Toxic Load

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

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),

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