What Are the Six Types of Alzheimer’s Identified by the ReCODE Program?

Last Updated: November 2025

In this FAQ, Dr. Jessica Knape of HealthSpan Internal Medicine in Boulder, CO, explains that Alzheimer’s is not a single disease but a set of distinct subtypes, each requiring different treatment. Using advanced diagnostics and IntellxxDNA genomics, she identifies each patient’s subtype to guide more effective, personalized care.

Traditional medicine often treats Alzheimer’s disease as one condition with a single cause—usually attributed to amyloid protein buildup. However, research from Dr. Dale Bredesen and the ReCODE Protocol reveals a very different reality: Alzheimer’s is not one disease. It is a collection of biologically distinct subtypes, each driven by different metabolic, inflammatory, hormonal, vascular, toxic, or traumatic processes.

Understanding a patient’s subtype matters because each type requires a different treatment plan. This is why one-size-fits-all medications show limited success, while personalized, root-cause approaches are far more effective—especially in early stages.

At HealthSpan Internal Medicine in Boulder, CO, we use advanced diagnostics and IntellxxDNA genomics to identify which subtype(s) are active for each patient. As someone who spent 10 years in memory care and has seen the limitations of symptom-based treatments firsthand, I believe subtyping is one of the most meaningful advances in cognitive medicine.

Here’s an in-depth look at the six Alzheimer’s subtypes identified by the ReCODE Program—and why they matter for treatment and prevention.

BrainSpan Insight

• Alzheimer’s has six biological subtypes, each with different root causes.

• The ReCODE Program identifies these subtypes using labs, imaging, genomics, metabolic markers, toxin testing, and clinical history.

• Subtyping matters because each type responds to different interventions.

• Genomics (IntellxxDNA) helps clarify inflammatory, detoxification, hormonal, mitochondrial, and vascular risk pathways.

• Personalized treatment consistently outperforms one-size-fits-all drug approaches.

• Early detection gives the best chance for stabilization or improvement.

Key Points

• Alzheimer’s is made up of multiple distinct biological patterns, not a single disease.

• The six ReCODE subtypes: Inflammatory (Type 1), Glycotoxic (Type 1.5), Atrophic (Type 2), Toxic (Type 3), Vascular (Type 4), and Traumatic (Type 5).

• Most patients have a combination of subtypes that interact with each other.

• Identifying subtypes allows for targeted metabolic, inflammatory, hormonal, and detoxification support.

• IntellxxDNA genomics enhances subtype precision by revealing individualized risk patterns.

• Early intervention is essential—MCI and early Alzheimer’s respond best.

• Personalized, root-cause care is more effective than relying solely on medications

Why Alzheimer’s Has Multiple Subtypes

Alzheimer’s symptoms (memory loss, confusion, processing difficulty) emerge when the brain’s support systems fail. But why they fail is different for each person.

ReCODE identifies Alzheimer’s subtypes based on the primary biological driver:

• Is inflammation high?

• Is insulin resistance present?

• Are hormones depleted?

• Are toxins overwhelming detox pathways?

• Are vascular issues decreasing blood flow?

• Has trauma disrupted brain function?

• Are genomic variants playing a role?

These distinctions matter because treatment must match the driver.
You cannot treat toxin-related Alzheimer’s the same way you treat glycotoxic Alzheimer’s.

The Six ReCODE Alzheimer’s Subtypes

1. Type 1 — Inflammatory (“Hot”) Alzheimer’s

Driven primarily by chronic inflammation, this subtype is common in those with:

• Elevated CRP or cytokines

• Chronic infections

• Leaky gut or chronic GI inflammation

• Autoimmune tendencies

• Periodontal disease

• Metabolic inflammation

Typical symptoms develop gradually.

Treatment focus:

• Reduce inflammatory load

• Treat chronic infections

• Heal gut and immune imbalance

• Support microglial regulation

• Evaluate genetics tied to inflammation (IntellxxDNA markers)

2. Type 1.5 — Glycotoxic (“Sweet”) Alzheimer’s

This hybrid subtype combines inflammation (Type 1) and insulin resistance (Type 2 diabetes physiology).

Common findings include:

• High fasting insulin

• Elevated glucose or HbA1c

• Metabolic syndrome

• Excess visceral fat

• Brain glucose hypometabolism

Treatment focus:

• Improve insulin sensitivity

• Consider ketogenic or low-glycemic nutrition

• Support mitochondrial function

• Lower inflammation

• Reduce advanced glycation end-products (AGEs)

This subtype is increasingly prevalent and highly responsive to metabolic repair.

3. Type 2 — Atrophic (“Cold”) Alzheimer’s

This subtype is driven by loss of hormonal, trophic (growth), and nutrient support to the brain.

Common triggers:

• Menopause/perimenopause

• Low sex hormones

• Low thyroid

• Low vitamin D, B12, folate

• Low nerve growth factors

• Chronic stress with adrenal dysfunction

Treatment focus:

• Restore hormone balance (with safety-first medical oversight)

• Correct nutrient deficiencies

• Support adrenal function and circadian rhythm

• Improve sleep architecture

• Genomics can clarify how hormones and nutrients are processed

Atrophic Alzheimer’s often responds extremely well when addressed early.

4. Type 3 — Toxic Alzheimer’s (“Vicious”)

This subtype is associated with environmental toxins, such as:

• Mold/mycotoxins

• Heavy metals

• Industrial chemicals

• Pesticides

• Airborne pollutants

Symptoms often include:

• Brain fog

• Word-finding issues

• Executive dysfunction

• Mood changes

• Multisystem inflammation

Treatment focus:

• Identify and remove toxin exposures

• Support detoxification pathways

• Use binders when appropriate

• Correct mitochondrial and inflammatory damage

• IntellxxDNA identifies detox gene vulnerabilities

This subtype requires careful medical guidance due to the complexity of detox.

