Why I Stopped Waiting for Patients to Get Sick
Why Dementia Prevention Became Personal
My father died of a cardiac arrest at age 44. I was 11 and prior to that had no real understanding of his health. I knew that he was diabetic, on insulin, slender (although he’d been chubby till his early 30s), exercised almost daily after work, and tried to eat carefully though even as a physician himself, seemed to not really have an understanding of how to do that. He lived the “American Dream” in Virginia as an immigrant from South Asia, working 60 hours per week, relatively isolated other than for his medical community. I’m now nearly 10 years older than his age at death and this extra decade often feels like a bonus as my own mortality looms.
The Question I Couldn’t Answer for Years
My father's siblings eventually died only in their late 80s, but all had significant cognitive decline that rendered them completely dependent on their families in their final decade. Understanding that they likely had vascular dementia, as well as the gravity of my father's own metabolic and cardiovascular disease, motivated me to question my own dementia risk and what I might do to mitigate or delay its onset.
Over the past 21 years I've had the same question from countless family members of patients with dementia: Doctor, what can I do to try and not let this happen to me? Until recently, like most doctors, I would tell them there's not much one can do besides trying to eat well, sleep, and exercise. I'd refer them to the MIND or Mediterranean diet but for the most part the sentiment was that dementia is devastating — but there's not much we can do about it.
Why Mainstream Medicine Has Lagged Behind Prevention
Dementia prevention isn't easy, but it doesn't have to be complicated. So why isn't mainstream medicine doing more? The reasons are straightforward:
First, pharmaceutical and medical device companies dictate the direction of physician education — just visit a medical conference and you'll see what I mean. Advocating for lifestyle change isn't going to satisfy their shareholders.
Second, our insurance payment model is disease-focused. There is no reimbursement code for dementia preventive care, so doctors have little time or incentive to learn about it.
Third, it takes 10 to 20 years for medical research to reach the clinic unless the face of that innovation is social media savvy — kudos to you, Dr. Mosconi.
Fourth, doctors are drowning in electronic medical records and insurance bureaucracy and don't have time to pursue independent learning out of curiosity.
Fifth, there is no standardized model of care or educational emphasis for dementia prevention established by professional neurologic societies such as the American Academy of Neurology.
The good news is that there are very actionable steps patients can take. But when traditional medical guidance is lacking, social media and influencers fill the gap — and then the volume and legitimacy of advice becomes overwhelming and hard to sort through. A patient could fill their days with a fistful of supplements, tonics, exercise regimens, breathwork, prescription medications, and specialty diets without knowing if they're making any real progress or even knowing what their goals are.
A More Systematic Approach to Brain Health
This is where a more structured, proactive approach to preventive neurology comes in. We start with a simple question: what do you want from your last decades of life in terms of cognitive function, and what does your physical health need to look like to support that? From there we take objective stock of where you are now and build a strategy to get you where you want to be — accounting for age-related change along the way. By breaking it down and knowing what data to track, we can prioritize which interventions are most relevant for you and build on them over time.
Turning the Lens on My Own Brain Health
In 2023 this is exactly what I did for myself. At a granular level: I want to be cognitively able to be useful to my family and my community. I want to be someone they look to for advice and to continue to be able to boss them around. I'd like to manage my finances independently. I want to feel grounded spiritually and have the concentration to meditate. I'd like to remain a continuous learner and hold meaningful conversations.
Physically, I'd like to have an abundant porch garden where I can prop an easel and paint. I'd like to be able to hike a gentle hill for a mile with a 10-pound pack. I'd like to travel internationally and cook for myself — cut vegetables and open lids. Along the way I'd like to achieve my dream retirement job of being a senior yoga instructor. None of these are unattainable, but it is a lot to ask of an 85 to 90-year-old body, mind, and brain. So I have my work cut out for me.
Taking stock of the physical picture was relatively easy. I was about 5 to 10 pounds above where I wanted to be. I thought I was relatively fit, exercising four to five times a week — but nothing regimented. I'd had chronic foot and back pain for about five years and had seen multiple physical therapists and chiropractors without making real progress. I love hiking but am typically slow and max out at about a 25-pound pack after six to seven hours. Mild stress incontinence limited jumping or sudden sprints.
The cognitive and spiritual self-assessment was harder. I've never been formally diagnosed with ADHD but have always compensated for poor attention and concentration through quick reasoning, fastidious lists, and shaping my environment to maintain focus. A year from my last period and experiencing hot flashes, I was finally living what dozens of middle-aged women had described to me over the years — that frustrating, hard-to-articulate brain fog. Lifelong insomnia, conditioned by decades of all-nighters in college and medical training, was made worse by night sweats and a racing mind. And perhaps most importantly, I saw a therapist and came to terms with the fact that my work as a physician within an industry driven by insurance and pharmaceutical profit was not aligned with my values — and was slowly wearing me down.
