This article focuses on the prevention of neurological disease in the post-infant phase of life and considers both the public health and individual strategies that have been employed for primary prevention. Secondary prevention is considered for certain conditions—for example, stroke.

To be able to devise primary preventive strategies, sound epidemiological evidence is required. Factors to consider are case definition, study design, and the resultant confidence with which interpretation of the results can be made. For many of the neurological conditions discussed case definition is problematic. In stroke, for example, a clinical definition is used in most research studies. The problem of silent cerebral infarction is consequently omitted. Technological advances, particularly in imaging, also potentially lead to changes in diagnostic acumen. For many neurological conditions there are detailed clinical case series but when assessing risks, most evidence has been based on case-control studies with the resultant biases.

This review primarily considers stroke, as it is the major cause of adult neurological death and disability. With current knowledge of risk factors it is the condition in which there is most scope for primary prevention. A brief review of some of the other major neurological diseases is included to illustrate areas where work has been reported or is required. The perspective in this review is that of the developed world.