Cognitive & Memory Disorders

Memory loss, brain fog, slowed processing, impaired attention, executive dysfunction, language difficulty, and other cognitive changes are symptoms—not diagnoses. Cognitive impairment can arise from dysfunction within specific brain regions and interconnected neural networks, but the underlying cause may be neurodegenerative, vascular, traumatic, autoimmune, infectious or post-infectious, metabolic, endocrine, nutritional, medication-related, sleep-related, or the result of several interacting neurological and physiological mechanisms.

Dr. Funk evaluates and treats cognitive and memory disorders including mild cognitive impairment (MCI), subjective cognitive decline, memory impairment, executive dysfunction, attention and concentration difficulties, slowed information processing, brain fog, post-concussion cognitive dysfunction, post-stroke cognitive impairment, vascular cognitive impairment, and cognitive changes associated with neurodegenerative and other complex neurological diseases.

The first objective is to determine what cognitive functions are actually impaired and localize the neurological systems responsible. Memory is not a single brain function, and neither is cognition. Depending on the patient's presentation, Dr. Funk evaluates attention, working memory, learning and memory encoding, consolidation and retrieval, processing speed, executive function, language, visuospatial processing, sensory integration, and other higher cortical functions.

These findings are interpreted anatomically and functionally. Cognitive impairment may involve the hippocampus and medial temporal structures, frontal and prefrontal cortex, parietal and association cortices, thalamus, basal ganglia, cerebellum, brainstem systems, white-matter pathways, and the distributed neural networks connecting these regions. Identifying the pattern of cognitive impairment can help distinguish different neurological processes and direct further diagnostic investigation.

Dr. Funk integrates the patient's cognitive symptoms and neurological examination with detailed medical history, neuroimaging, laboratory testing, medications and nutraceuticals, vascular risk factors, sleep, autonomic function, endocrine and metabolic status, inflammatory and neuroimmune findings, infectious and post-infectious history, previous brain injury, and other objective diagnostic information. When clinically appropriate, additional advanced laboratory testing, neuroimaging, neuromarkers, cognitive testing, or other diagnostic studies may be ordered to investigate the underlying cause.

Advanced neuroimaging can be particularly important when evaluating cognitive and memory decline. Dr. Funk personally reviews relevant brain imaging rather than relying solely on the written radiology report, correlating structural and vascular findings with the neurological examination and cognitive presentation. He evaluates for patterns of cerebral atrophy, hippocampal and temporal-lobe involvement, white-matter disease, cerebral small-vessel disease, previous infarction or stroke, traumatic abnormalities, and other structural or neurovascular findings that may contribute to cognitive dysfunction.

A polysubspecialty approach is particularly important in cognitive and memory disorders because cognitive decline frequently crosses traditional neurological boundaries. Dr. Funk integrates Cognitive and Memory Neurology with Neurodegenerative Neurology, Vascular Neurology, Brain Injury Medicine, Neuroimmunology, Neuroendocrinology, Neuro-Infectious Disease, Dysautonomia, Neuroimaging, and other relevant neurological subspecialties to determine how multiple abnormalities may be interacting within the same patient.

This is especially important when investigating potentially modifiable contributors to cognitive dysfunction. Depending on the individual case, Dr. Funk may evaluate vascular and cerebrovascular disease, glucose and metabolic dysfunction, thyroid and other endocrine abnormalities, nutritional deficiencies, neuroinflammation and autoimmunity, infectious and post-infectious mechanisms, sleep disturbance, autonomic dysfunction and cerebral perfusion, medication effects, previous traumatic brain injury, and other factors capable of affecting neuronal health and cognitive function.

Treatment follows the diagnosis and neurological localization. Rather than treating every patient with memory loss or cognitive impairment using the same protocol, Dr. Funk develops an individualized strategy based on the cognitive systems affected, the underlying disease process, potentially modifiable contributors, and the specific brain regions, pathways, and neural networks involved.

Depending on the neurological localization and the patient's clinical status, treatment may incorporate individualized cognitive and neurological rehabilitation, transcranial photobiomodulation, neuro-optometric rehabilitation, vestibular and oculomotor rehabilitation, sensory and motor rehabilitation, peripheral nerve stimulation, transcutaneous auricular vagus nerve stimulation (taVNS), pulsed electromagnetic field therapy (PEMF), and other targeted neurological rehabilitation and neuromodulation strategies. Nutraceutical and over-the-counter medication strategies may also be individualized according to the patient's neurological, metabolic, vascular, inflammatory, and biochemical findings.

A central objective of rehabilitation is neuroplasticity. Targeted and repeated activation of appropriate neurological systems is designed to strengthen functional neural connections and promote adaptive synaptic, dendritic, axonal, and network-level remodeling. Transcranial photobiomodulation may also be incorporated when clinically appropriate to target specific cortical regions involved in the patient's cognitive dysfunction and support cellular energy metabolism, antioxidant and anti-inflammatory mechanisms, neuroplasticity, and neurological function.

When prescription medication or disease-specific medical management is appropriate, Dr. Funk educates patients regarding relevant therapeutic considerations and coordinates or co-manages care with prescribing clinicians and other specialists.

The goal is not simply to document that a patient has memory loss or cognitive decline. Dr. Funk works to determine what type of cognitive impairment is present, localize the brain regions and neural networks involved, diagnose the underlying neurological disease when possible, identify potentially modifiable contributors, and build an individualized strategy designed to preserve, restore, and optimize cognitive and neurological function.