The Neurologist's Role in Promoting Brain Health

 

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The Neurologist's Role in Promoting Brain Health

Linda M. Selwa https://orcid.org/0000-0001-9539-5225, Brenda L. Banwell https://orcid.org/0000-0001-6354-6770, Meeryo Choe https://orcid.org/0000-0001-8142-9471, Louise D. McCullough https://orcid.org/0000-0002-8050-1686, Sara Merchant https://orcid.org/0009-0006-1885-4938, Bruce Ovbiagele https://orcid.org/0000-0002-9958-0644, Joel Salinas https://orcid.org/0000-0002-3735-0018, Ann H. Tilton https://orcid.org/0000-0002-3829-971X, and Gregory Scott Day https://orcid.org/0000-0001-5133-5538Authors Info & Affiliations

January 14, 2025 issue

104 (1)

https://doi.org/10.1212/WNL.0000000000210226

• • Abstract
  • Introduction
  • Scope and Disclaimers
  • Discussion
  • Glossary
  • Study Funding
  • Disclosure
  • Publication History
  • Supplementary Materials
  • References
• • Information & Authors
  • Metrics & Citations
  • View Options
  • References
  • Media
  • Tables
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Abstract

Neurologic conditions are a leading cause of morbidity and mortality within the United States and worldwide. Brain health is a global concern, and the American Academy of Neurology's Brain Health Initiative promises to drive progress in this field over the next decades. Neurologists with detailed training and insight into brain function are uniquely positioned to apply emerging preventive health data to promote healthy brain development and maintain optimal brain function throughout the lifespan. The neurologist's role in promoting brain health is also vital in patients with active neurologic disease, in whom preventive measures may reduce recurrence or slow progression of disease and may enhance quality of life and overall function. In this Emerging Issues in Neurology article, we present the factors that may protect brain function and frame a practical approach to screening assessments and preventive interventions that neurology clinicians may consider to improve the brain health of patients at all life stages.

Introduction

Neurologic conditions are a leading cause of morbidity and mortality, affecting more than 3 billion people worldwide and exacting an increasing toll across the United States.^1–3 Limitations on CNS regrowth and repair emphasize the need to prevent or treat neurologic disease at the earliest symptomatic stages to slow progression, minimize disability, optimize development, and improve brain health. As the world's largest association of neurologists and neuroscience professionals,⁴ the American Academy of Neurology (AAN) is best positioned to empower and equip neurologists to accomplish these goals. Promoting brain health for all is central to the AAN's mission and at the core of the AAN's groundbreaking Brain Health Initiative,⁵ which includes a call to action to ensure that individuals attain and maintain the optimal neurologic function that best supports their physical, mental, and social well-being from the earliest stages of development to their oldest years.⁶ Clear synthesis of practical evidence-based practices to promote brain health is essential to this mission.

Scope and Disclaimers

This Emerging Issues in Neurology (EIN) article summarizes emerging evidence that informs strategies to support and maintain brain health across the patient lifespan and across neurologic subspecialties. A high priority is placed on identifying accessible interventions that can be readily integrated within the standard neurologic assessment to promote brain health at every clinical encounter. Special attention is given to vulnerable populations who experience a disproportionate burden of neurologic disease and may benefit most from approaches designed to optimize brain health. This EIN article also explores gaps in the evidence concerning brain health (i.e., what is not known), outlining possible next steps required to realize the ambitious mission of ensuring brain health for all.

EIN articles are published by the AAN and its affiliates with the goal of providing timely and informal guidance (derived from expert consensus opinion) to neurologists about new or emerging issues that have immediate implications for patient care, but for which a formal evidence base is still evolving. The information in an EIN article (1) should not be considered inclusive of all proper treatments or methods of care, (2) does not represent a statement of the standard of care, (3) is not continually updated, (4) does not mandate any specific course of medical care, (5) is not the result of a systematic review, and (6) is not intended to replace the independent professional judgment of the treating provider. In all cases, decisions about patient care should be considered in the context of treating the individual patient. Use of the information is voluntary.

This article was approved by the AAN Quality Committee on July 1, 2024, and by the AANI Board of Directors on July 18, 2024.

What We Know

Many factors are known to be associated with brain health. We organized the emerging evidence into a mnemonic that defines the various domains that may support the development and maintenance of the SAFEST BRAINS (Figure). The final “S” in the mnemonic references “structural and social determinants of health” (SSDoH), referring to the broad range of social, economic, environmental, sociocultural, and structural conditions that influence an individual's health, function, and quality of life. All SAFEST BRAINS factors influence aspects of brain health over a person's life; their often-complex interplay with SSDoH warrants consideration throughout many of the other topics we discuss. SSDoH are also fundamental contributors to health disparities. Accordingly, addressing SSDoH is critical to the effective promotion of brain health across all populations.

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