In a 2024 article in Neurology1 titled “The Neurologist’s Role in Promoting Brain Health,” the American Academy of Neurology (AAN) shifts the conversation from simply treating neurological disease to actively preventing it. Leading experts outline a comprehensive strategy to preserve brain function across the entire human lifespan.
The Core Framework: SAFEST BRAINS
Traditionally, neurologists have focused on diagnosing and treating neurological conditions after they emerge. This framework proposes an earlier intervention model—one centred on prevention by managing modifiable risk factors. To make brain health actionable, the authors introduced a memorable mnemonic, SAFEST BRAINS, which defines twelve key domains neurologists should address at every clinical visit:
- Sleep & Social determinants of health
- Affect, mood, and mental health
- Food, diet, and supplements
- Exercise
- Supportive social interactions
- Trauma avoidance
- Blood pressure control
- Risks: Metabolic and genetic factors
- Affordability and adherence to treatment
- Infection prevention (vaccinations)
- Negative exposures (toxins, pollutants, substances)
- Structure and social equity
Why This Matters
Neurological conditions impact over 3 billion people worldwide. The central nervous system’s limited capacity for repair makes prevention vital. Midlife hypertension, sleep disruption, loneliness, and toxins raise the risk of dementia, stroke, and neurodegenerative diseases later.
Crucially, the authors argue that addressing Structural and Social Determinants of Health (SSDoH)—such as food security, housing stability, and access to care—is as important as prescribing medication. They provide practical screening tools (such as sample questions for adult patients) to help clinicians integrate these conversations into routine care.
The Bottom Line
This is not just advice for healthy living; it’s a call to action for the medical community. By expanding their role to include proactive lifestyle coaching, trauma prevention, and advocacy for equitable health policies, neurologists can help patients not just live longer, but think clearly and function well for as long as possible.
“The neurologist’s role… is vital in patients with active neurologic disease, in whom preventive measures may reduce recurrence or slow progression.” — Selwa et al., Neurology 2025.
Our screening tool
Based on the screening questions from Selwa et al., we at NeuroCreare created a dynamic online tool for personal use. Share results with your doctor, healthcare provider, or adviser before appointments to facilitate focused discussions on risk factors. To save results, click “Save my results” to download a CSV file. Results are not stored or shared.
Brain Health Screening Factors
Instructions: Please answer each statement by selecting a single option – “Yes” or “No”.
1) Selwa LM, Banwell BL, Choe M, McCullough LD, Merchant S, Ovbiagele B, Salinas J, Tilton AH, Day GS. The Neurologist’s Role in Promoting Brain Health: Emerging Issues in Neurology. Neurology. 2025 Jan 14;104(1):e210226. doi: 10.1212/WNL.0000000000210226. Epub 2024 Dec 16. PMID: 39680817.