5. Type 4 — Vascular (“Pale”) Alzheimer’s

This subtype is driven by compromised blood flow, often from:

• Hypertension

• High LDL or triglycerides

• Atherosclerosis

• Microvascular damage

• Sleep apnea

• Chronic endothelial dysfunction

Treatment focus:

• Improve vascular health

• Treat sleep apnea

• Reduce blood pressure and lipid risk markers

• Support nitric oxide and microcirculation

• Genomics can reveal vascular and lipid metabolism variants

Addressing vascular drivers often produces significant cognitive improvement.

6. Type 5 — Traumatic (“Dazed”) Alzheimer’s

This subtype is related to:

• Traumatic brain injury (TBI)

• Concussions

• Repetitive head trauma

• PTSD-associated brain changes

Treatment focus:

• Support neuroplasticity

• Reduce inflammation

• Optimize sleep and oxygenation

• Improve metabolic resilience

• Enhance mitochondrial repair pathways

These patients often need layered treatment strategies combining metabolic, neurological, and psychological support.

Why Subtyping Matters

Identifying Alzheimer’s subtype(s) changes everything.

Without subtyping:

• Treatments are generic

• Medications offer limited results

• Key drivers go unaddressed

• Early changes are missed

• Patients decline despite “doing everything right”

With subtyping:

• Treatment becomes targeted

• Metabolic, hormonal, inflammatory, and toxic pathways are corrected

• Genomics clarifies unique vulnerabilities

• Progress is monitored and measurable

• Early intervention becomes powerful

Most patients have more than one subtype, and their treatment plan must address all relevant pathways.

How IntellxxDNA Genomics Enhances Precision

At HealthSpan Internal Medicine, IntellxxDNA helps us refine subtype identification by analyzing:

• Inflammatory risk genes

• Detoxification and toxin sensitivity genes

• Hormone metabolism pathways

• APOE and Alzheimer’s-specific variants

• Methylation and mitochondrial genes

• Vascular and lipid gene variants

• Oxidative stress pathways

Genomics turns guesswork into precision and helps us tailor a plan that matches your unique biology.

Early Detection Matters Most

ReCODE subtyping is most effective when applied to:

• Mild cognitive impairment (MCI)

• Early Alzheimer’s

• Subjective cognitive decline

• Individuals with strong family history

• High-risk genomic patterns (e.g., APOE ε4)

The earlier we identify the subtype(s), the more we can do to preserve or improve cognitive function.

When to Seek Urgent Care

Seek immediate medical attention for:

• Sudden confusion

• One-sided weakness or facial drooping

• Severe headache or vision changes

• Sudden speech difficulty

• Chest pain or shortness of breath

These symptoms may indicate a stroke or medical emergency.

Sources

1. Reversal of Cognitive Decline: A Novel Therapeutic Program

Bredesen DE, 2014

This landmark paper was the first to demonstrate that cognitive decline in Alzheimer’s disease and mild cognitive impairment could be reversed using a comprehensive, personalized therapeutic protocol. It documents case studies showing measurable improvement within months, laying the foundation for what is now known as the ReCODE Protocol.

Read the full article:
https://pubmed.ncbi.nlm.nih.gov/25324467/

2. Precision Medicine Approach to Alzheimer’s Disease

Toups K, Bredesen DE et al., 2022

This clinical trial evaluated the ReCODE/precision-medicine approach in a larger cohort, showing that most participants experienced significant improvements in cognitive testing over 9 months. The study reinforces that targeted, multi-domain interventions can stabilize or reverse early Alzheimer’s disease.

Read the full article:
https://pubmed.ncbi.nlm.nih.gov/36365455/

3. ReCODE: A Personalized, Targeted, Multi-Factorial Therapeutic Program for Reversal of Cognitive Decline

Rao RV, Bredesen DE et al., 2021

This peer-reviewed paper outlines the scientific foundation of the ReCODE Protocol and documents measurable cognitive improvements in individuals with early Alzheimer’s disease and MCI. It highlights how a precision-medicine, multi-factorial approach can stabilize or reverse decline—supporting the idea that improvements often emerge over the first several months of treatment.

Read the full article:
https://pmc.ncbi.nlm.nih.gov/articles/PMC8533598/

4. Sustained Cognitive Improvement in Alzheimer’s Disease and Mild Cognitive Impairment Following a Precision Medicine Protocol

Bredesen DE et al., 2024

This publication presents long-term follow-up data showing that many patients not only improve on the ReCODE Protocol but maintain gains for multiple years. It provides real-world evidence that cognitive benefits can emerge gradually and continue to strengthen with ongoing protocol adherence.

Read the full article:
https://www.mdpi.com/2227-9059/12/8/1776v

5. Reversal of Cognitive Decline: 100 Patients

Bredesen DE et al., 2018

This expanded case-series analysis follows 100 patients treated with the ReCODE Protocol, demonstrating consistent cognitive improvements across multiple subtypes of Alzheimer’s disease and mild cognitive impairment. The paper provides real-world evidence that a personalized, multi-domain therapeutic approach can produce measurable gains in memory, executive function, and daily performance—often within the first several months of intervention.

Read the full article:
https://pubmed.ncbi.nlm.nih.gov/30005175/

Medically reviewed by
Dr. Jessica Knape, MD, MA Board Certified in Internal Medicine and Integrative and Holistic Medicine
Healthspan Internal Medicine — serving patients in Boulder, CO

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This content is for educational purposes and does not replace personalized medical advice.