Now more than ever, the research community should be concentrating on finding ways to reduce the incidence of dementia. The population is aging, and the number of individuals affected by dementia remains a major public health challenge. The reality is that we have no effective treatments for dementia. In the absence of treatments to cure the disorder (or even reduce the associated burden by delaying onset or reducing disability), the prevention of dementia must be a priority research topic. Modifiable risk factors are associated with dementia 1 (eg, diabetes and attendant behavioral risks, such as diet and physical activity); these risk factors are important but complex targets for intervention. However, as with many neurologic and psychiatric disorders, we have a scant appreciation of the environmental risk factors that contribute to dementia risk. There is an urgent need to generate new candidate risk factors for dementia. In contrast to genetics, for which there are now cost-efficient, high-throughput screening methods that can generate genetic candidates, epidemiology relies on a mix of creative researchers and access to suitable databases that contain the variables of interest. Epidemiologists are envious of our colleagues in genetics, in which the search space for risk variants is more tractable and bounded. The study by Kessing and colleagues 2 presents evidence that low lithium concentration in the drinking water may be associated with an increased risk of dementia. The hypothesis is surprising but is mechanistically plausible. The hypothesis builds on preliminary evidence from clinical trials that suggest that lithium supplementation may improve cognitive outcomes in groups with mild cognitive impairment 3 and Alzheimer disease. 4 The new study links Danish health registers with area-level studies that map observed and imputed lithium concentrations in drinking water supplies. The link between lithium and neuropsychiatry has a venerable history. More than 50 years ago, Australian 5 and Danish psychiatrists 6 pioneered the use of lithium as a treatment for mania. Attempts have been made to reverse engineer the neurobiology of bipolar disorder from the known biological properties of lithium. However, lithium affects many biological pathways linked to neuroprogressive and neurodegenerative disorders. 7 For example, lithium affects diverse homeostatic mechanisms that include intracellular calcium, microglial activation, glutamate excitotoxicity, apoptosis and autophagy, inflammation, oxidative stress, and mitochondrial dysfunction. Lithium increases synaptic