The best books on rethinking brain aging and neurodegeneration

Alberto Espay Author Of Brain Fables: The Hidden History of Neurodegenerative Diseases and a Blueprint to Conquer Them
By Alberto Espay

Who am I?

I am a professor of neurology at the University of Cincinnati, interested in the many ways in which we acquire impairments in movements, in cognition, or in both. I have sought to measure these behaviors, quantify their responses to different pharmacological treatments, and determine how they inform the biology of the aging brain. In publications along the way, I have increasingly questioned how we classify neurological diseases and treat those affected.


I wrote...

Brain Fables: The Hidden History of Neurodegenerative Diseases and a Blueprint to Conquer Them

By Alberto Espay, Ben Stecher,

Book cover of Brain Fables: The Hidden History of Neurodegenerative Diseases and a Blueprint to Conquer Them

What is my book about?

The narratives we have chosen to understand abnormal brain aging have shaped what we have done to improve it. Among the most important narratives is this one: proteins become toxic to the brain and cause disease. Billions of dollars and dozens of randomized trials later, not one of the promising anti-protein therapies have slowed the progression of neurological symptoms. This book reviews the milestones of Parkinson’s and Alzheimer’s stories from the sources, with fresh eyes. When the data are reviewed without our age-old biases, a different story emerges. This book's ideas inspired the first biomarker study of aging (the Cincinnati Cohort Biomarker Program or CCBP), designed to match people affected with neurodegenerative disorders to available therapies from which they are most biologically suitable to benefit, regardless of their clinical diagnoses. 

The books I picked & why

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American Dementia: Brain Health in an Unhealthy Society

By Daniel R. George, Peter J. Whitehouse,

Book cover of American Dementia: Brain Health in an Unhealthy Society

Why this book?

This book explains the tight connection between Alzheimer’s disease and education, health, income, and environment, and why the rate of Alzheimer’s disease in the population actually decreased in the decades following the most important societal changes enacted after World War II. Social safety, environmental protections, and income inequality have had far greater impact than any of the pharmacological approaches ever attempted. The authors make the compelling case that brain health is intimately connected to societal health.


The Structure of Scientific Revolutions

By Thomas S. Kuhn,

Book cover of The Structure of Scientific Revolutions

Why this book?

This classic book is relevant to anyone interested in the brain. Our teachers told us that our knowledge evolves linearly, small discoveries accumulating over time. But Kuhn (1922-94), a theoretical physicist, reviewed the history of discoveries and concluded they happened after “crises.” He defined and popularized many of the terms we still use today. A “paradigm” creates the boundaries within which “normal science” can operate to answer “puzzles.” Normal science does not aim at novelty but at discovering what it expects to discover based on a hypothesis. Any “anomalies” that cannot be resolved with further studies lead to a “crisis” of the prevailing paradigm, whose “revolution” contains the seeds of a new paradigm and, with it, new boundaries for “normal science” to ask questions it could not with the prior paradigm. This book convinced me that the current protein-toxicity paradigm of neurodegeneration checks all of Kuhn’s boxes for a scientific revolution.


How the Brain Lost Its Mind: Sex, Hysteria, and the Riddle of Mental Illness

By Allan H. Ropper, Brian Burrell,

Book cover of How the Brain Lost Its Mind: Sex, Hysteria, and the Riddle of Mental Illness

Why this book?

This book offers a captivating tale of how the increasing knowledge of one disease, syphilis, created the foundations to understanding that the brain and mind are one and the same. The authors narrate the stories of patients whose “hysteria” (today referred to as functional neurological disorder) were traced to degenerative brain lesions that only belatedly were understood to be complications caused by remote infections with the bacterium Treponema pallidum. Several chapters follow the story of the important characters depicted by André Brouillet in the Une leçon clinique à la Salpêtrière (A Clinical Lesson at the Salpêtrière), one of the most recognized paintings by neurologists, as it depicts Jean-Martin Charcot, shown among many of his disciples, demonstrating a “hysteric” seizure in one of his patients. The authors illustrate how we have gotten away with conceptualizing behaviors without biological basis and put the reader on notice that “mental illnesses” are neurological problems –with a solution somewhere in the brain, waiting to be found.   


Madness and Memory: The Discovery of Prions--A New Biological Principle of Disease

By Stanley B. Prusiner,

Book cover of Madness and Memory: The Discovery of Prions--A New Biological Principle of Disease

Why this book?

Stan Prusiner received the Nobel Prize of Medicine in 1997 for identifying what at the time was considered a novel mechanism of neurodegeneration: the prions. These “infectious proteins” were responsible for ravaging the brains of animals suffering from scrapie and mad cow disease, and of humans with Creutzfeldt-Jakob disease. Although I have come to doubt that prions are a cause of rapidly progressive dementia and may instead represent a consequence, Prusiner’s memoir is filled with moments of skepticism, self-doubt, adversity, and intellectual rivalries –the ingredients for a gripping drama in neurosciences. 


This Idea Must Die: Scientific Theories That Are Blocking Progress

By John Brockman,

Book cover of This Idea Must Die: Scientific Theories That Are Blocking Progress

Why this book?

This collection of essays blew my mind. Researchers in a range of disciplines were asked to elaborate on why a given idea in their field should be put to rest. There is a chapter dedicated to big data, nature versus nurture, cause and effect, race, Linnaean classification, etc. The book’s essays inspired me to shape a section on “Reductionism and related ideas that will die” as part of a solicited article I wrote with Tony Lang in 2018 aiming to predict the future of Parkinson’s disease research in the 2020s (Ben Stecher credited it as his reason to relocate to Cincinnati to work with us in our CCBP study). This book is also a reminder that progress requires new ideas, and most cannot emerge without first abandoning outdated ones (as Kuhn articulated).  

An idea that must die in neurology is the clinico-pathologic model of classifying neurodegenerative diseases: abnormalities on brain autopsies (clumps of abnormal protein, or pathology) are most likely a consequence of disease, not their cause (or pathogenesis). By trying to clean the brain from pathology, we have thought we can end the diseases they define –to no avail.


5 book lists we think you will like!

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And, 3 books we think you will enjoy!

We think you will like The Essential Tension: Selected Studies in Scientific Tradition and Change, Changing Order: Replication and Induction in Scientific Practice, and Personal Knowledge: Towards a Post-Critical Philosophy if you like this list.