The longevity industry's brain problem

Spend an hour with longevity content on the internet and you will learn about NAD+, peptides, GLP-1 drugs, rapamycin, blood markers, supplements, cold plunges, methylation tests, mitochondrial therapies, and the resting heart rate of a 47-year-old man named Bryan Johnson. You will learn a great deal about the heart, the liver, the immune system, and the skin.

You will hear remarkably little about the brain.

This is a strange asymmetry. The brain is the organ most people seem to care about most. It is the organ that defines who they are. And it is the organ most likely to fail in ways that matter as they age. Yet the longevity industry, with its remarkable energy and resources, has largely overlooked it.

What the longevity industry tracks

A typical "longevity stack" includes:

• Blood biomarkers like HbA1c, cholesterol panels, inflammatory markers
• Continuous glucose monitoring
• VO2 max testing
• DEXA body composition scans
• Genetic testing for variants associated with disease risk
• Various epigenetic ageing clocks

Almost none of this measures the brain.

You can spend tens of thousands of dollars optimising your insulin sensitivity, your body fat distribution, and your sleep architecture, and never have an estimate of how your brain is doing.

What it misses

This matters because:

• The single most feared outcome of ageing in surveys is cognitive decline, not heart disease
• Dementia is the leading cause of disability-adjusted life years lost in older adults
• Most longevity interventions plausibly affect the brain but are not measured for it
• Brain ageing trajectories can diverge sharply from physical ageing trajectories in the same person

A 60-year-old can have the cardiovascular profile of a 40-year-old and the brain ageing trajectory of a 70-year-old, or vice versa. Without measuring the brain, you do not know which case applies.

Why the gap exists

A few reasons:

• Brain measurement is harder. There is no fingerstick test for the brain. The best non-invasive measurements involve MRI, which is expensive and not built for monthly monitoring.
• The brain is less responsive to acute interventions. Cardiovascular markers can change in weeks. Brain age measurements move over years.
• The longevity industry is largely commercial. The interventions sold are the ones that produce visible, measurable, satisfying results. Brain interventions move slowly and resist easy quantification.

What we think it should look like

The shift we want to see, and the work we are doing at Neureka:

• Routine brain age measurement from a single MRI scan, becoming a normal part of an annual health snapshot
• Cognitive assessment as a sibling to a blood panel, not a thing you only get when something has gone wrong
• Lifestyle interventions evaluated for brain effects, not just metabolic effects. We need trials that report cognitive endpoints alongside everything else.
• Cross-cultural validity built in from the start, not bolted on later. Brain health for the global population, not just the worried-well in California.

There is nothing wrong with caring about a low fasting glucose. There is something missing about not also caring about whether your brain is keeping up.