My motivation to start a preventive neurology practice

It's cliché, I went to medical school to help people. My mom would always say, as long as you are healthy and happy, you have everything you need. Growing up, I didn't appreciate this sentiment to the extent I have come to over time. I didn't have a clear understanding of the impacts of my undergraduate major and educational pursuits early on, so I meandered in college. I ultimately simplified my decision to pursue medical school as a career I could live with. I figured I wouldn't have to sell anyone anything they didn't need and I'd help people be healthy so they could pursue their happiness. 

I definitely learned in my training how to help people be less sick. Modern medicine is an interesting practice with specialists focused on their favorite body system - neurologist (brain and nerves), cardiologists (heart), nephrologists (kidneys), orthopedic surgeons (musculoskeletal system), gastroenterologists (gastrointestinal system), etc - you get the picture! As a neurologist, I learned the basics of lifestyle factors:

Sleep - get enough of it, especially if you have migraines or seizures

Nutrition - eat a balanced diet, unless you have epilepsy then maybe can try keto

Exercise - do it, but with accommodations, if you have weakness or balance issues

Mental health - yes

Smoking - no

I prescribed a lot of clopidogrel and statins as a neurologist seeing stroke patients. I referred patients to physical therapy and counseled them on general lifestyle practices. I remember thinking once a neurologist identifies and treats a stroke, the next step is intense diabetes, high blood pressure, cholesterol, nutrition, and exercise follow-up...but what did that have to do with neurology?

I prescribed donepezil as a neurologist seeing Alzheimer's patients in my resident clinic. I remember being taught that this class of drugs can delay the need for a nursing home. I don't remember being exposed to the idea of preventive neurology for dementia, such as the results of FINGER trial (demonstrated that multidomain lifestyle interventions can prevent dementia and cognitive decline in a Finnish population) or the work of Dr. RIchard Isaacson during my training. 

January 2015: The Alzheimer’s Prevention Clinic at Weill Cornell Medical College / New York - Presbyterian Hospital: Risk Stratification and Personalized Early Intervention

March 2015: A practical algorithm for managing Alzheimer's disease: What when, and why?

June 2015: A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial

March 2016: Nutritional interventions for Alzheimer's prevention: A clinical precision medicine approach

November 2018: The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach

And then when you come upon these studies during the early stages of your mother's diagnosis of Primary Progressive Aphasia, it changes everything. These studies changed my life, seeking an in-depth characterization of my metabolic health and exercise capacity. These studies changed my mind about the impact I could have on preserving health. 

The basics of lifestyle factors I learned early on in training form the basis of a much more in-depth and earlier application of preventive neurology. I have had to shift from the organ system-based way of thinking about medicine. I still have a soft spot for my favorite organ, the brain, and appreciate how all of our lifestyle choices can play a role in our health, ultimately our health and happiness.