MedFlow

Chief Executive Officer

MedFlow transforms healthcare quality and cost—we help providers get paid more for delivering better care, while reducing costs.

Co-Founder

Frontier Psychiatry

Currently providing specialized dementia care and clinical support as a neuropsychiatrist while guiding the company's strategic direction through its next growth phase as a board member.

Board Member, Neuropsychiatrist

Co-founded and bootstrapped Frontier Psychiatry, architecting the technology infrastructure that enabled rapid scaling to 75 staff serving 5,000 monthly patients. Developed innovative care delivery models integrating digital health tools and value based care to improve access to specialized psychiatric services in underserved communities.

Co-Founder, COO

BrainCheck

Led clinical R&D team while supporting sales, marketing and other functions from seed stage through Series B funding. Guided product development to enhance cognitive assessment technology for neurodegeneration detection and improved clinical workflows.

Chief Medical Officer

EvergreenHealth

Served as the memory and behavior expert at EvergreenHealth's Neuroscience Institute and for the geriatric clinic. providing specialized clinical neuropsychiatry expertise for comprehensive workup and diagnosis of dementia and related conditions. Applied innovative digital biomarkers and assessment technologies to enhance diagnostic accuracy while developing technology-enabled care models for this vulnerable patient population. Collaborated with an outstanding multidisciplinary team to deliver cutting-edge care.

Neuropsychiatrist

NeuroLex Labs

Led research and development of pioneering digital biomarkers for neuropsychiatric conditions and neurodegeneration. Directed innovative voice diagnostics pilot studies across academic, private, and non-profit partnerships nationwide, advancing clinical assessment technology for early disease detection. Provided healthcare leadership to a team of over 30 research assistants and graduate/undergraduate fellows, driving technology-enabled care models that transformed traditional neuropsychiatric evaluation approaches.

University of Washington - School of Medicine

Practiced neuropsychiatry across multiple sites in Washington state including Harborview Medical Center, and the Seattle Veterans Administration Medical Center. Specialized in dementia and movement disorders.

Senior Fellow, Neurology - Movement Disorders

Veterans Administation

Parkinson's Disease Research, Education and Clinical Center (PADRECC) Advanced Fellowship

Advanced Fellow, Neurology, Movement Disorders

Brainstorm: Stanford Laboratory for Behavioral Health Innovation and Entrepreneurship

Director of Partnerships and Strategy at the world's first academic laboratory for behavioral health entrepreneurship.

Founding Partner

University of Washington Medical Center

Practiced psychiatry across multiple sites in Washington state including University of Washington Medical Center, Harborview Medical Center, and the Seattle Veterans Administration Medical Center.

Resident Physician

King County, WA

Board Member - King County Behavioral Health Advisory Board

My path:
Age 12: I built my first computer
Age 15: I started a small business making first websites for local orgs with HTML and JavaScript
Age 16: I learned C++ and made some primitive games
Age 22: I graduated from RPI with a degree in computer and electrical engineering and took a job that seemed cool working on designing and building a US Navy destroyer
Age 23: Finished chemo and hit remission from Hodgkin's Disease and took a hard look in the mirror
Age 25: Finished a masters in biomedical engineering at Hopkins, focusing on AI and machine learning for medical imaging 
Age 26: Had my first big win in engineering & medicine – invented a modular MRI-compatible exercise device for muscle testing and digital biomarkers
Age 27: Got into UMass medical school on my 3rd try, pursuing neuropsychiatry
Age 30: Built an electronic health record (EHR) while in medical school for a Boston-based company, my first foray into healthcare entrepreneurship and technology-enabled care models
Age 34: Built my first health-tech company, NeuroLex, using voice as a digital biomarker to detect neurodegeneration and disease earlier
Age 36: Finished residency and fellowship at University of Washington and founded a specialized dementia clinic for EvergreenHealth, applying clinical neuropsychiatry expertise
Age 37: Sold NeuroLex and helped build BrainCheck, a digital cognitive assessment technology company pioneering digital biomarkers for dementia assessment
Age 38: Founded and bootstrapped Frontier Psychiatry and grew it to 75 staff and 5k patients/month diving into innovative technology-enabled care models and healthcare leadership
Age 40: Raised a series A and transitioned to scaling mode, implementing value-based care approaches and quality improvement methodologies
Age 41: Handed off Frontier Psychiatry and Founded MedFlow, a workflow automation company for healthcare transformation and optimized care delivery systems

It's been a journey. 

My goal here is to share what I've learned in clinical neuropsychiatry, digital biomarkers, healthcare entrepreneurship, and healthcare leadership to move the needle on outcomes in healthcare, especially dementia care. Healthcare needs absolutely everyone's help to change the status quo. We need to demand better from our systems through technology-enabled care models and organizational change management.

For more information please follow me here and visit rezahg.com

I diagnosed Patricia with Alzheimer's at age 59.
Her first symptom wasn't memory loss.

It was rage.

She came to my clinic because her husband insisted. She was furious about the appointment. Told me nothing was wrong. Said her family was overreacting.

Then she started crying.

"I don't know what's happening to me. I'm so angry all the time. At everyone. About everything. This isn't who I am."

Her husband described the changes: Previously patient and kind. Now explosive over minor frustrations. Snapping at grandchildren. Road rage that scared him.

No memory complaints. She could recall conversations perfectly. Remembered appointments. Managed household tasks.

But her personality had transformed.

This is the Alzheimer's presentation that's easy to miss.

We're trained to look for memory loss. Ask about forgetting names and appointments. 

Screen with recall tests.

Patricia passed every memory test I gave her.

But when I tested executive function and behavioral regulation, everything fell apart.

She couldn't plan a simple task sequence. Couldn't shift between concepts flexibly. Couldn't inhibit inappropriate responses.

Brain imaging showed early frontal lobe changes. Spinal fluid biomarkers confirmed Alzheimer's pathology.

