It’s long been believed that it's easier to prevent a problem from occurring in the first place than it is to fix that problem after it occurs.
Benjamin Franklin famously coined the expression, “An ounce of prevention is worth a pound of cure” to advocate for strategies to reduce the risk of fires in Philadelphia in the 1730s.
The field of preventive medicine is based on the concept that strategies that prevent disease from occurring in the first place are often more effective, less expensive and leads to better health outcomes than reactive approaches that start treating diseases once symptoms begin to show.
With the rates of neurological diseases such as stroke, Alzheimer's disease and Parkinson's disease expected to increase exponentially in the next few decades, could a new “preventive” approach to brain health help to move the field of neurology forward?
This is the case made by a team of physician investigators in a recent article in the journal Neurology, “An Ounce of Prevention: The Growing Need for Preventive Neurologists.”
Natalia Rost, MD, MPH, the C. Miller Fisher Endowed Chair in Stroke Research at Massachusetts General Hospital and a professor of Neurology at Harvard Medical School, is senior author of the article. Here are five things to know:
Due to advances in our treatment of infectious and cardiovascular diseases, neurological diseases are now the leading cause of death and disability worldwide, and the global burden of neurological diseases is increasing. 
More individuals are living with long-term disabilities after experiencing strokes, developing dementia or suffering from other neurological disorders.
A 2021 study found that 3.4 billion people (nearly half the global population) had a neurological condition that year. The economic burden of neurological diseases is significant, with dementia alone expected to cost more than $290B in the United States annually—and this cost is expected to exceed $3 trillion by 2050 if current trends continue.
Traditional neurological care and training has focused on a reactive approach—diagnosing and managing neurological diseases after patients start experiencing symptoms.
By contrast, a preventive approach to neurology is built on the concept of brain health, which emphasizes preserving brain health throughout life and reducing the risk of stroke, cognitive decline and other neurological diseases through lifestyle modifications, the reduction of environmental stressors and other changes.
Preventive approaches to care have already shown benefits in the field of cancer and cardiovascular disease, and there's strong evidence to suggest that it could be beneficial in neurology as well.
American Stroke Association guidelines suggest that up to 80% of strokes can be preventable through lifestyle modifications and management of risk factors. Similarly, the Lancet Commission’s 2024 report highlights 14 risk factors that be addressed to delay or prevent most dementia cases.
So what would a shift to preventive neurology look like?
At the patient care level, neurologists can collaborate with primary care providers, cardiologists and other specialists to identify at-risk individuals and develop targeted interventions to slow or prevent the onset of neurological diseases. They can advocate for and oversee regular screenings, lifestyle modifications and early treatment.
At the government level, neurologists can work with officials to develop policies that support brain health by reducing exposures to risk factors such as traumatic brain injury, air pollution and unhealthy food products. They can ensure access to healthcare services for early detection and intervention.
At academic medical centers such as Mass General Brigham, neurologists can train future neurologists to prioritize strategies for early intervention. Researchers can help to identify high risk groups through genetic testing, biomarkers and neuroimaging. Clinical trials can be conducted to identify the most effective strategies for preventing disease.
Patients can be and should be educated about proactive approach and empowered to work with their care teams on their brain health (https://www.brainandlife.org/articles/12-ways-to-build-a-healthy-brain ).
In summary, the concept of preventive neurology, with its focus on brain health, marks a transformative shift from a disease-centered approach to one focused on preserving and enhancing the brain’s structural and functional integrity.
By emphasizing proactive measures to help patients sustain the cognitive, motor and social functions of their brains, neurologists can reduce the rates of stroke, Alzheimer's disease and other devastating disorders.
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