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The Neurologist's Role in Promoting Brain Health
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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