done through support for emotional, psychological, and spiritual needs of individuals and their families.

Person-centered care emphasizes the individual’s preferences, values, and autonomy in decision-making, fostering a sense of dignity and empowerment throughout the progression of cognitive decline. By honoring personhood, we can enhance quality of life and promote wellbeing throughout cognitive stages. Collaboration with a multidisciplinary team, with an emphasis on psychological care as much as medical care, is also essential in providing comprehensive care for individuals. Coordinating supportive services and community resources may ensure holistic support for individuals and caregivers. Providing comfort measures, symptom management, and emotional support for individuals with dementia and their families helps alleviate suffering and encourage a sense of peace.

Conclusion

Cognitive decline is a complex process that is influenced by a number of genetic, lifestyle, and physiological factors. By addressing underlying contributors to dementia that are changeable–through lifestyle interventions, personalized treatment strategies, and compassionate care–we can promote resilience, enhance quality of life, and support individuals and their families throughout the journey of cognitive decline. 

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

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Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.