Cognitive Assessment
(Cognoscopy)
Online consultations are also available
Dementia is now overtaking ischaemic heart disease as Australia's leading cause of death for the first time in 2024. The 2024 Lancet Commission on Dementia concluded that up to 45% of dementia cases could be prevented or delayed by addressing 14 modifiable risk factors across the lifespan. Almost half. Preventable.
The problem is not that the science does not exist. The problem is that most Australians are not being assessed early enough for prevention to matter.
"This is not a sentence. It's not a given. Even if you have two copies of the so-called Alzheimer's gene, the APOE4, you've come in at the perfect time. We have the evidence, the research, and the tools to understand what your risk factors actually are, and what we need to turn around before any of this ever shows up."
Jo Grabyn, Clinical Naturopath and ReCODE 2.0 Certified Practitioner, speaking with patients at first appointment
What is a cognoscopy?
A cognoscopy is a structured, comprehensive brain-health assessment designed to identify your modifiable cognitive risk factors before symptoms appear.
The term was coined by neurologist Dr Dale Bredesen in his 2017 book The End of Alzheimer's and developed through his work at Apollo Health. The analogy he uses is deliberate: most Australians over 50 are familiar with the recommendation to have a colonoscopy, a structured look at the bowel while you are still well, to detect problems early when they are still highly treatable. A cognoscopy applies the same logic to the brain.
In Bredesen's words: "If each one of us were to obtain a cognoscopy, and target our identified risk factors for cognitive decline, we could truly make Alzheimer's a rare disease, just as it should be."
At Bounce Matters, the cognoscopy has been adapted into a 90-minute clinical assessment. It integrates three components:
- Comprehensive blood biomarkers: the modifiable drivers of cognitive risk, across metabolic, inflammatory, nutrient, hormonal, vascular, and toxin categories
- Cognitive performance testing: a multi-tool assessment that measures how your brain is performing today, compared to age-matched peers
- Brain imaging (optional): structural MRI with volumetric analysis, where clinically indicated
Earlier question. Bigger opportunity.
The standard memory screen detects disease that already exists. The cognoscopy asks an earlier question.
How a cognoscopy differs from a standard GP cognitive check
| Standard GP Memory Screen | Cognoscopy | |
|---|---|---|
| Duration | 5–10 minutes in-clinic | 90 minutes + laboratory turnaround |
| Purpose | Detect existing impairment | Identify modifiable risk before impairment |
| Tools | MMSE or brief recall tasks | MoCA, CNS Vital Signs, AQ-21, blood panel |
| Biomarkers | Typically none | 30–60 markers across 6 functional categories |
| Imaging | Rarely ordered | MRI with volumetrics where indicated |
| Outcome | Pass/fail, refer/no referral | A personalised risk profile with a treatment direction |
The standard memory screen is a useful tool for what it was designed to do: detect cognitive impairment that already exists. A cognoscopy asks a different and earlier question: what is happening in your brain biochemistry right now, and what are your modifiable risks?
Why age 45 is the right starting point
Alzheimer's pathology begins ten to twenty years before the first symptom appears. By the time someone notices they are forgetting names or losing things more often, the underlying biology has often been changing for a very long time. That long pre-symptomatic window is also the prevention window. It is when risk factors are most modifiable, and when small changes compound into large differences over ten to twenty years.
The 20-Year Prevention Window
The optimal cognoscopy window is age 45–55. Standard screening begins much later — at the point where the prevention window has largely closed.
Around age 45, several things converge. The natural rate of cognitive change begins to accelerate. Hormonal shifts, particularly in women approaching perimenopause, start affecting brain energy, sleep, and inflammation. Metabolic changes including insulin resistance often emerge. APOE4 carriers begin to show measurable differences from non-carriers around this age.
Forty-five is a baseline opportunity. Collect the data while you are well, and you have something meaningful to compare against if anything changes.
For people with a strong family history (a parent or sibling diagnosed before 65, close relatives who are APOE4-positive, or a personal history of repeated head injuries), Bredesen recommends starting earlier: at the age before their family members showed symptoms.
The Australian Institute of Health and Welfare reports that around 433,300 Australians are currently living with dementia, with projections reaching 812,500 by 2054. Around 29,000 of those people have younger-onset dementia, meaning they are in their 30s, 40s, and 50s. The prevention window is not infinite. Earlier is better.
