Understanding that brain illnesses aren’t an unavoidable aspect of life

Sanjula Singh aims to convey that stroke, dementia, and depression are significantly more preventable than commonly perceived.

“The prevalent fallacy that many hold is that Alzheimer’s or depression or stroke is akin to a train hurtling down the tracks,” stated Singh, a principal investigator at Massachusetts General Hospital and Harvard Medical School’s Brain Care Labs, who has been examining brain diseases for years.

While genetics can contribute to the onset of these conditions, Singh’s findings have illustrated that as much as 80 percent of strokes, 45 percent of all dementia cases, and 35 percent of instances of late-life depression can be mitigated through lifestyle changes.

One of the most significant risk factors for dementia, Singh elaborated, is elevated blood pressure. Contrary to merely treating illnesses, Singh has focused on assisting individuals in avoiding them in the first instance.

“What I share is a highly optimistic message,” she remarked. “There is so much within your control that you can undertake to stay healthy and content. … It’s incredibly straightforward, but I believe that’s what makes it so impactful.”

Born to a family of medical professionals in the Netherlands, Singh initially aspired to be a singer-songwriter following her high school graduation. However, after studying at the Codarts Conservatory in Rotterdam, her passion for science resurfaced.

“I cherished the creative process, and I also enjoyed tackling complex problems. I realized I didn’t need to pick one — I desired a life that accommodated both.”

“There’s so much you have in your own hands that you can do to remain healthy and happy. … It’s so simple, but I think that’s what makes it so powerful.”

After exploring various parts of the globe, she began her medical education the following year, initially intending to become a neurosurgeon.

Aiming to impress Bart Brouwers, a neurosurgeon she thought might have space in his lab, she spent an entire night in her first year of med school memorizing his dissertation. He directed her to Gabriël Rinkel, a professor of neurology at University Medical Centre Utrecht. Although Singh hadn’t yet taken a course on the brain, Rinkel allowed her to start participating in research that would eventually form her Ph.D. thesis.

As she maneuvered through medical school in Utrecht, it was the research aspect that captivated her the most. She devoted much of her neurosurgery Ph.D. to studying cerebellar intracerebral hemorrhage, a lethal subtype of stroke affecting the cerebellum.

The outcomes of her research ultimately influenced changes to international treatment guidelines for this condition. While it was a gratifying result, she also realized that, although her work could benefit a small population, it wouldn’t prevent strokes from occurring.

“I wanted to be at the forefront,” she said. “I sought to avert the suffering.”

She gained her first significant exposure to some of these changeable risk factors during graduate school while working in the lab of Josh Goldstein, a professor of emergency medicine at Harvard Medical School and a co-supervisor with Rinkel. Her projects focused on specific neurosurgical subjects, but she began to observe how impactful modifiable risk factors could be, even for those who had already experienced a stroke.

To acquire skills in formulating questions and conducting analytical studies on these risk factors, she dedicated a year to studying epidemiology and statistics during her master’s program at the University of Oxford.

“I encountered numerous excellent datasets that vividly demonstrated how many brain diseases could be forestalled,” she reflected, “but I wasn’t certain who was truly spearheading that initiative.”

80%

—Of strokes are linked to modifiable risk factors, according to Singh’s findings

Singh hadn’t sought to return to the U.S. after finishing her Ph.D. until Jonathan Rosand, a Harvard professor of neurology and a member of her Ph.D. dissertation committee, persuaded her otherwise.

During a walk-and-talk, Rosand shared his vision for a new lab dedicated to preventing brain diseases, which eventually adopted the name Brain Care Labs.

“I had faith in him — and in his vision,” Singh noted. “I told him, ‘I want you to be my mentor. Wherever you go, I will follow.’”

At the Brain Care Labs, Singh began dedicating her time to exploring brain wellness and the elements that influence it. In 2022, she was the lead author of “Brain health begins with brain care,” an article in The Lancet that called for a swift response to what major health organizations have termed a global brain-health crisis.

“Although preventing brain diseases has yet to become a focal point of primary care medicine,” she wrote, “a vital opportunity exists to capitalize on the global consensus that over 40 percent of dementia, stroke, and depression cases result from modifiable risk factors.”

With her new colleagues, Singh contributed to developing the Brain Care Score, a tool designed for individuals to evaluate how their habits impact their brain health, supported by data collected from hundreds of thousands of adults monitored for over a decade.

Rather than merely forecasting disease, the score was crafted to aid individuals in altering risk factors that may elevate the probabilities of stroke, dementia, and depression. These risk factors encompass three domains: physical (e.g., blood
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pressure, glucose levels, cholesterol), lifestyle choices (nutrition, physical activity, rest), and social-emotional aspects (stress, interpersonal relationships, life purpose).

“It’s irrelevant where you commence. What truly counts is that you take the first step. Enhancing — even if it’s just slightly — is the path ahead.”

Singh is continually expanding her investigations to fortify the scientific connection between alterable risk elements and neurological disorders.

Recently, she and her team uncovered 17 intersecting variables that influence the likelihood of stroke, cognitive decline, and depression in older age. By recognizing and modifying even a single one of these elements, individuals can diminish their chances of experiencing neurological conditions once deemed unmanageable.

“Initiate with something minor and manageable,” Singh stated. “Those initial actions can generate momentum — and over time, they can produce significant transformation.”

While Singh assesses the origins of neurological disorders, she is also focused on assisting people in modifying their lifestyles. “We understand that changing behavior is quite challenging,” she remarked, “and, among other methods, we realize that personal health coaching can indeed be effective.”

She and her research team are tackling implementation from multiple angles. Through the Global Brain Care Coalition established by Rosand in 2024, Singh and her associates have crafted community-specific Brain Care Scores to ensure that modifications to aspects such as nutrition are pertinent and suitable for various cultural groups globally.

Additionally, they have recently sought funding for an AI Avatar designed to assist individuals in making small adjustments to their daily routines.

They are also developing practical tools, such as a product aimed at enhancing medication adherence that is currently under evaluation in a clinical trial. Singh envisions creating a comprehensive range of products that enable individuals to manage their health in simple, accessible manners. She aims to design items that seamlessly integrate into a living room — unobtrusive solutions for improving health.

This motivation has led her back to academia — this time in an M.B.A. program at Columbia, where she is working to transform her ideas into tangible products.

“I want to ensure that individuals have easy-to-use tools that can be incorporated into their homes, which are enjoyable, creative, and genuinely impactful.”

Singh is convinced that brain wellness deserves the same level of recognition and action as cardiac wellness.

“The significant studies are published,” she noted. “We’re getting the information out there.” The actual effect, she understands, will manifest when individuals integrate the research into their daily lives. “It’s irrelevant where you commence,” she declared. “What truly counts is that you take action. Progressing — even if it’s just slightly — is the path ahead.”