The Fragile Brain
The Fragile Brain: the strange, hopeful science of dementia
(Oxford University Press, published 24 November 2017)
If you’d like to know more, the book has had its first review in Nature.
Please note that as an academic, I cannot act as a clinical consultant. If you are concerned about your memory, concentration, mood, or other aspects of brain health please consult a medical professional, or one of the organisations listed in the book and on my Advice page.
About the Book
Ask people what they fear most about growing older, and the chances are their answer will involve dementia. The condition, which mainly strikes from the seventh decade onwards, gradually takes away a person’s independence, power to act and communicate, memory, and identity. Like other disorders of brain ageing, such as stroke, dementia is both common and poorly understood. It is also, for now, an incurable, terminal illness.
The Fragile Brain is my attempt to summarise and translate the burgeoning and immensely complicated science of dementia. I wrote it because I needed to know more about what was happening in my family – and is happening in countless other families. It is thus a more personal book than my other works.
The science includes a vast range of neuro-related material, including:
- neuropathology (chopping up and staining dead brains)
- cognitive and systems neuroscience (studying brain functions like memory, often using neuroimaging techniques like fMRI and PET)
- epidemiology (the study of who gets what brain diseases in what circumstances)
- cell biology and biochemistry (how the brain’s various cells are built and operate)
However, as I delved into the research it soon became clear that any comprehensive understanding of dementia must extend beyond the brain to the body. Among the most important body systems affecting how brains age are the heart and blood circulation, the gut, the immune system, and the pancreas.
The book begins with some context: human examples of brain disorders, the statistics and economics of dementia, a little about Alois Alzheimer. I look at how doctors and scientists have approached dementia: in terms of a cure, of treatment, or of prevention. Then, in the second of the book’s three parts, it’s on to the science, with a discussion of various risk factors. In the final part, I look at mechanisms, and the dominant theory of Alzheimer’s to date, the amyloid cascade hypothesis. Amyloid-beta is a protein, and not the only protein implicated in brain disorders, so much of the science in the The Fragile Brain is about how cells make, transport, and use proteins. But fat and sugar also have a role in healthy – and unhealthy – brain ageing. I conclude with some thoughts about the near future of dementia research, and about how we can each improve our chances of a healthy old age.
The Fragile Brain takes a whole-body approach to a disorder most people think of as restricted to the brain. Explaining complicated material clearly and carefully, it combines individual case studies with cutting-edge brain research, supplying both a guide for further scientific reading and a list of organisations for newly diagnosed patients and their carers. While the book is rigorous and has extensive notes, it tells a fascinating and exciting story – the story of how science is closing in on new treatments for dementia. And it does so always remembering the people at the heart of this science: the patients.