The three components of a cognoscopy
1. The blood biomarker panel
The blood panel is the investigative backbone of the cognoscopy. It covers the modifiable drivers of cognitive risk across six functional categories:
| Category | What it investigates |
|---|---|
| Metabolic | Fasting glucose, fasting insulin, HbA1c, HOMA-IR — the glucose and insulin regulation picture |
| Inflammatory | hs-CRP, homocysteine, fibrinogen — the inflammatory burden picture |
| Nutrient | Active B12, vitamin D, RBC magnesium, zinc, selenium, ferritin — the brain fuel picture |
| Hormonal | Full thyroid panel, oestradiol, progesterone, testosterone, DHEA-S, cortisol — the neurochemical regulation picture |
| Vascular | Full lipid panel with particle size, Lp(a), ApoB — the vascular risk picture |
| Toxin / Immune | APOE genotyping (optional), mycotoxin markers where indicated, autoimmune panel where indicated |
Many of these markers can be ordered with Medicare rebates through a GP partner when there is appropriate clinical reasoning. Specialty markers are typically paid out of pocket. You will receive a full cost breakdown before any testing is ordered.
2. Cognitive performance testing
Three instruments are used together at Bounce Matters. The MoCA (Montreal Cognitive Assessment) is the 30-point screening tool used in memory clinics and geriatric settings. It is brief, standardised, and broadly available. It is a useful anchor point but alone is insufficient for the cognoscopy purpose.
CNS Vital Signs is an online cognitive assessment measuring executive function, processing speed, verbal memory, and visual memory. It produces a percentile score against age-matched peers, which is more clinically meaningful than a pass/fail. It can detect subtle processing changes that a brief in-clinic screen would miss.
The AQ-21 is an informant-based questionnaire completed by a partner, adult child, or close friend. This matters because one of the recognised features of early cognitive change is reduced insight: the person experiencing it often does not notice, while the people around them have been quietly watching for months or years. Together, these three instruments produce a picture that is far more complete than any single tool alone.
3. Brain imaging (optional)
Structural brain imaging is the optional third component, and it is not necessary for every person who has a cognoscopy. An MRI with volumetric analysis measures the size of specific brain regions and compares them to age-matched reference ranges. The most informative measurement is hippocampal volume, the seahorse-shaped memory centre that is the first region to show atrophy in Alzheimer's pathology.
Imaging is most useful when you have current cognitive symptoms or concerns, a strong family history, APOE4-positive status, or a history of repeated head injuries (also see the Concussion Recovery page). For most healthy people in their 40s and early 50s with no symptoms and no strong family history, the blood panel and cognitive testing are the right starting point. Imaging can be deferred. A brain MRI with volumetric analysis in Australia typically costs $300 to $600 with the right referral wording.
The APOE4 question: testing it, or not
APOE4 testing is one of the most contested decisions in the cognoscopy, and it deserves a careful answer rather than a reflexive one in either direction. APOE is a gene involved in lipid metabolism and brain repair. The ε4 variant, carried by approximately 15–25% of the population, increases late-onset Alzheimer's risk. A 2023 JAMA Neurology analysis is among the most thorough assessments of APOE4 risk across age, sex, and population groups.
Carrying one copy of APOE4 increases risk roughly two to three fold. Carrying two copies increases it significantly more. But APOE4 is a risk factor, not a destiny: many APOE4 carriers never develop Alzheimer's, and many non-carriers do. APOE testing at Bounce Matters is offered with proper pre-test counselling, only when the person genuinely intends to act on the result, with post-test support, and never as the only input. The decision is a clinical conversation, not a tick-box on a request form.
Risk Factors: What We Can Change
Non-Modifiable Risk
- Age
- Biological sex
- Family history
- APOE4 genetic status
- Past head injuries
Modifiable Risk
- Insulin resistance & metabolic health
- Systemic inflammation
- Nutrient status (B12, Vitamin D, etc)
- Hormonal balance
- Gut microbiome health
- Toxin exposure (Mycotoxins, Metals)
Non-modifiable risk factors inform your starting point. Modifiable risk factors are what the cognoscopy investigates.
