Brain Blog

I am not in resident clinic this month. Which means, for the first time in a while, I have had time to sit with the journals rather than just scan them between placing orders and writing notes. One article stopped me. Published just this week in FEBS Open Bio, researchers from King's College London reported pre-clinical results on a compound called KCL-286 — a drug that targets something most people have never considered in the context of Alzheimer's disease: DNA damage. Not

I have not been in resident clinic this month (although I am now officially a PG-Y3!). Which has given me time to do something I rarely get enough of during a busy resident schedule: sit with topics that deserve more careful attention than they typically receive in a neurology training environment. Art therapy is one of them. It is the kind of intervention that gets discussed at the edges of clinical conversations — mentioned in passing at care conferences, offered in memor

There is a question I ask every new patient in my resident neurology clinic that many people do not expect to hear in that setting. "What did you do for work?" In a clinic focused on memory and cognitive health, the question surprises some patients. They came in about their brain — what does their career have to do with it? Sometimes I can see them wondering if I have pulled up the wrong chart on my laptop (this has literally happened to me twice). But the occupational his

My program director gave a talk recently on Parkinson's disease. It was a good talk, the kind that reminds you how much territory a single neurological condition covers: the dopamine, the tremor, the rigidity, the gait, the autonomic dysfunction, the sleep problems. I left thinking I had a reasonably solid grasp of the disease. Then, literally later that same day, I saw a Parkinson's patient in resident clinic. He was there for his routine motor symptom follow-up following t

I came back to the hospital service recently after spending several months focused on outpatient neurology, and I was reminded immediately of something I had not thought about in a while: the sheer volume of stroke patients moving through our facility. Ischemic strokes mostly, hemorrhagic strokes occasionally, TIAs daily, young patients not infrequently, and octogenarians predictably — the stroke service is relentless in a way that focuses your clinical attention almost entir

This week I had two separate visits in my resident clinic that were striking in similarity. Both patients were brought in by family — one an adult child, the other a spouse — people who clearly love the person sitting beside them and who had taken time off work, rearranged their schedules, driven through Nashville traffic, and parked in the wilds of our hospital construction to be in that room. Both patients were in what I would describe as a difficult middle place: still m

Most of my blog topics come from patients. A question asked across the exam room in my resident clinic, a family navigating something I had not written about yet, a clinical moment that stays with me on the drive home. This week was different. One of my favorite attendings — an epileptologist whose clinical instincts I deeply respect — mentioned a term in passing during a conversation: epilepsy-related dementia. I nodded, but when I got home I realized I had never given this

It started earlier this week with a conversation that had nothing to do with a patient. A pharmaceutical representative visited my resident clinic to discuss a medication that had just received FDA approval — not for Alzheimer's disease itself, but for one of its most disruptive and distressing symptoms: agitation. And as I listened, something clicked that I have been meaning to write about for a while. We spend so much of our energy in this area — and correctly so — talking

There is a particular type of silence that falls over the room when this question gets asked. A family came into my resident clinic recently — adult child and spouse accompanying a loved one with early dementia — and at some point during the visit, one of them turned to me and asked whether their loved one should still be driving. I have been asked this before. But something about this specific encounter stayed with me. I could read the room clearly: the family wanted permis

There is a question I ask every new patient in my neurology resident clinic, and I ask it regardless of what brought them in. "Have you ever had a significant head injury?" The answers surprise people. Not the question — the answers. Because once I ask it and give them a moment to think, the stories come out. A car accident in their thirties that put them in the ER overnight. A fall from a ladder that left them with a headache for two weeks. Years of playing football or ho

Something happened in my resident neurology clinic recently that I have been thinking about ever since. A patient came in to discuss Leqembi and Kisunla — the two newer anti-amyloid medications that represent the first drugs in history to actually slow the progression of Alzheimer's disease rather than just manage its symptoms. The conversation was going well. Then I looked at the genetic results in the chart. This patient carried two copies of the APOE-E4 gene — what we ca

Several months ago, I published a post on this blog about the emerging research into GLP-1 receptor agonists — drugs like semaglutide (Ozempic, Wegovy) — and their potential role in Alzheimer's disease prevention and treatment. I was careful then to frame the science accurately: the observational data was compelling, the biological rationale was sound, and the Phase 3 EVOKE and EVOKE+ trials were the rigorous test the field needed. I promised to update when the results arrive

There is a particular kind of number that stops you mid-sentence when you first encounter it. Not because it is surprising, exactly, but because seeing it written down forces a reckoning with something you knew abstractly but had never quite confronted directly. Here is one of those numbers: today, in the United States, someone develops Alzheimer's disease every 65 seconds. I want to spend this post sitting with numbers like that — not to alarm, but to understand. Because o

Let me be direct about something before we begin. I am skeptical of supplements by default. As a neurology resident (neurologist-in-training), I have watched patients spend significant money on products that are, at best, inert and, at worst, misleading. The supplement industry is poorly regulated, the marketing is frequently ahead of the evidence, and the word "supports" on a label can mean almost anything. So when I recommend a supplement, it is because I have done the re

I know what happens when I bring up exercise in the clinic during appointments with my patients. There is a particular look. A slight shift in the chair. Sometimes a polite nod that communicates, clearly, that this conversation has been had before and that it did not result in a gym membership. I understand it. The word "exercise" carries decades of cultural baggage — images of early mornings, discomfort, athletic ability that was never there to begin with, and a time commit

I want to tell you about a conversation I have frequently in my resident clinic. A patient comes in concerned about memory. They're forgetting names, losing their train of thought mid-sentence, feeling mentally foggy in a way that wasn't there a few years ago. We go through the workup. And somewhere in the history, frequently as an afterthought, they mention that they haven't been sleeping well for years. They wake up at 3 am and can't get back down. Or they're in bed for ei

There is a conversation I have had a few times in the last several months in my resident clinic that I believe is worth blogging about. A family comes in — often adult children accompanying a parent in their mid-to-late eighties — and they describe a pattern that has been quietly unfolding for years. The memory has been slipping. Slowly. Names, recent conversations, why they walked into a room. But the person sitting across from me can still tell me where they vacationed in 1

I want to tell you about a patient I see more often than you might think. She comes in worried about her memory. She's been forgetting names. She walked into the kitchen last week and couldn't remember why. Her family is concerned. And when I sit across from her with her MoCA results and her chart, I notice something that never surprises me anymore: her blood pressure has been quietly elevated for years. Her last echocardiogram showed reduced ejection fraction. Nobody connect

If you are caring for a loved one in cognitive decline, the last thing you need is a 20-step recipe involving fancy ingredients you can’t even find at your local grocery store. You are already managing medications, appointments, and daily safety; the idea of "overhauling" a pantry feels impossible. However, the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) is widely considered the "gold standard" of nutritional neuroscience for a reason: it works. R

In the world of Alzheimer’s research, we often get caught up in the hunt for the "miracle cure"—the breakthrough drug that will stop neurodegeneration in its tracks. Because the current standard-of-care medications don't do that, they often get a bad, or at least boring, reputation. You may have heard them described as "minimally effective" or "not worth the side effects." However, in clinical practice, I see a different story. I’ll dub them the "Big 4"—Donepezil (Aricept),