At 59, with perfect memory, she had Alzheimer's disease.

This presentation - personality and behavioral changes before memory loss - accounts for about 15% of early-onset Alzheimer's cases.

Families spend years thinking it's depression. Or stress. Or menopause. Or marital problems.

Doctors prescribe antidepressants. Refer to marriage counseling. Suggest stress management.

Meanwhile, the disease progresses silently.

Patricia's family felt guilty. They'd been frustrated with her anger. Thought she was choosing to be difficult. Had arguments about her "attitude problem."

Nobody realized her brain was changing.

After diagnosis, everything shifted. Her family understood the anger wasn't intentional. They learned strategies to reduce triggers. They stopped taking the outbursts personally.

Patricia herself felt relieved. "I thought I was losing my mind. Now I know I'm losing my brain. Somehow that's better."

We started treatment immediately. Medications to support remaining function. Therapy to manage behavioral symptoms. Family education and support.

Three years later, she's declined. But slower than expected. Her family is prepared. They're not in crisis.

Because we caught it when behavioral symptoms appeared. Not years later when memory failed.

Patricia taught me to screen for dementia any time personality changes unexpectedly.

Especially when the person is confused by their own behavior.

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Reza Hosseini Ghomi, MD, MSE

Neuropsychiatrist | Engineer | 4x Health Tech Founder | Cancer Graduate | Frontier Psychiatry & MedFlow Co-Founder - Follow to share what I've learned along the way.

I taught a primary care doctor how to diagnose dementia in 10 minutes yesterday.

She'd been avoiding cognitive assessments for years because she thought they were too complicated.

Here's exactly what I showed her:

Start with the functional question. Not memory questions. Function.

"Can your mom manage her medications independently?"
If the answer is no, something's wrong. That's your screening.

Then do the 3-word recall test. Say three unrelated words. Apple. Table. Penny.
Ask them to remember these words. Then continue your other exams.
At the end, ask them to recall the three words.

Normal aging: they remember 2-3 words.
Early dementia: they remember 0-1 words, and don't even remember being asked.

Finally, ask them to draw a clock showing 10 past 11.
This simple test reveals executive function and visuospatial skills. It takes 30 seconds.

That's it. Three simple assessments. Total time: 3 minutes.

If there is functional decline and confirmed cognitive decline with these test (ruling out mimics like low thyroid and untreated sleep apnea), you should make a dementia diagnosis.

The doctor looked at me like I'd just handed her a superpower.

"That's all I need? I've been terrified to touch cognitive assessment for years."

I've trained hundreds of primary care doctors. They all think dementia diagnosis requires specialists.

It doesn't.

The specialist-level complexity comes when you need to distinguish between types of dementia. But that's not the first step.

The majority of my time is working with complex cases. The diagnosing dementia (functional decline) is the easy part we can all do, the hard part is understanding the root cause and evaluating the specific phenotype.

The first step is recognizing that something's wrong. That's what primary care does brilliantly.

60% of dementia cases go undiagnosed. Not because the tools don't exist. Because doctors think diagnosis is too complicated.

It's not.

Simple questions. Simple tests. Clear next steps.

Primary care can diagnose dementia. They just need someone to show them it's this straightforward.

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Blood tests now detect Alzheimer's 20 years before symptoms.

I'm working to make early detection available everywhere.

The diagnostic breakthrough:
P-tau217 protein in blood predicts brain changes
↳ More accurate than expensive PET scans
↳ Available in standard laboratory
↳ Results within 24 hours
↳ Costs under $500 vs $5,000+ imaging

The biomarker revolution:
Blood proteins reflect brain pathology
↳ Detects amyloid buildup decades early
↳ Tracks tau tangle formation
↳ Monitors inflammation levels
↳ Predicts cognitive decline trajectory

Combined assessment approach:
Blood biomarkers show brain pathology
↳ Digital tests measure cognitive function
↳ Together provide complete picture
↳ Guide treatment decisions
↳ Monitor intervention effectiveness

Why this changes everything:
Current diagnosis happens too late
↳ New treatments work only in early stages
↳ Prevention strategies need early detection
↳ Primary care lacks specialist tools
↳ Millions undiagnosed and untreated

The implementation reality:
FDA approval advancing for blood tests
↳ Medicare coverage being evaluated
↳ Clinical guidelines being developed
↳ Provider training programs expanding
↳ Technology becoming mainstream

What early detection enables:
Lifestyle interventions work better early
↳ Exercise protects remaining neurons
↳ Diet changes reduce inflammation
↳ Social engagement maintains networks
↳ Stress reduction preserves function

The patient impact:
Early knowledge allows planning
↳ Families prepare for future needs
↳ Financial and legal decisions made
↳ Treatment access while effective
↳ Hope instead of crisis management

Current limitations:
Not all doctors trained in interpretation
↳ Insurance coverage still limited
↳ Patient education needed
↳ Integration with care workflows required
↳ Cost barriers for some populations

The economics:
Early intervention saves money long-term
↳ Delays nursing home placement
↳ Reduces hospitalizations
↳ Maintains independence longer
↳ Lowers family caregiving burden

This technology exists today

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Citations: Palmqvist S, et al. Performance of fully automated plasma assays for Alzheimer disease. JAMA Neurology. 2019. Ashton NJ, et al. Plasma p-tau231: biomarker for incipient Alzheimer pathology. Acta Neuropathologica. 2021.

The most important dementia symptom has nothing to do with memory.

It's apathy.

And providers miss it constantly.

In my practice, families describe this pattern:
"Dad stopped going to his woodworking shop. Says he's just not interested anymore."
"Mom quit her book club. Claims she's too busy, but she's not doing anything."
"He used to love cooking elaborate meals. Now he microwaves everything."

When I ask about memory, families say it's fine. Dad remembers conversations. Mom recalls appointments perfectly.

So most assumes it's depression. Or retirement adjustment. Or just getting older.

They're wrong.

