Preventive Neurology

Congratulations to  Al Sandrock , from Biogen, for never giving up on science and for being a  risk-taker extraordinaire .   Photo by Markus Winkler on Unsplash The FDA’s controversial approval of aducanumab for the treatment of Alzheimer’s disease on Monday has caused a shitstorm. The main reason is that in November the FDA’s independent advisory committee voted against recommending approval; they said the data failed to demonstrate persuasively that aducanumab slowed cognitive decline. In a NY Times article Dr Lon Schneider, director of the California Alzheimer’s Disease Center at the University of Southern California and one of the aducanumab site investigators said “This should not be approved, because substantial evidence of effectiveness hasn’t been shown and there’s very little potential that this will address the needs of patients.” What the FDA has done is use the so-called Accelerated Approval Pathway , which allows them to approve a drug for a serious ...

The role sleep plays in normal human brain physiology is becoming more clear as the link between abnormal sleep and dementia gets stronger. Here is yet another epidemiological study linking reduced sleep in middle age to a higher risk of dementia. Quin Stevenson on Unsplash Is the association between reduced sleep and dementia causal or is it due to reverse causation? Sleep is required to consolidate memories and to allow the brain to cleanse itself, i.e. flush out all the intracellular debris that could aggregate to cause Alzheimer’s disease. Therefore, sleep deprivation by impairing memory consolidation and not allowing you to clear the brain's intracellular debris properly could lower your threshold for developing dementia in the future. Reverse causation states that people who are destined to develop dementia have pathology that starts decades before dementia manifests, for example, amyloid deposition and neurofibrillary tangles. The pathology affects parts of the brain that c...

"What is it that one wants to achieve?" 'Traditionally preventive medicine is a combination of medical practices that are designed to avoid disease and illness. It is a proactive approach to patient care with the aim of using evidence-based preventative measures to ensure that any sickness is minimised and detected early so that a patient has the best chance of recovery to optimum health.' This definition is based on a medicalised worldview of preventive medicine. Why can't we use social or political practices to avoid disease and illness? Surely the aim is better population health and is not necessarily about the individual? A healthier population will have a better quality of life, less need for healthcare and in theory should be happier and more content than an unhealthy population.  I have been criticised for jumping onto the social determinants of health bandwagon now that it is a hot topic. I counter this by stating that it is only a hot topic because COVID-...

Obesity is a hot potato topic. People who are overweight don’t want to be fat-shamed. However, it is now evident that given our current environment, which favours a sedentary lifestyle and has a different food landscape to the one our species evolved in, that obesity is a disease. Yes, a metabolic disease that is associated with systemic inflammation, which puts obese people at risk of a large number of diseases including multiple sclerosis and dementia . We estimate that about 10-15% of incident cases of MS could be prevented if we could prevent childhood and adolescent obesity. This is easier said than done. Obesity is now one of the major social determinants of health (SDoH). Obesity is strongly linked to deprivation and lower socioeconomic class. Why? Because cheap food is to blame. I have little doubt that most obesity is attributable to the imbalance in our macronutrient content and the relative excessive consumption of processed and ultra-processed carbohydrates.  Changing ...