The evidence for acting early: what the research shows
The evidence that a comprehensive, personalised approach to cognitive risk reduction can change outcomes is now substantial, and growing. The 2024 Lancet Commission on Dementia identified 14 modifiable risk factors across the lifespan that together account for up to 45% of dementia cases. This is mainstream medical science, not fringe theory, and it forms the scientific basis for why a cognoscopy matters.
The FINGER trial, published in The Lancet in 2015, was the first large-scale randomised controlled trial to demonstrate that a multidomain lifestyle intervention significantly improved cognitive performance in people at elevated risk. Across 1,260 participants, the intervention group showed 25% greater improvement in global cognitive function, 83% greater improvement in executive function, and 150% greater improvement in psychomotor speed compared to the control group.
The 2018 Bredesen 100-patient case series documented objective cognitive improvement across multiple Alzheimer's subtypes using a precision medicine approach. The WHO's 2019 Guidelines on Risk Reduction of Cognitive Decline and Dementia formally endorsed lifestyle and metabolic intervention as the most evidence-supported approach to prevention. The ReCODE 2.0 trial (ClinicalTrials.gov NCT05894954) is the current registered trial evaluating the Bredesen Protocol in a controlled setting.
"The cognoscopy is not a test you pass or fail. It is a map. And a map is only useful if you use it to navigate. That is what the rest of the ClearPath Method is for."
Jo Grabyn, Bounce Matters Founder
In clinic: three cases
Daniel
de-identified, used with permission
Daniel was in his late 40s, running a large international investment firm, with two teenagers and a toddler at home. His father had died of a heart attack at 62. He was not experiencing cognitive symptoms. He came for a cognoscopy because he wanted data. His results showed APOE4 heterozygous status, elevated fasting insulin, low ferritin, and a CNS Vital Signs processing speed score at the 40th percentile. He was not impaired. He was not well-optimised. Twelve months into the ClearPath Method, his insulin had normalised, his ferritin was at 85 ng/mL, and his processing speed had moved to the 72nd percentile. His own assessment: 'I make better decisions faster. I don't know how to quantify that, but I know it is true.'
Margaret
de-identified, used with permission
Margaret was 69 when her son was told by her GP to start looking for a nursing home. Her mother had had dementia in her 90s, but this was twenty years younger, and the presentation had come on faster. Her cognoscopy identified a cluster of four active drivers: mycotoxin exposure from a water-damaged home she had lived in for eight years, significant hormonal deficiency, elevated homocysteine, and a ferritin of 14 ng/mL. Addressing those drivers in sequence, within the ClearPath Method, produced a meaningful and measurable improvement in her cognitive function over 18 months. Her own words: 'Why did I not do this? It gave me my life back. I've had five or six years with my grandkids. I'm living a normal life, and six years ago the doctors said I would be in a nursing home.'
Liz
de-identified, used with permission
Liz was a GP and neuroscientist in her 50s when she had her cognoscopy. She was APOE4-positive and had become increasingly concerned about her own cognitive trajectory. Her pTau levels were elevated at baseline. Her CNS Vital Signs cognitive assessment placed her around the 50th percentile. Following a targeted protocol developed from her cognoscopy results, her pTau normalised on repeat testing. Her CNS Vital Signs score moved to the 95th percentile. Her own words: 'I don't think I've felt like this since I was 40.' She is now a practitioner who refers patients into the ReCODE 2.0 framework.
Who is the cognoscopy for?
The cognoscopy IS the right next step when you are:
- 45 or older with no current symptoms but a family history of dementia or Alzheimer's disease
- Younger than 45 with a first-degree relative diagnosed before 65, known APOE4 status, or a history of repeated head injuries
- Experiencing early subjective concerns about memory, processing speed, word retrieval, or mental clarity
- A high-functioning professional who has noticed a change from your own baseline
- Someone who has received an Alzheimer's risk result (p-Tau blood test, genetic panel) with no accompanying clinical plan
- A partner or adult child seeking a starting point alongside someone who has already been diagnosed
The cognoscopy is NOT the right first step when you are:
- Experiencing acute new neurological symptoms: your GP first, always, and then a neurologist if indicated
- Looking for a guaranteed reversal: the evidence supports the framework, not a specific outcome for every individual
- Unwilling or unable to act on results: the cognoscopy only has value if the results feed into a real clinical plan
If you are in the brain fog or mood and cognitive resilience space rather than a prevention or reversal focus, the cognoscopy still applies, but the framing and urgency are different.