Apathy appears 3-7 years before memory problems in many dementia cases. Especially frontotemporal dementia and most Alzheimer's presentations (but really most dementias).

The brain regions controlling motivation and initiative fail first. Memory comes later.

But our screening focuses entirely on memory. We ask: "Do you forget names? Miss appointments? Repeat yourself?"

We don't ask: "Did you stop doing things that used to bring you joy? Lost initiative to start projects? Feel emotionally flat?"

So we miss years of potential intervention time.

Here's how apathy differs from depression:
Depression: "I want to do things but feel too sad or hopeless"
Apathy: "I don't want to do anything and I'm not particularly bothered by it"

Depression responds to antidepressants. Apathy in dementia doesn't.

Depression includes negative thoughts and self-criticism. Apathy includes emotional flatness and indifference.

When someone over 60 suddenly loses interest in lifelong hobbies without seeming distressed about it, that's a red flag.

Not a guarantee of dementia. But it deserves cognitive screening, not just antidepressants.

I've diagnosed hundreds of patients whose families spent 2-3 years treating "depression" that never improved.

Because it wasn't depression. It was early dementia with apathy as the first symptom.

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I can't remember my patient's name.

She's sitting across from me. We've met three times before. I've written detailed notes about her case.

Her name is completely gone from my mind.

I'm stalling. Making small talk. Desperately hoping she'll say something that triggers the memory.

She doesn't.

Finally, I give up the pretense. "I apologize - I'm having a mental block on your name."
She laughs. "It's Margaret. Happens to me all the time."

My first thought: Is this dementia starting?

My second thought: No. This is attention deficit I've trained into myself.

Here's what's actually happening:

I've conditioned my brain to hold information for seconds, not minutes. The constant interruptions have rewired how I process information.

During our last appointment, I was simultaneously:
- Listening to Margaret
- Checking lab results on another patient
- Responding to a nurse's question
- Watching for the next appointment notification
- Thinking about the urgent call I needed to make

I never fully encoded her name in the first place. Not because my memory is failing. Because my attention was fractured.

This isn't age-related cognitive decline. It's trained attention deficit.

The modern medical environment has destroyed sustained attention.

I've counted: I get interrupted an average of 27 times per hour during clinical work.

This isn't just me. This is everyone.

We've all trained ourselves to have attention spans measured in seconds. Scrolling feeds. Switching apps. Multitasking constantly.

Then we wonder why we can't remember names, conversations, or why we walked into a room.

It's not memory failure. It's attention failure.

Here's the difference:
Memory problems: You can't recall information that was properly encoded
Attention problems: You never encoded the information in the first place

Most of what we call "memory issues" are actually attention issues.

The good news: attention is trainable.

I've been working on this deliberately for the past year:

When meeting patients, I close all other windows. Turn off notifications. Give them undivided attention for the entire visit.

I've removed most phone notifications. Reduced app switching. Stopped pretending multitasking works.

The results are dramatic:
I remember patient names now. Not because my memory improved. Because I'm actually paying attention when they introduce themselves.

Conversations stick. Details matter. I notice things I was missing.

The solution isn't memory supplements or fear of dementia.

It's retraining attention. Removing distractions. Practicing sustained focus on one thing at a time.

Margaret's name is now in my mind. Along with details about her case. Her family situation. Her concerns.

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I'm a dementia doctor.
Here's what terrifies me most about my own brain health.

It's not genetics. It's not age.

It's the illusion of control.

I spend my days telling families about irreversible brain changes that started decades before symptoms appeared.

The hardest part: realizing I can't predict my own cognitive future.

What keeps me up at night:
I could have early brain changes right now
↳ My patients seemed perfectly normal years ago
↳ Cognitive reserve masks early damage
↳ By the time symptoms appear, it's often too late
↳ Even experts miss their own early changes

The vulnerability hits different when it's personal:
I've diagnosed colleagues with dementia
↳ Watched brilliant minds gradually fade
↳ Seen families struggle with role reversals
↳ Witnessed the loss of professional identity
↳ Understood the fear behind every patient's questions

What I've learned from thousands of patients:
Denial is the brain's first protective mechanism
↳ Families notice changes before patients do
↳ Insight into deficits diminishes early
↳ Independence feels more precious when threatened
↳ Dignity matters more than perfect cognition

My honest prevention strategy:
I can't control my genetics
↳ But I can optimize modifiable risk factors
↳ Exercise becomes medicine, not recreation
↳ Social connections require intentional effort
↳ Sleep quality matters more than career demands

The humbling reality: expertise doesn't provide immunity.

Every symptom I help diagnose could someday be my own.

This work teaches profound empathy for the uncertainty families face.

None of us know what our cognitive future holds.

What we can control: living fully while our minds are clear.

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I missed an early Alzheimer's diagnosis in 2019.

The patient was 62. Sharp as ever in conversation, or so I thought. Held down a demanding job. Came to me worried about memory.

I reassured her everything looked fine.

Six months later, her daughter brought her back. She'd been fired. Couldn't remember meetings. Got lost driving to familiar places. Was hiding things from her family.

I had missed the signs completely.

Here's what I didn't see the first time:

She was compensating brilliantly. Her social skills were intact. She could chat about current events. She seemed completely normal in a 15-minute appointment.

What I should have asked: How are you managing complex tasks at work? Are you using more lists and calendars than before? Have you stopped doing hobbies that require planning?

I asked none of these questions.

Instead, I did a basic cognitive screen. She passed easily. I sent her home.

That failure haunts me.

By the time we diagnosed her six months later, she'd already lost her job. Her family was in crisis. Treatment options were less effective.

All because I didn't dig deeper when someone came asking for help.

I changed everything about how I screen for dementia after that case.

Now when patients say "my memory's not what it used to be" - even if they seem fine - I take it seriously.

I ask about function, not just memory. I talk to family members separately. I test executive function, not just recall.

