Cognitive Well-Being: A Clinical Review of Brain Health, Dementia Risk Reduction, and Emerging Biomarkers for the Osteopathic Family Physician

Abstract

Background: As people age, they grow more aware of brain health, and interest in keeping the mind sharp has grown alongside anti-aging culture. Neurologic disease is a leading global burden: stroke is the fifth leading cause of death, migraine is the second most burdensome neurological disorder, and more than 57 million people live with dementia worldwide, a figure projected to more than double. Data Sources: This narrative clinical review is based on a CME presentation delivered at the ACOFPCA’50 Annual Convention and Scientific Seminar and the sources it cited, including the 2024 Lancet Standing Commission analysis of modifiable dementia risk factors, American Academy of Neurology brain-health guidance, and primary literature on cognitive assessment, fluid and imaging biomarkers, and disease-modifying therapy, framed for primary care. Results: Fourteen modifiable risk factors span vascular, mental, developmental, and physical-health domains and inform a life-course prevention strategy. Mild cognitive impairment has a heterogeneous course and may remain stable, improve, or progress to dementia. Plasma phosphorylated tau 217 (p-tau217) is emerging as a screening biomarker, with a two-step confirmatory pathway raising positive predictive value above 95%. Cholinesterase inhibitors and memantine remain symptomatic mainstays, while anti-amyloid monoclonal antibodies are the first disease-modifying therapies, carrying amyloid-related imaging abnormality (ARIA) risk that mandates MRI monitoring. Conclusion: A preventive-neurology approach (reducing modifiable risk, screening early, and applying new biomarkers and therapies judiciously) positions the primary care physician to advance cognitive well-being across the lifespan.