What comes out the other side: the ClearPath Method
A cognoscopy is the beginning of the clinical story, not the end of it. The results of the cognoscopy feed directly into The ClearPath Method: the five-phase framework Jo uses to translate a risk profile into a personalised brain-health plan.
THE CLEARPATH METHOD
Reveal
The Cognoscopy
Fuel
Nutrition & Energy
Rebalance
Gut, Hormones, Stress
Build
Rhythms & Reserve
Stay on Course
Monitoring & Refinement
The cognoscopy is phase one. The plan is what follows.
| Phase | Focus |
|---|---|
| Reveal | The cognoscopy. Comprehensive history, blood biomarkers, cognitive testing, optional imaging. You will be heard, not rushed. |
| Fuel | Brain energy foundations. Sustainable metabolic changes to support mitochondrial function, glucose regulation, and nutrient sufficiency. |
| Rebalance | Your specific contributors: inflammation, gut-brain patterns, stress physiology, hormonal balance, toxin exposure. |
| Build | Repeatable daily and weekly actions that fit your actual life: movement, sleep, cognitive challenge, social connection. |
| Stay on Course | Ongoing review at three, six, and twelve months. You are not left to manage this alone. |
"I love working with patients who come in with the cognoscopy as their starting point. They already understand that it is not one thing, it is a picture. We tweak the program as we go. We plug the holes. And bit by bit, their brain starts to feel like their brain again."
Jo Grabyn, Bounce Matters Founder, on working with cognoscopy-first patients
What to expect at Bounce Matters
How the 90-minute cognoscopy appointment runs
The first 60 minutes: A comprehensive clinical history. This includes your symptom timeline, family history, occupational and environmental exposures, hormonal history (for women: menstrual and menopausal history), gut and immune history, head injury history, sleep architecture, stress narrative, and medication and supplement history. By the end of this section, the most likely modifiable drivers are already shortlisted.
The remaining 30 minutes: Cognitive testing (MoCA and CNS Vital Signs), the AQ-21 questionnaire for your accompanying person (a partner or trusted family member or friend is encouraged to attend), and a clear explanation of which blood panels will be ordered and why.
After the appointment: Laboratory results typically arrive within two to six weeks. A separate synthesis appointment (30 to 45 minutes) is then scheduled to walk through: what was found, what it means, which drivers are operating in your specific case, and in what order to address them.
Cost transparency
The cognoscopy appointment itself has a consultation fee. Laboratory costs depend on which panels are clinically indicated. Many routine markers can be partially Medicare-rebated through a GP partner. Specialty markers are paid out of pocket. Brain imaging, where indicated, is a separate cost ($300 to $600 with the right referral wording). You will receive a full cost breakdown before any testing is ordered. There are no surprises.
"The cost of the cognoscopy is the cost of knowing. The cost of not knowing is usually much higher, in both money and years."
Jo Grabyn, in clinical consultation
A Closing Thought
It is not a guarantee.
It is a starting point.
And for the patients who have used it as a starting point at Bounce Matters, including Daniel, Margaret, and Liz, it has been the difference between being a passenger in the story and being in the driver's seat.
Book a Discovery Call30 minutes, complimentary. Available in clinic at Manly and via telehealth across Australia.
Frequently Asked Questions
What is a cognoscopy?
A cognoscopy is a structured, comprehensive brain-health assessment designed to identify your modifiable cognitive risk factors before symptoms appear. Coined by neurologist Dr Dale Bredesen in The End of Alzheimer's (2017), it combines a comprehensive blood biomarker panel, multi-tool cognitive performance testing, and optional structural brain imaging. At Bounce Matters it is delivered as a 90-minute clinical appointment, followed by a laboratory phase and a synthesis appointment to interpret results and build a personalised plan.
How often should I repeat a cognoscopy?
A full cognoscopy at age 45 (or earlier with family history or personal risk factors) provides the baseline. Most patients then repeat cognitive testing every 12 months and the full blood panel every 24 to 36 months, unless a specific clinical reason warrants more frequent monitoring. Patients on the ClearPath Method typically have quarterly pathology reviews built into their plan.