Because people with early dementia are experts at hiding their deficits. They've spent years developing compensation strategies. They pass simple tests easily.

The ones who seek help early are often the ones we miss.

They're still functional enough to recognize something's wrong. But not impaired enough to fail our crude screening tools.

Missing that diagnosis taught me more than any lecture or textbook.

Now I listen differently when patients express concern about their cognition.

Even when they look completely fine.

Especially when they look completely fine.

What cognitive concerns have you or your family members had dismissed?

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5 dementia prevention strategies that actually work.
Based on 15 years of research and treating thousands of patients.

No supplements. No expensive interventions. Just evidence.

The research is overwhelming: these 5 interventions reduce dementia risk by 30-40% when combined.

1/ Protect your hearing
Hearing loss doubles dementia risk
↳ Use hearing aids if needed
↳ Protect ears from loud noise
↳ Social isolation from hearing loss accelerates decline
↳ Hearing aid users show slower cognitive decline

2/ Exercise like your brain depends on it
150 minutes weekly moderate activity
↳ Walking, swimming, or cycling work equally well
↳ Exercise increases brain-derived neurotrophic factor
↳ Promotes new brain cell growth
↳ Improves blood flow to memory centers

3/ Stay socially connected
Loneliness increases dementia risk by 50%
↳ Maintain close friendships and family relationships
↳ Join clubs, volunteer, or attend religious services
↳ Quality of relationships matters more than quantity
↳ Social engagement exercises multiple brain networks

4/ Manage cardiovascular risk factors
High blood pressure damages brain blood vessels
↳ Control diabetes and cholesterol
↳ Don't smoke and limit alcohol
↳ What's good for your heart protects your brain
↳ Vascular dementia is largely preventable

5/ Challenge your brain consistently
Learn new skills throughout life
↳ Read complex material regularly
↳ Play strategy games or learn instruments
↳ Take classes or pursue hobbies
↳ Cognitive reserve delays symptom onset

The timing matters: prevention works best when started early, but benefits occur at any age.

These interventions work by building resilience against brain changes.

Even people who develop Alzheimer's pathology can maintain function longer with strong cognitive reserve.

The beautiful truth: the lifestyle that prevents dementia also improves quality of life immediately.

You don't need to wait decades to feel benefits.

💬 Comment which prevention strategy you want to focus on
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Citations: 
Livingston G, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020. 
Stern Y, et al. Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurology. 2012.

I teach medical students to diagnose dementia using the "Three Questions Method."

It takes 2 minutes. 
Most doctors never learn this approach or avoid diagnosing dementia altogether. All providers should feel comfortable making the diagnosis, no specialist needed for the vast majority of cases.

After training hundreds of physicians, I've found this is the fastest way to identify cognitive 
impairment that actually needs workup. 

Dementia is a functional diagnosis, you don't need any special tools to diagnose it and diagnosing it mobilizes significant resources for the patient and family. There should be no delay.

Here's exactly what I do:
Question 1: "Can you manage your medications independently?"
If they need help organizing pills, remembering doses, or refilling prescriptions - that's a functional red flag.
Normal aging: Maybe they use a pill organizer for convenience.
Dementia: They can't remember if they took medications today.

Question 2: "Have you gotten lost in familiar places?"
Not "do you have memory problems" - everyone says yes to that.
Ask specifically about navigation and spatial orientation.
Normal aging: Occasionally forget where they parked.
Dementia: Get confused driving routes they've taken for years.

Question 3: "Have you stopped doing hobbies or activities you used to enjoy?"
This reveals apathy and executive dysfunction.
Pay attention to WHY they stopped.
Normal aging: "My knees hurt" or "I don't have time"
Dementia: "It got too complicated" or "I can't concentrate like I used to"

If any of these answers suggest functional decline, I do one more thing:

I ask to speak with a family member privately.

"Have you noticed any changes in their thinking, memory, or personality?"

Family members almost always know something's wrong before the patient admits it.

This combination - three functional questions plus family input - catches 90% of dementia cases that need further evaluation.

No fancy tests. No expensive screening tools. Just the right questions.

I've diagnosed hundreds of dementia patients this way. Often before they fail standard cognitive screens.

The secret: focus on function, not memory.

Memory complaints are universal. Functional decline is meaningful.

After these questions, if I'm concerned, then I do formal testing. But these three questions determine who needs testing at all.

Primary care doctors tell me they avoid cognitive assessment because it's too complicated and time-consuming.

It doesn't have to be.

Start with function. Let that guide everything else.

Do you or your family members have trouble with any of these three areas?

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I'm a neuropsychiatrist.
I spend my days diagnosing people with diseases that will erase their memories.

Last week, I forgot where I parked my car.

Stood in the parking garage for 5 minutes trying to remember which level. Total blank.

My first thought: "Is this how it starts?"

I know too much. I've seen too many brilliant people lose themselves to dementia. Every time I forget something, a small part of my brain wonders if this is the beginning.

My patients tell me they have the same fear. Every forgotten name. Every misplaced key. Every moment of walking into a room and forgetting why.

"Doctor, is this normal aging or is this dementia?"

I give them the professional answer about benign forgetfulness versus progressive decline.

But inside, I'm thinking: I ask myself the same question.

The truth I don't usually share: knowing the science doesn't make the fear go away.

I can explain the difference between normal aging and pathological change. I can cite the research. I can describe the patterns.

But when I'm searching for a word I know I know, or forgetting why I opened the refrigerator, I still feel that flash of panic.

Being an expert doesn't provide immunity from worry. If anything, it makes it worse because I know exactly what early dementia looks like.

What helps me: I track patterns, not individual events.

Everyone forgets where they parked sometimes. That's normal.
Forgetting how to drive home? That's concerning.

Forgetting one appointment? Normal.
Forgetting all appointments? Concerning.

Repeating a story once? Normal.
Not remembering you already told it? Concerning.

The pattern matters more than the individual moment.

