The Root Cause Medicine Podcast · Rupa Health

The #1 Risk Factor for Dementia You’re Ignoring with Dr. Kellyann Niotis

April 8, 2025·58 min·4 clips

Perimenopause and menopause can change cerebral perfusion and brain metabolism on scans.

1. The Root Cause Medicine Podcast episode centers on Dr. Kellyann Niotis and the topic of preventing neurodegenerative disease before symptoms appear. 2. Dr. Keri Jones hosts the conversation and presents Niotis as a preventive neurologist whose work focuses on Alzheimer's disease, Parkinson's disease, and Lewy body dementia. 3. The episode asks what brain health means in practical terms and how listeners can lower risk years before a diagnosis. 4. Niotis says the brain is a “use it or lose it organ” and reduces brain health to two requirements: adequate blood flow and sensory activation. 5. She names hearing loss and vision loss as modifiable risk factors and says the Lancet Commission added vision loss to its list of 14 modifiable risk factors. 6. Niotis explains that preventive neurology starts far earlier than the usual neurology visit, because disease processes can begin decades before symptoms. 7. She says she is the first and still the only official fellowship-trained preventive neurologist and credits Dr. Richard Isaacson as her mentor. 8. Niotis distinguishes preclinical or prodromal disease from being at risk, and says preclinical disease means neurodegenerative pathology is already forming without obvious symptoms. 9. She says strong family history and first-degree relatives such as a mom, dad, or sibling matter when estimating risk. 10. She also discusses genetics, including ApoE4, and says one gene alone does not explain risk because protective and polygenic effects also matter. 11. Niotis says memory loss is not a normal part of aging, even though attention and processing speed often decline with age. 12. She notes that people may seem forgetful because they never fully absorbed information in the first place, not because memory storage failed. 13. On lifestyle, she says family history must be interpreted in context, because social isolation, addiction, and lack of engagement can shape outcomes. 14. She describes exercise as probably top three among the most important levers because it lowers obesity, blood pressure, diabetes, depression, and sleep problems. 15. She says the Mediterranean-based diet is her general recommendation, emphasizing extra virgin olive oil, nuts, whole grains, fatty fish, leafy greens, and berries. 16. Niotis says ketogenic dieting may help some neurological conditions, but people with ApoE4 often do poorly on it and may develop high ApoB and inflammatory markers. 17. She explains that blood pressure, sleep apnea, and oxygen delivery matter because high blood pressure damages vessels over time and sleep apnea likely raises dementia risk. 18. The interview stays clinical and practical, with Dr. Jones asking for definitions, risk-stratification details, and concrete examples that listeners can apply. 19. People concerned about aging, family history, menopause-related brain fog, or modifiable brain-health risks would get the most from this episode. 20. People looking for a quick lifestyle pep talk without medical detail or diagnostic nuance may skip it.

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