I have a parent with dementia. Does that change my starting point?
Yes, meaningfully. Having a first-degree relative with dementia roughly doubles your personal risk. If your parent was diagnosed before 65, the genetic and familial loading is higher and earlier action is appropriate. The cognoscopy in your 40s, or earlier if your family history suggests it, is a clinically sensible step. APOE4 testing, with appropriate counselling, is also worth discussing in this context.
Can cognitive decline actually be reversed?
The evidence is promising, with important caveats. The 2022 Toups pilot trial found that more than 80% of 25 patients with MCI or early Alzheimer's showed cognitive improvement over nine months using a precision medicine approach. The 2018 Bredesen 100-patient case series documented objective cognitive improvement across multiple Alzheimer's subtypes. The FINGER trial (2015) showed that a multidomain lifestyle intervention produced 25% greater cognitive improvement than standard advice in at-risk adults. These are best characterised as promising evidence rather than certainty. The cognoscopy is the clinical tool that makes 'personalised' possible.
Is a cognoscopy covered by Medicare in Australia?
Partially. Many routine metabolic, inflammatory, nutrient, and hormonal markers can be ordered with Medicare rebates through a GP partner when there is appropriate clinical reasoning. Specialty markers, including APOE genotyping, mycotoxin panels, advanced lipids, and salivary cortisol patterns, are typically paid out of pocket. Cognitive testing and brain imaging have their own cost structures. You will receive a full cost breakdown before any testing is ordered.
What is the difference between a cognoscopy and the memory test my GP does?
A brief in-clinic memory test is designed to detect cognitive impairment that already exists. A cognoscopy is designed to identify modifiable risk factors before impairment appears, which is when intervention is most effective. A standard GP test is a five-to-ten-minute pass/fail screen. A cognoscopy is a 90-minute structured assessment with a blood panel, three cognitive instruments, and optional imaging, producing a personalised risk profile rather than a referral decision.
What if my standard blood tests have come back normal?
Standard blood tests are designed to detect diagnosable disease, not pre-disease dysfunction. The 'normal' range is population-based, not optimal-based: it includes a great many people who are functioning poorly. A cognoscopy blood panel asks a different question, about optimal function rather than the absence of named disease, and investigates markers that standard panels do not include.
Related on jograbyn.com
Conditions where cognitive health is central
How we investigate and how we work
References
- Australian Bureau of Statistics. Dementia is Australia's leading cause of death. November 2025. abs.gov.au
- Livingston G, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 2024. thelancet.com
- Alzheimer's Disease International. Lancet Commission identifies two new risk factors for dementia and suggests 45% of cases could be delayed or reduced. 2024. alzint.org
- Bredesen DE. The End of Alzheimer's: The First Program to Prevent and Reverse Cognitive Decline. Avery, 2017. apollohealthco.com
- Ngandu T, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet, 2015. The Lancet FINGER trial
- Bredesen DE, Sharlin K, Jenkins D, et al. Reversal of Cognitive Decline: 100 Patients. Journal of Alzheimer's Disease and Parkinsonism, 2018; 8:450. omicsonline.org
- Toups K, Hathaway A, Gordon D, et al. Precision Medicine Approach to Alzheimer's Disease: Successful Proof-of-Concept Trial. Journal of Alzheimer's Disease, 2022. pubmed
- World Health Organization. Risk Reduction of Cognitive Decline and Dementia: WHO Guidelines. 2019. who.int
- Bellou V, et al. APOE Genotype and Alzheimer Disease Risk Across Age, Sex, and Population Ancestry. JAMA Neurology, 2023. jamanetwork.com
- Australian Institute of Health and Welfare. Dementia in Australia. aihw.gov.au
- Dementia Australia. Dementia facts and figures. 2026. dementia.org.au
- ClinicalTrials.gov. Precision Medicine for Cognitive Decline: The ReCODE Study. NCT05894954. clinicaltrials.gov
Important: This page is for educational purposes only. It does not replace medical advice, diagnosis, or emergency care. If you are experiencing sudden neurological symptoms, seek urgent medical attention. All case studies are de-identified composite clinical patterns for educational purposes only and do not represent specific individuals or guarantee any particular outcome. Individual outcomes vary.