I found my car eventually. Wrong level, right where I left it.

Relief washed over me. Then embarrassment about the relief.

This is what it's like being a dementia doctor who's also human.

We're all aging. We're all experiencing our brains change. We're all facing uncertain cognitive futures.

Even those of us who study it professionally.

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I watched a colleague develop early-onset Alzheimer's at 60.

Brilliant physician. Healthier than me in many ways. Committed to healthy habits.

It destroyed him anyway.

I knew him peripherally. His colleagues mentioned some concerns and connected me with his family. It wasn't easy building rapport to address this subject. But once he was willing to sit down with me, the rest moved quickly.

Our workup confirmed probable Alzheimer's Disease.

He had done everything right:
- Ran marathons. Ate Mediterranean diet religiously. Never smoked. Moderate alcohol only. -  - Managed his blood pressure and cholesterol perfectly.
- Stayed intellectually engaged. Published research. Taught medical students. Learned new languages for fun.

None of it stopped his disease.

This is the truth about dementia prevention nobody wants to hear:
You can do everything right and still get dementia.

The lifestyle interventions we recommend reduce risk by 30-40%. That's significant. That's meaningful.

But it's not 100%.

My colleague understood this intellectually. He knew genetics and likely unknown environmental triggers trumped lifestyle in his case.

But watching him decline was brutal. Because he'd invested so much in prevention.

Every morning run felt like a betrayal. Every healthy meal seemed pointless. Every intellectual challenge mocked by his failing brain.

His wife asked me: "What was the point of all that prevention if it didn't work?"

I didn't have a good answer.

Here's what I've learned watching him and hundreds of other patients:

Prevention is not a guarantee. It's risk reduction.

The same interventions that didn't prevent his Alzheimer's probably delayed it by years. 

Maybe he would have gotten sick at 50 instead of 60.

Those 6 extra years of health mattered. To him. To his family. To his patients.

Prevention also improved his quality of life before diagnosis. He was healthier, happier, more energetic than he would have been otherwise.

My colleague died three years after diagnosis. Way too young. Devastating loss.

But those three years were better because of the prevention work he'd done before getting sick.

Here's the uncomfortable truth I tell patients:

Do prevention work anyway. Even knowing it might not be enough.

Exercise won't prevent all dementia. But it makes whatever cognitive aging you experience less severe.

Diet won't stop genetic Alzheimer's. But it reduces inflammation that accelerates decline.

Social engagement won't cure brain disease. But it preserves function longer when disease hits.

Intellectual challenge won't override genetics. But it builds reserve that buffers against symptoms.

We do prevention not because it's a guarantee. We do it because it's the best chance we have.

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Eating breakfast after 9 AM linked to higher mortality risk.
Circadian biology research reveals why meal timing matters.

The breakthrough research findings:
People who eat breakfast after 9 AM have:
↳ Higher rates of depression
↳ Increased fatigue and brain fog
↳ Disrupted sleep patterns
↳ Elevated mortality risk

The circadian biology explanation:
Your body expects food when cortisol peaks
↳ 6-8 AM is optimal metabolic window
↳ Insulin sensitivity highest in morning
↳ Late breakfast fights natural rhythms
↳ Creates metabolic confusion all day

What happens when you delay breakfast:
Cortisol stays elevated longer
↳ Blood sugar regulation deteriorates
↳ Appetite hormones get scrambled
↳ Evening hunger increases
↳ Sleep quality suffers

The aging connection:
Meal timing shifts naturally with age
↳ Older adults often eat later
↳ Could be early sign of health decline
↳ Biomarker for accelerated aging
↳ Simple intervention with major impact

The neuroscience behind meal timing:
Brain glucose uptake varies by time
↳ Morning fuel optimizes cognitive function
↳ Late meals disrupt memory consolidation
↳ Circadian clocks in brain need food signals
↳ Timing affects neurotransmitter production

What I tell my patients:
Eat breakfast within 2 hours of waking
↳ Include protein to stabilize blood sugar
↳ Make it your largest meal when possible
↳ Stop eating 3-4 hours before bed
↳ Consistency matters more than perfection

Why this matters for brain health:
Irregular meal timing increases dementia risk
↳ Disrupts brain energy metabolism
↳ Impairs memory consolidation during sleep
↳ Accelerates age-related cognitive decline
↳ Simple fix with major protective benefits

The shift work challenge:
Night shift workers have unique needs
↳ Eat largest meal before shift starts
↳ Light meals during work hours
↳ Avoid food 3 hours before sleep
↳ Maintain consistent schedule on days off

The research limitations:
↳ Healthy people may naturally eat earlier
↳ Meal timing linked to other healthy habits
↳ Individual variation exists

What surprised me most:
Effect size larger than many dietary interventions
↳ Timing may matter more than specific foods
↳ Free intervention everyone can implement
↳ Works alongside any eating pattern
↳ Measurable benefits within weeks

The longevity connection:
Centenarians typically eat early
↳ Long-lived populations have consistent patterns
↳ Evening fasting promotes cellular repair
↳ Circadian health linked to lifespan
↳ Simple habits compound over decades

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Citations: Scheer FA, Morris CJ, Shea SA. The internal circadian clock increases hunger and appetite in the evening independent of food intake and other behaviors. Obesity. 2013. Garaulet M, Gómez-Abellán P. Timing of food intake and obesity. Reviews in Endocrine and Metabolic Disorders. 2014.

The 3-minute dementia assessment every primary care doctor should know.

After training hundreds of physicians, this is the most practical screening approach that actually gets used.

Most screening tools are too complex for busy primary care. This works in real clinical workflows.

The practical assessment:
Start with specific functional questions
↳ Can they manage finances independently?
↳ Do they get lost in familiar places?
↳ Have medications been missed or doubled?
↳ Are they repeating questions or stories?