Why Advanced Testing Changed My Strategy
From an objective standpoint, I started with the data I had. My blood pressure was consistently healthy. An MRI at age 40 for migrainous symptoms had been normal, so given the cost I didn't repeat it. I'd been resisting a statin despite high cholesterol and LDL, perhaps falsely reassured by a coronary calcium score of zero at age 45. Advanced lipid testing revealed that I was in the 20% of the population with markedly elevated risk of early heart and cerebrovascular disease. My hemoglobin A1c was technically normal, but post-meal glucose monitoring revealed significant spikes despite low-normal fasting blood sugar and insulin levels. A DEXA scan showed that despite regular exercise and a healthy vegetarian diet, I was adequately nourished but significantly under-muscled. My grip strength and cardiovascular recovery were low-average. Additional labs indicated I was trending toward Hashimoto's thyroiditis, though most routine inflammatory markers were reassuring. The picture was clear: I had real room for improvement in muscle mass, strength, and cardiovascular fitness — and given how rapidly both decline after age 50 and menopause, there was no time to lose.
Working Smarter, Not Harder
Addressing all of this at once would have been overwhelming, so I needed to prioritize. When it comes to the brain, all roads lead to three things: energy delivery, energy efficiency, and how well the brain clears its waste. Looking at my results through that lens, improving my metabolic health was the obvious starting point.
The first step was a continuous glucose monitor, which I've now worn intermittently for nearly two years. It has been genuinely life-changing in terms of understanding how my behavior affects my blood sugar and staying accountable. I committed to a statin and began following an advanced lipid panel periodically. After a month or two of that foundation, I refined my protein intake and added targeted time-restricted eating a few days a week.
I asked my gynecologist to prescribe menopausal hormone therapy and within weeks the hot flashes were gone. I took a sleep medicine course, implemented behavioral changes, and began sleeping better — and feeling cognitively sharper as a result. I've never been inclined toward supplements, but the more I learned about our modern food supply, the more convinced I became that certain vitamins and minerals genuinely need supplementing given their role in neuronal function. I added targeted probiotics for glucose regulation and reintroduced lean meat and fish into my previously vegetarian diet to support energy and protein needs.
On the fitness side, I added a progressive kettlebell regimen to my daily walks several times a week, two hard cardio-interval sessions weekly, and continued weekly yoga. A pelvic floor regimen resolved the incontinence. A chiropractor specializing in Dynamic Neuromuscular Stabilization helped me address the back and foot pain that had limited me for years. Reaching my physical goals will by definition be a lifelong endeavor — but by working systematically rather than randomly, I have a clear strategy and a way to track progress safely.
Why I Left Traditional Neurology
Perhaps most importantly, I took time to reflect on what mattered to me. After 21 years of practicing and managing a neurology private practice alongside colleagues and staff I genuinely loved, I realized I needed to make a change if I wanted to stay connected to what drew me to medicine in the first place.
I love understanding people — what motivates them, what makes them happy, and finding ways to help them function better. I was getting glimpses of that in my former practice, but I always felt rushed, forced to work within silos rather than engaging with the full complexity of the nervous system and how it relates to the rest of the body. The administrative burden of fighting insurance and pharmaceutical companies was exhausting and unsustainable. In 2024, with a heavy heart, I said goodbye to my colleagues and patients.
Why Preventive Neurology and Dementia Prevention Matter Now
This kind of granular, personalized approach doesn't have to be complicated — but it isn't automatic either. My strategies won't be right for everyone. Being a physician gave me the framework to prioritize and identify which tactics to pursue. But for relatively modest cost — other than the DEXA and CGM, all of my testing was covered by insurance — I've seen real benefit. I'm stronger. I sleep better. I have cognitive resilience I hadn't felt in years. Most of all, I have agency over my own health rather than feeling adrift in it.
By defining clear goals with specific parameters, I've identified where to focus, how to build the support I need, and where work remains.
There is so much we can be doing to prevent dementia. Even with decades of experience as a neurologist, I didn't previously know what to tell patients beyond simple platitudes. I'm genuinely excited about the work ahead. If we can stay curious and open-minded while remaining scientifically rigorous, there is much to learn and much to offer.
Eventually, one way or another, our time will be up. My own life experience and this work remind me that any day can bring the unexpected. But ultimately, I'd like anyone who knows me to say that she went down trying.
