Neurotransmitter & Cognitive Health

Please check the appropriate number on all questions below ("0" leave blank as the least/never to "3" as the most/always).

Section 1 Brain Circulation

Rows	1	2	3
Low brain endurance for focus and concentration
Cold hands and feet
Must exercise or drink coffee to improve brain function
Poor nail health
Fungal growth on toenails
Must wear socks at night
Nail beds are white instead of pink
The tip of the nose is cold

Brain Circulation Score

Based on your results, you may need support to optimize blood flow to your brain.

Section 2 Sugar Metabolism

Rows	1	2	3
Irritable, nervous, shaky, or light-headed between meals
Feel energized after meals
Difficulty eating large meals in the morning
Energy level drops in the afternoon
Crave sugar and sweets in the afternoon
Wake up in the middle of the night
Difficulty concentrating before eating
Depend on coffee to keep going

Sugar Metabolism Score

Based on your score, you may need to support your blood sugar metabolism.

Section 3 Peripheral Use of Sugars

Rows	1	2	3
Fatigue after meals
Sugar and sweet cravings after meals
Need for a stimulant, such as coffee, after meals
Difficulty losing weight
Increased frequency of urination
Difficulty falling asleep
Increased appetite

Peripheral Use of Sugars Score

Based on your score, you may need support increasing insulin sensitivity + blood sugar metabolism.

Section 4 Stress

Rows	1	2	3
Always have projects and things that need to be done
Never have time for yourself
Not getting enough sleep or rest
Difficulty getting regular exercise
Feel that you are not accomplishing your life’s purpose

Stress Score

Based on your score, you may need support to counter the metabolic effects of stress.

Section 5 Essential Fatty Acids

Rows	1	2	3
Dry and unhealthy skin
Dandruff or a flaky scalp
Consumption of processed foods that
are bagged or boxed
Consumption of fried foods
Difficulty consuming raw nuts or seeds
Difficulty consuming fish (not fried)
Difficulty consuming olive oil, avocados, flax seed oil, or natural fats

Essential Fatty Acids (EFAs) Score

Based on your score, EFAs may be beneficial for you. EFAs from fish or algae, e.g. is vital to brain function + heath.

Section 6 Gut

Rows	1	2	3
Difficulty digesting foods
Constipation or inconsistent bowel movements
Increased bloating or gas
Abdominal distention after meals
Difficulty digesting protein-rich foods
Difficulty digesting starch-rich foods
Difficulty digesting fatty or greasy foods
Difficulty swallowing supplements or large bites of food
Abnormal gag reflex

Gut Score

Based on your score, you may need to support your brain health by restoring your gut health. Nutrients to build and maintain intestinal mucosal integrity, restore intestinal immune function, balance the microbiome + overall digestion may be helpful.

Section 7 Gluten Digest

Rows	1	2	3
Grain consumption leads to tiredness
Grain consumption makes it difficult to focus and concentrate
Feel better when bread and grains are avoided
Grain consumption causes the development of any symptoms
A 100% gluten-free diet (Leave blank for no, "3" for yes)

Gluten Digest Score

Based on your score, digestive enzymes with specially targeted bioflavonoids to address gluten + casein exposures may be supportive for your gut + overall health.

Section 8 Immune

Rows	1	2	3
Brain fog (unclear thoughts or concentration)
Pain and inflammation
Noticeable variations in mental speed
Brain fatigue after meals
Brain fatigue after exposure to chemicals, scents, or pollutants
Brain fatigue when the body is inflamed

Immune Score

Based on your score, antioxidants + natural anti-inflammatories may be supportive for your immune system + how it relates to your brain function.

Section 9 Intestinal Barrier

Rows	1	2	3
A diagnosis of celiac disease, gluten sensitivity, hypothyroidism, or an autoimmune disease (Leave blank if no, 3 if yes)
Family members have been diagnosed with an autoimmune disease (Leave blank if no, 3 if yes)
Family members who have been diagnosed with celiac disease or gluten sensitivity (Leave blank if no, 3 if yes)
Changes in brain function with stress, poor sleep, or immune activation

Intestinal Barrier Score

Based on your score, your intestinal environment may need support in order to optimize your immune system + brain health.

Section 10 Serotonin

Rows	1	2	3
A loss of pleasure in hobbies and interests
Feel overwhelmed with ideas to manage
Feelings of inner rage or unprovoked anger
Feelings of paranoia
Feelings of sadness for no reason
A loss of enjoyment in life
A lack of artistic appreciation
Feelings of sadness in overcast weather
A loss of enthusiasm for favorite activities
A loss of enjoyment of favorite foods
A loss of enjoyment in friendships and relationships
Inability to fall into deep, restful sleep
Feelings of dependency on others
Feelings of susceptibility to pain

Serotonin Score

Based on your score, nutrients to support your serotonergic system may be helpful.

Section 11 Dopamine

Rows	1	2	3
Feelings of worthlessness
Feelings of hopelessness
Self-destructive thoughts
Inability to handle stress
Anger and aggression while under stress
Feelings of tiredness, even after many hours of sleep
A desire to isolate yourself from others
An unexplained lack of concern for family and friends
An inability to finish tasks
Feelings of anger for minor reasons

Dopamine Score

Based on your score, your dopamine levels may need nutrient support to enhance feelings of motivation + well-being.

Section 12 Acetylcholine

Rows	1	2	3
A decrease in visual memory (shapes and images)
A decrease in verbal memory
Occurrence of memory lapses
A decrease in creativity
A decrease in comprehension
Difficulty calculating numbers
Difficulty recognizing objects and faces
A change in opinion about yourself
Slow mental recall

Acetylcholine

Based on your score, you may need to support your acetylcholine levels primarily to stimulate cognition + memory function.

Section 13 Catecholamines

Rows	1	2	3
A decrease in mental alertness
A decrease in mental speed
A decrease in concentration quality
Slow cognitive processing
Impaired mental performance
An increase in the ability to be distracted
Need coffee or caffeine sources to improve mental function

Catecholamines Score

Based on your score, you may need to support your catecholamine levels, which are involved in alertness, concentration, working memory, + mental speed.

Section 14 GABA

Rows	1	2	3
Feelings of nervousness or panic for no reason
Feelings of dread
Feelings of a "knot" in your stomach
Feelings of being overwhelmed for no reason
Feelings of guilt about everyday decisions
A restless mind
An inability to turn off the mind when relaxing
Disorganized attention
Worry over things never thought about before
Feelings of inner tension and inner excitability

GABA Score

Based on your score, Supporting your GABA levels for better stress adapatation + sleep may be warranted.

ASSESSMENT COMPLETE
The Path to Cognitive Restoration

You have successfully mapped your current neuro-chemical landscape. While this data offers a snapshot of your biology, the true value lies in translating these results into a functional strategy for recovery.

If you are ready to resolve brain fog, expand your cognitive bandwidth, and restore neurological integrity, it is time to bridge the gap between data and action.

THE DISCOVERY PROCESS

To ensure a high standard of care and clinical alignment, we invite you to a 10-minute Neuro-Clinical Discovery Call. During this brief session, Dr. Varela will:

Analyze: Briefly review your assessment findings.

Strategize: Outline the initial clinical path toward cognitive clarity.

Evaluate: Determine if our comprehensive, data-driven approach is the right fit for your goals.

RECLAIM YOUR EDGE Provide your name below to submit your results, then select a time for your call.

[ BOOK YOUR DISCOVERY CALL ]

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