Clock drawing test (2 minutes, although newer generations won't know how!):
Ask them to draw a clock showing 10 past 11
↳ Tests executive function and visuospatial skills
↳ Abnormal results warrant further evaluation
↳ Easy to score and interpret
↳ Detects early cognitive changes

Brief cognitive screen (1 minute):
Three-word recall after 5-minute delay
↳ Orientation to date and location
↳ Spell "world" backwards
↳ Count backwards from 100 by 7s
↳ Simple but effective screening

Red flags that demand immediate workup:
Getting lost in familiar environments
↳ Difficulty managing complex tasks
↳ Personality changes or poor judgment
↳ Forgetting recent important events
↳ Safety concerns while driving

The missed diagnosis problem:
60% of dementia cases remain undiagnosed
↳ Families notice changes years before evaluation
↳ Primary care lacks confidence in diagnosis
↳ Specialists have months-long waiting lists
↳ Early intervention opportunities lost

What happens after positive screening:
Rule out reversible causes first
↳ Check B12, thyroid, depression screening
↳ Review medications causing confusion
↳ Assess sleep disorders and hearing loss
↳ Then pursue specific dementia evaluation

The reimbursement reality: Medicare covers annual cognitive assessments for all patients over 65.

Simple tools work when they fit clinical workflows.

Early diagnosis enables better outcomes for patients and families.

💬 Comment if your doctor has assessed your cognitive health
♻️ Repost if primary care should screen for dementia routinely
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for practical dementia diagnosis

Citations: 
Borson S, et al. The Mini-Cog: a cognitive vital signs measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry. 2000. 
Holsinger T, et al. Does this patient have dementia? JAMA. 2007.

Too many people are focused on the wrong dementia prevention strategies.
Crossword puzzles. Sudoku. Brain training apps. Supplements.

I see this pattern every single day in my clinic.

Patients spending $200+ monthly on brain supplements. While refusing to treat their high blood pressure because "I don't like taking pills."

Doing crossword puzzles religiously. But sitting 23 hours a day because "I'm mentally active."

Buying brain training apps. While completely socially isolated because "I'm too busy."

The message is not to avoid these things entirely - it's to get priorities in order and make sure you're doing the highest yield interventions first.

Here's what actually prevents dementia, ranked by evidence:
1. Treating high blood pressure in midlife - Strongest modifiable risk factor. Uncontrolled hypertension silently damages brain blood vessels for decades.
 
2. Hearing aids when needed - Hearing loss doubles dementia risk. Social isolation from untreated hearing accelerates decline.
 
3. Cardiovascular exercise - Walking 150 minutes weekly reduces risk by 30%. Actual movement, not mental games. Moderate intensity is even better.
 
4. Managing diabetes and cholesterol - High blood sugar damages brain blood vessels. Proper control dramatically reduces risk.
 
5. Social connection - Loneliness increases dementia risk by 50%. Real relationships matter.

What doesn't work despite popularity:
1. Crossword puzzles and Sudoku - No evidence for dementia prevention. You get better at puzzles. That's it.

2. Most supplements - Ginkgo, fish oil, vitamin E - large trials have not shown benefit for prevention in healthy people.

3. Brain training apps - Improves game performance. Doesn't transfer to real-world function.

The effective interventions are boring. Require lifestyle changes. Often need medications.

The popular interventions are convenient. Feel productive. Don't require actual change.

That's why supplement sales boom while exercise rates drop.

Here's the math:

Baseline dementia risk by age 85: about 1 in 3

Risk after addressing top modifiable factors: about 1 in 5

Risk after crosswords and supplements: still 1 in 3

The evidence-based interventions aren't guarantees. Genetics matter enormously.

But they're your best shot. And they improve your health in dozens of other ways simultaneously.

💬 Comment what you're focusing on - evidence-based discussion welcome
♻️ Repost if boring interventions beat sexy supplements
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for evidence-based dementia prevention

Diet drinks age your brain 1.6 years faster.
New study of 12,000 people reveals the hidden cost of artificial sweeteners.

Brazilian researchers followed middle-aged adults for 8 years and found shocking results.

The data:
Highest sweetener users had 62% faster cognitive decline
↳ Equivalent to 1.6 extra years of brain aging
↳ One diet soda daily puts you in high-risk category
↳ Effects strongest in people under 60
↳ Memory and verbal fluency hit hardest

Which sweeteners cause problems:
Aspartame (most diet sodas)
↳ Saccharin (Sweet'N Low)
↳ Acesulfame-K (baking blends)
↳ Erythritol (sugar-free gum)
↳ Xylitol (diabetic products)
↳ Sorbitol (sugar-free candy)
Tagatose was the only one NOT linked to decline.

The mechanisms behind the damage:
Neuroinflammation in brain tissue
↳ Aspartame triggers inflammatory cascades
↳ Disrupts blood-brain barrier integrity
↳ Alters gut-brain axis communication
↳ Starves brain of glucose fuel

The diabetes connection:
Effects even worse in diabetic patients
↳ Brain already stressed from poor glucose control
↳ Artificial sweeteners may confuse glucose processing
↳ Double hit to cognitive reserves
↳ Accelerated decline in executive function

What surprised researchers:
Under 60 group showed strongest effects
↳ Expected older adults to be more vulnerable
↳ Midlife exposure may set trajectory for aging
↳ Small daily exposures compound over decades

The dosage reality:
High consumption: 191mg daily (one diet soda)
↳ Middle consumption: 66mg daily (half diet soda)
↳ Low consumption: 20mg daily (occasional use)
↳ Even middle group had 35% faster decline

Hidden sources you're missing:
Flavored waters and sports drinks
↳ Light yogurt and protein bars
↳ Sugar-free medications and vitamins
↳ Chewing gum and breath mints
↳ Low-calorie baking mixes

The inflammation theory:
Animal studies show brain tissue damage
↳ Sweeteners alter microbiome composition
↳ Gut bacteria changes affect brain function
↳ Increased production of inflammatory markers

What this means for prevention:
Switch to sparkling water with lemon
↳ Use small amounts of real sugar instead
↳ Try monk fruit or stevia as alternatives
↳ Read labels on "healthy" processed foods
↳ Focus on whole foods without additives

The research limitations:
Observational study can't prove causation
↳ Self-reported dietary data has limitations
↳ Other lifestyle factors may contribute
↳ Need randomized controlled trials
↳ More research on specific mechanisms needed

I'm personally reducing my use of artificial sweeteners (confession: I love diet sodas and will still enjoy one once in a while)

💬 Comment with your current artificial sweetener use
♻️ Repost if this changes how you think about diet drinks
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Citations: Gonçalves et al. Association Between Consumption of Low- and No-Calorie Artificial Sweeteners and Cognitive Decline. Neurology. 2025.

