This changes how we should think about monitoring our brain health.
First, monitoring your brain health is critical to track the effectiveness of your interventions. What is tracked can be improved. Without tracking you are basically spinning your wheel.
I have written a few articles about tracking on our blog https://apoe4.co
If You’re Not Tracking, You’re Guessing
Ok- back to the video:
I just finished analyzing another six presentations from AAIC 2025, and the findings are both sobering and empowering.
The core insight: Your "good days and bad days" (or in other words the variability in your cognitive performance) might be a more powerful early warning signal than your average test scores.
And here's the part that hit home for me: we as APOE4 carriers show MORE cognitive variability than non-carriers even when we're clinically healthy. Even when traditional testing shows we're "fine."
What the research revealed:
📊 Dr. Katie Bangen (UC San Diego) tracked 818 people for 3 years. For APOE4 carriers , high variability at baseline predicted faster decline in real-world functioning (e.g. managing money, taking meds, handling complex tasks) before cognitive tests became abnormal.
📱 Dr. Andy Aschenbrenner (Washington University) used a smartphone app to track people 4x/day for a week. APOE4 carriers had more ups and downs across the week. And here's what's wild: on days when the app showed worse cognition, people had MORE adverse driving events THAT SAME DAY. More hard braking, more speeding, more sudden acceleration. (They analyzed 20,000+ car trips to prove this.)
But there's a silver lining: people seemed to know when they were having off days. They avoided risky nighttime driving on low-cognition days without even realizing why.
🌍 Dr. Laiss Bertola validated this in 9,000+ Brazilians over 8 years. Higher variability at baseline = higher odds of impairment eight years later.
⚠️ Dr. Andrew Kiselica revealed the nuance: variability scores are unreliable in asymptomatic people (mostly just noise), but become highly informative once symptoms appear. This means daily smartphone monitoring might be better for us in the asymptomatic stage.
Why this matters for us:
Unlike expensive biomarkers ($5K for amyloid PET, $1.5K for CSF testing), variability can be tracked through:
✓ Standard neuropsych tests
✓ Smartphone apps (minutes per day)
✓ Remote monitoring
✓ No invasive procedures
My questions for the community:
1. Have any of you noticed patterns in your "good days" vs. "bad days"?
2. Would you use a smartphone app to track daily cognitive variability if it were available?
3. For those who've had neuropsych testing, did your doctor ever mention your score variability, or just your averages?
Most Newsletters? One-way street.
How boring…
This is the Phoenix Community after all—so let's make it a two-way street.
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