The challenge
David, 72, was convinced his brain was failing.
A retired healthcare professional who exercised four days weekly and had practiced meditation for over 50 years, he came seeking a neurocognitive assessment. He was afraid he had early dementia. He forgot why he walked into rooms. He started projects but couldn’t finish them. His mind, he said, was “constantly lying” to him with worst-case scenarios.
His screening scores told a reassuring story: PHQ-9 of 1 (minimal depression), GAD-7 of 2 (minimal anxiety), and cognitive testing solidly in the normal range.
An easy case to reassure and discharge.
What standard care would have done
Standard care would have validated his “age-related cognitive concerns,” possibly ordered expensive neuroimaging to rule out dementia, and perhaps prescribed an SSRI for the worry. His social situation—living alone on a rural property—would likely never have been assessed as clinically relevant.
He would have left with a clean bill of cognitive health and the same profound isolation that was actually driving his symptoms.
What Assess surfaced
- Social isolation as the real problem. David lived alone on a rural property, his siblings scattered across the country and overseas. He had no local support network. He would need to fly his brother in for any medical procedure requiring a driver. “I’m kind of nervous about living alone because if something happens, no one’s gonna know till months.”
- Anxiety, not dementia. His “memory problems” were actually attention deficits caused by chronic anticipatory worry. His inability to complete projects was avoidance behavior driven by overwhelm, not cognitive decline.
- MDQ false positive prevented. His mood screening showed 9/13 bipolar items endorsed—but severity was “no problem.” Without detailed exploration, he could have been started on an unnecessary mood stabilizer.
- Unprocessed trauma contributing to negative thought patterns. Childhood emotional abuse, witnessing parental infidelity, and unresolved feelings about his 2011 divorce were fueling his catastrophic thinking.
- CPAP-induced nightmares. New-onset dreams of asphyxiation correlating with CPAP initiation—a modifiable treatment side effect that could have led to device abandonment.
What changed
Diagnosis: Not dementia. Not major depression. Adjustment Disorder with Anxiety—fueled by profound social isolation that no one had thought to assess.
Treatment: Instead of neuroimaging and unnecessary antidepressants, we recommended:
- Community connection resources for when he sells his home
- Evidence-based bibliotherapy for his negative self-talk patterns
- Silexan (lavender supplement) for mild anxiety—honoring his preference against pharmaceuticals
- Continuation of his yoga and meditation practices
- CPAP optimization with sleep medicine follow-up
Within weeks, David attended his first social event in years. “That’s my brain telling me not to go,” he said. “But I’m going anyway.”
”I'm kind of nervous about living alone because if something happens, no one's gonna know till months.
David, 72PHQ-9: 1 | Cognitive testing: Normal
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These findings came from real assessments at Texas Center for Lifestyle Medicine. We have detailed documentation on 50+ patient evaluations, with more being added from ongoing clinical work.