Teen depression rates doubled after smartphones arrived.
New research reveals why the timing matters more than screen time.

The critical window for brain development gets hijacked by social media algorithms.
Behavior from birth (and even before!) has impact on cognitive aging throughout life.

2007: iPhone launches
↳ 2009: Instagram and social platforms expand
↳ 2012: Teen depression starts sharp rise
↳ 2015: Anxiety disorders peak in adolescents
↳ 2020: Suicide attempts up 167% in teen girls

Ages 10-15 critical for emotional regulation
↳ Prefrontal cortex still developing
↳ Dopamine system easily hijacked
↳ Social comparison becomes hardwired
↳ Sleep disruption during growth spurts

Constant notifications rewire reward circuits
↳ Natural activities become less satisfying
↳ Attention spans shrink measurably
↳ Face-to-face social skills atrophy
↳ Anxiety when disconnected from device

Algorithms optimize for engagement, not wellbeing
↳ Negative content gets more interaction
↳ Comparison with curated highlights
↳ Cyberbullying follows kids home
↳ FOMO becomes constant background stress

Young adults struggling with:
↳ Sustained attention and focus
↳ Emotional regulation under stress
↳ Real intimacy and relationships
↳ Self-worth independent of likes
↳ Sleep without device presence

Delayed smartphone introduction helps
↳ Device-free family meals
↳ Real-world hobbies and sports
↳ Face-to-face friend interactions
↳ Consistent sleep routines

What parents can do:
Set age-appropriate boundaries
↳ Model healthy device relationships
↳ Create phone-free zones at home
↳ Teach digital literacy skills
↳ Monitor usage and content

Brain changes possible until age 25
↳ Digital detox can help recovery
↳ Real-world experiences rebuild circuits
↳ Social skills can be relearned
↳ Earlier intervention more effective

Adolescent experiences shape adult mental health
↳ Depression patterns established early persist
↳ Anxiety disorders often become chronic
↳ Social skills deficits affect relationships
↳ Attention problems impact career success

Heavy social media use correlates with:
↳ Increased depression and anxiety
↳ Poor sleep quality
↳ Lower academic performance
↳ Reduced life satisfaction
↳ Higher suicide risk

Simple interventions that work:
30-minute daily social media limit
↳ No phones in bedrooms overnight
↳ One device-free day per week
↳ Outdoor activities without devices
↳ Regular family conversations about usage

💬 Comment with your family's device rules
♻️ Repost if teens need protection from addictive algorithms
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for digital wellness strategies

Citations: Haidt J, Allen N. Scrutinizing the effects of digital technology on mental health. Nature. 2020. Twenge JM, Campbell WK. Associations between screen time and lower psychological well-being among children and adolescents. Psychological Science. 2018.

I diagnosed over 100 dementia patients last year.

Here are the 3 questions I ask that reveal more than any cognitive test.

Question 1: "What hobbies or activities have you stopped doing in the past year?"
Why it works: Functional decline happens before test scores drop. People naturally stop complex activities when executive function fails. Stopped balancing checkbooks, quit elaborate cooking, abandoned complicated hobbies.

What I'm listening for: Not "I'm too busy" but "I lost interest" or "It got too hard." The person often doesn't realize they stopped. The family remembers clearly.

Question 2: "Tell me about a time recently when you got confused about what day it was."
Why it works: Opens door to discussing orientation problems without shame. Everyone forgets the date sometimes. But the pattern matters.

What I'm listening for: How they recover. Normal aging: "Oh right, it's Tuesday." Early dementia: Confabulates a reason, gets defensive, or shows no awareness this is unusual.

Question 3: "Has anyone mentioned concerns about your memory or thinking?"
Why it works: Anosognosia (lack of insight) appears early in dementia. They genuinely don't notice their deficits. But families do.

What I'm listening for: "No, everyone else is overreacting" combined with family nodding vigorously behind them. That disconnect is diagnostic gold.

These questions work because dementia affects insight, executive function, and social awareness before it affects memory tests.

A patient can pass cognitive screening while:
- Unable to manage medications independently
- Losing ability to handle finances
- Stopping complex hobbies without realizing it
- Dismissing family concerns as overreactions

The tests measure what the brain can do under perfect conditions. These questions reveal what actually happens in real life.

After these 3 questions, I have a hypothesis. Then I confirm with objective testing. But I've never been surprised by the results.

Because functional impairment tells the real story.

💬 What questions have helped you identify cognitive changes?
♻️ Repost to help clinicians refine their diagnostic approach
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for practical dementia diagnosis strategies

Most "brain training" apps don't help with dementia.

Years ago, I remember being skeptical when I saw brain training apps advertising that they could help with cognitive decline and even dementia. 

I thought someone's wrist was going to be slapped, and sure enough, Lumosity later paid $2 million in FTC fines for false advertising.

Yet millions still pay for cognitive exercises that don't transfer to real-world function.

The uncomfortable truth: your brain needs challenge, not games.

