Cognitive & Social Reserve

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

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

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 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

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