There are moments in a medical career when you realize that you are not exactly where you intended to be, even when you have done everything “right.”
When I studied medicine and later specialized in neurology, I wanted to help people protect their brains: to prevent decline when possible, improve function, and make a meaningful difference in long-term health.
Over the years, I became very good at diagnosis. I knew how to identify a neurological condition, give it a name, explain what was happening, and offer the accepted treatment. But I felt that an important piece was missing.
Because a diagnosis often tells us what a person has, but it does not necessarily explain why the process developed in that particular person, what may be influencing it now, and which of those factors can potentially be changed.
The point when I began asking different questions
In 2016, I started changing the way I approached my patients. Instead of focusing only on “What is the diagnosis?”, I began asking additional questions:
What happened before the symptoms appeared?
What has changed over the past few years?
How does this person sleep? What do they eat? What is their metabolic health like? Are there nutritional deficiencies? What is their hormonal status? Is there evidence of inflammation? What about gastrointestinal health? And what about their lifestyle and the environment in which they live?
Not every question is relevant to every person, and not every abnormal test result is necessarily clinically significant. The goal is to connect the medical history, neurological examination, and relevant findings, and understand the whole picture. This is how my approach to Personalized Neurology evolved.
The brain does not function separately from the rest of the body
Memory, concentration, processing speed, mood, and mental energy are influenced by multiple systems throughout the body.
Poor sleep, metabolic dysfunction, hormonal changes, nutritional deficiencies, certain medications, physical inactivity, and other factors can all affect cognitive function.
In some cases, depending on the clinical history and symptoms, it may also be appropriate to investigate less conventional factors, such as environmental exposures or chronic medical processes.
This is why someone may come to my clinic with a “memory problem,” yet ultimately discover that the evaluation and treatment do not begin and end with the brain.
Especially when cognitive changes are still subtle
I believe this approach is particularly important when someone senses that something has changed: more difficulty finding words, reduced concentration, brain fog, cognitive fatigue, or changes in memory while still functioning independently in everyday life.
Not every cognitive change indicates a neurodegenerative disease, and certainly not every memory complaint means Alzheimer’s disease. At the same time, persistent or progressive changes should not always be dismissed as simply “age” or “stress.”
The first goal is to understand what has changed and why.
Sometimes we identify a treatable or modifiable contributor. Sometimes several smaller factors are acting together. In other cases, the evaluation may reveal an early cognitive process that requires further assessment, monitoring, and appropriate treatment.
From diagnosis to improving brain health
My approach does not replace conventional neurology, it begins with it.
Accurate diagnosis matters. A neurological examination matters. Imaging and other diagnostic tests matter, and medications have an important role when indicated. But for me, the work does not necessarily end there. I also want to understand what can be improved.
Sometimes the intervention involves sleep. Sometimes it is nutrition or metabolic health. In other cases, the focus may be physical, cognitive, and social activity, correcting documented deficiencies, or using carefully selected supplements when clinically appropriate. And sometimes further investigation is needed to understand what may be contributing to ongoing symptoms.
There is no single protocol that is right for everyone.
That, to me, is at the heart of Personalized Neurology: not simply treating the name of a disease, but treating the individual behind the diagnosis.
Less waiting for disease, more protecting health
In recent years, there has been growing interest in the concept of longevity. But for me, the underlying idea began much earlier.
The goal is not simply to live longer. It is to extend, as much as possible, the years in which we function well — thinking, remembering, working, staying active, and maintaining a good quality of life.
And we do not always need to wait until a disease appears before we act.
We can pay attention to changes earlier, understand individual risk factors, identify areas of health that may be moving out of balance, and intervene where there is a meaningful opportunity to make a difference.
That was the turning point for me as a physician:
Not only to diagnose what is wrong, but to understand what is influencing health, what can be changed, and how we can support brain health and function over time.