Brain Blog

No two people arrive at this website for exactly the same reason. Some of you are in your 50s and have watched a parent disappear into dementia, and you are quietly, but urgently, wondering whether you are next. Some of you are caregivers — a spouse, an adult child — navigating a diagnosis that arrived without a roadmap. Some of you have noticed something subtle in yourself: a name that won't come, a word that hovers just out of reach, a sharpness that feels slightly less sh

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),

For decades, we viewed the aging brain through a narrow lens. We saw "memory loss" as the starting line for Alzheimer’s and "mood changes" as a secondary byproduct of getting older. But the emerging science tells a much more proactive story. We now know that the link between depression and dementia is not just real—it is foundational. In many cases, depression isn't just a reaction to losing one's memory; it is a "pre-clinical" symptom—a biological red flag that appears year

If I told you there was a new drug that could simultaneously lower cortisol, improve gait and balance, trigger deep-seated memories in non-verbal patients, and stimulate neuroplasticity in the hippocampus—all with zero side effects—it would be the lead story on every news cycle. That "drug" actually exists. It’s music. However, we need to move past the idea/misunderstanding that music therapy is just putting headphones on a patient and walking away. While passive listening

In the high-stakes world of neurology, we often get caught up in the "glamour" of $5,000 PET scans and the latest monoclonal antibody infusions like Leqembi and Kisunla . But as a resident clinician, the most important ten minutes of my day aren’t spent looking at a computer screen—they are spent sitting across from a patient with a single sheet of paper and a pen. That single sheet of paper is the Montreal Cognitive Assessment (MoCA) . I recently became officially accredi

In the world of neurodegeneration, we mark time by the "before" and the "after." For twenty years, we lived in the "before"—an era where our only tools were medications that masked symptoms without touching the underlying disease. Then, in 2023 and 2024, the landscape shifted. With the arrival of Leqembi (lecanemab) and Kisunla (donanemab) , we entered the "after." I have long maintained that these drugs represent a monumental leap forward—not because they are "cures," but

In my resident clinic, I often meet families who are confused when I don't immediately use the "A-word." They’ve noticed a loved one is struggling, and they’ve already jumped to the conclusion that it’s Alzheimer’s. When I explain that we are looking at something else—perhaps Vascular Dementia or Lewy Body Dementia—the reaction is often a mix of relief and confusion. "Isn't that just another name for Alzheimer's?" they ask. The answer is a firm no . Dementia is not a single

The landscape of modern healthcare is shifting toward shared accountability. We see it in the explosion of wearable fitness trackers and the availability of at-home kits for everything from cholesterol to colon cancer screening. It was only a matter of time before this trend reached the world of memory care. Today, the "Black Box" of neurology is opening. Patients no longer have to wait for a specialist appointment to begin investigating their cognitive health. However, as a

In the field of neurology, we are often forced to manage expectations as much as we manage symptoms. For decades, the search for effective Alzheimer’s treatments has been marked by more setbacks than breakthroughs. However, a new area of study is gaining significant momentum in the research community, centered on a surprising class of medications: those originally designed to treat Type 2 Diabetes (DM2). While the headlines are full of "new hope," as a provider, it is my res