The brain training industry sells false hope:

Promises to prevent dementia with daily puzzles
↳ Markets to anxiety about cognitive aging
↳ Uses impressive-sounding neuroscience terminology
↳ Charges monthly fees for glorified video games
↳ Provides no evidence of real-world benefits

What the research actually shows:
Getting better at specific games doesn't improve general cognition
↳ Skills learned don't transfer to daily activities
↳ Memory games don't prevent memory loss
↳ Processing speed exercises don't speed up thinking
↳ Brain training performs no better than reading

Real cognitive protection comes from:
Learning complex new skills like languages or instruments
↳ Engaging in challenging work or volunteer activities
↳ Building and maintaining social relationships
↳ Physical exercise that increases blood flow to brain
↳ Managing stress and getting quality sleep

The difference matters:
Video games train narrow, specific abilities
↳ Real-world activities exercise multiple brain networks
↳ Social learning provides emotional engagement
↳ Physical challenges support brain health directly
↳ Meaningful activities create lasting motivation

Why people fall for brain training:
Convenient and feels productive
↳ Provides immediate feedback and progress tracking
↳ Seems scientific with colorful brain imagery
↳ Offers sense of control over cognitive aging
↳ Requires less effort than genuine challenges

(Caveat: If you want to get better at a specific skill like quickly calculating tip on a restaurant bill, then by all means, use apps that gamify this for you to practice.)

The irony: time spent on brain training apps would be better invested in reading, conversation, or learning real skills.

Your brain needs novelty, challenge, and meaning.

Not repetitive exercises designed to keep you clicking.

Save your money. Challenge your mind with activities that matter.

The best brain training happens when you're not trying to train your brain.

💬 Comment if you've tried brain training apps
♻️ Repost if real learning beats artificial challenges
👉 Follow me (Reza Hosseini Ghomi, MD, MSE) for evidence-based brain health

Citations: 
Simons DJ, et al. Do "brain-training" programs work? Psychological Science in the Public Interest. 2016. 
Owen AM, et al. Putting brain training to the test. Nature. 2010.

I built 4 healthcare companies.
Every investor meeting ended the same way: "This is great, but how do you scale?"

I'd explain our model. Show our growth. Present our margins.

They'd nod. Then ask again: "But how do you SCALE?"

What they meant: how do you grow without adding proportional costs?

In software, scaling is elegant. Add users without adding staff. Margins improve exponentially.

In healthcare, scaling is messy. Add patients, add providers. Add locations, add overhead. 

Margins stay flat or compress.

This is why healthcare innovation fails.

Investors want software economics. Healthcare is a service business.

You can't deliver medical care without humans. And humans don't scale like code.

We bootstrapped a company to 50 staff and 4,000 patients monthly. Profitable from year 3. Sustainable growth.

Investors told me I was "thinking too small."

What they wanted: venture-backed growth. Triple revenue yearly. Dominate the market. Exit in 5 years.

What we built: stable business delivering quality care. Predictable growth. Long-term sustainability.

Completely different models. Completely different outcomes.

That's not to say there may not be lucrative exits along this short term path for investors, but for long term success where we move the needle on real patient outcomes, we need a different model.

The pressure to scale too fast destroys healthcare companies.

You hire too fast. Quality suffers. Patients notice. Reputation damage is permanent in healthcare.

You automate too much. Care feels impersonal. Patients leave. Trust disappears.

You expand too quickly. Systems break. Staff burns out. Everything falls apart.

I've watched brilliant healthcare founders ruin their companies chasing scale.

Healthcare is local. Healthcare is relationship-based. Healthcare is high-touch.

These things don't scale the way investors want.

The best healthcare companies I know grow slowly. They prioritize quality over expansion. 

They're still here decades later. While the "revolutionary" venture-backed competitors burned through $50 million and failed.

Healthcare needs different rules.

Growth that respects the human nature of medical care. Investment that values sustainability over explosive scale. Success metrics beyond just revenue multiples.

Until we accept that healthcare is fundamentally different from software, we'll keep setting up promising companies for failure with unrealistic growth expectations.

💬 Comment if you've seen quality suffer from rapid scaling
♻️ Repost if sustainable beats explosive in healthcare
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60% of dementia goes undiagnosed in the United States.
And most primary care doctors believe the problem is a lack of specialists.

They're wrong.

The real problem is we designed a system where diagnosis is impossible at scale.

Here's what I mean:

You need a neuropsychologist for comprehensive testing. Average wait time: 6-12 months. 

Cost: $3,000-5,000. Most insurance won't cover it, at least without a fight.

You need specialized brain scans for confirmation. 

PET amyloid imaging costs >$5,000 and is not availably to the vast majority of the population and spinal fluid testing most patients want to avoid and is also difficult to complete. (We are starting to see blood tests slowly reach the market).

You need a dementia specialist for diagnosis. There are fewer than 1,000 true specialists in the US. 

Keep in mind general neurologists, psychiatrists, and even geriatricians are not specialty trained in dementia and have similar comfort in diagnosis and treatment as the average PCP. 

Do the math. Even if every specialist worked 100 hours weekly, we couldn't diagnose everyone who needs it. Not even close.

We built a diagnostic pathway that requires:
- Rare specialists (1 per 1,400 patients)
- Expensive tests (most uninsured)
- Long wait times (when early detection matters most)
- Urban access (rural patients left behind)

Then we act surprised when 60% go undiagnosed.

The solution isn't more specialists. It's reimagining who can diagnose and how.

Primary care physicians can diagnose dementia accurately with the right tools. Digital cognitive testing takes 15 minutes, costs under $100, works anywhere.

With the right support, the entire provider workforce can catch dementia, but this is a gap in our healthcare system and a culture issue, not an issue with individual providers.

We don't have a specialist shortage. We have an access design problem.

The current system works perfectly for the 40% who get diagnosed. Wealthy, urban, with time and resources.

Everyone else gets memory loss dismissed as normal aging.

💬 What's been your experience accessing dementia diagnosis?
♻️ Repost if diagnosis should be accessible, not elite
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