Caring for Your Brain & Preventing Cognitive Decline

Brain health is such a hot topic right now.  It seems that everyone has someone in their family who has dementia, or knows of someone with this condition.  The World Health Organization defines dementia as a term for several diseases that affect memory, thinking, & the ability to perform daily activities.  Intellectual functioning and the ability to problem-solve & maintain emotional control have become impaired.  Personality changes and behavioral problems such as agitation, paranoia, delusions, hallucinations, and combativeness may also be present. These symptoms tend to worsen over time.

Alzheimer’s disease is a type of dementia that accounts for around 60-80% of dementia cases.  Other types of dementia include vascular dementia, Lewy Body dementia, frontotemporal dementia, mixed dementia, Parkinson’s disease dementia, and others.  Dementia can be diagnosed with cognitive testing and certain blood markers.

Startlingly, brain decline often begins 20 or more years before symptoms appear.  Cognitive impairment has been observed in people as early on as their 40’s! 

There is a lot of fear and misunderstanding around this topic, including myths around the genetic connection.  What may appear to be a heightened risk of dementia within families is often the product of shared habits. 

Poor health habits + time = illness.

While it is considered normal to forget now and then why, for instance, we entered a room, changes like being unable to remember the names of family members or cognitive impairment that interferes with the ability to function and perform activities of daily living is not.

The good news is that up to 53% of dementia cases are actually preventable!  Neuroplasticity – the brain’s ability to shape, grow, and rewire itself – means that we have a lot of control over our brain health at any age and stage.  It turns out that many of the ways we care for our overall health also benefit our brains.  This post explores the ways that we can most effectively care for this critical aspect of our health. 

Alzheimer’s is now optional. – Dr. Dale Bredesen

Stages of Dementia

Dementia does not just appear out of nowhere.  It is the end result of a process of brain decline. The 4 stages of dementia are:

Stage 1   Although blood markers for the condition are present, the individual is asymptomatic.

Stage 2  There is subjective cognitive impairment, meaning that the person is noticing changes in their ability to think clearly, function well, and remember words, names, etc.; but others may not notice this.

Stage 3  Mild cognitive impairment (MCI) exists that is now visible to people in the person’s life.

Stage 4  Dementia is diagnosable as a significant decline in intellectual/cognitive functioning interferes with the ability to carry out normal activities and relationships.

Core Causal Factors

Dr. David Bredesen, renowned neurologist on the forefront of research about and treatment of dementia, identifies 3 core causes of dementia.  While a genetic predisposition may also be present, these 3 lifestyle and environmental factors are central, and to a large extent, controllable.

Energetics 

Does the brain have the resources it needs to function well?   This organ requires proper oxygenation, blood flow, vascular health, and mitochondrial (energy power house of cells) function.  If not, dementia is more likely to develop.

Systemic Inflammation 

Metabolic syndrome, including conditions like insulin resistance, extra weight, high blood pressure, and dyslipidemia (high “bad” cholesterol and/or low “good” cholesterol), and infections all contribute to dementia.

Toxins 

Environmental toxins such as air pollution, microplastics, and mold build up toxin levels in the body and contribute to dementia.

The NEURO Framework

The brain is an amazing organ. Weighing in at around 2 pounds, it consumes up to 25% of our calorie intake.  It is highly vascular, and the neurons contained within are capable of creating trillions of connections. 

Husband-wife team Drs. Ayesha & Dean Sherzai are neurologists, scientists, researchers and authors who are prominent voices in the brain health space.  They have distilled through their research and experience 5 habits to improve brain health and prevent cognitive decline.  Using the acronym NEURO, they provide a clear, simple, and convenient description of these habits.  

By adopting 1-2 of the following habits, you can reduce your risk of cognitive decline by up to 30%.  This risk is reduced by a whopping 60% when 4-5 of the habits are undertaken.  Each letter of the word NEURO stands for a specific habit.

N is for nutrition. 

A plant-based, whole-foods diet that contains leafy greens, cruciferous vegetables, nuts, seeds, legumes, berries, coffee or tea, spices, and fermented foods promotes brain health.  A varied selection of healthful foods promotes gut microbiome diversity, which supports the health of the brain and the body.  Studies show that good nutrition reduces the risk of Alzheimer’s by up to 53%.  In another study, eating a daily serving of leafy greens resulted in a brain that was, on imaging, 11 years younger.  

Vitamin D3 plays an important role in the production of a substance called BDNF (brain-derived neurotropic factor), which is like fertilizer for the hippocampus, the memory center of the brain.  In addition to a daily dose of healthy natural light, a dosage of 2000 IU’s of vitamin D3 confers this benefit. 

B vitamins such as B12 & folate and fiber are necessary for brain health as well.

E is for exercise. 

Both cardiovascular and resistance exercise have beneficial effects upon brain health.  Cardiovascular exercise increases the production of BDNF.  Both cardiovascular and resistance training help to regulate blood glucose, blood pressure, and promote blood flow to the brain.  The regulation of blood glucose is especially important as dementia and Alzheimer’s have been conceptualized by some as a “type 3 diabetes”, and muscle is the body’s inbuilt glucose disposal system. 

The legs are considered to be the biggest “pumps” that increase blood flow to the brain and are therefore especially important in one’s exercise regime. 

During muscle-building strength training exercise, myokines are released.  These are small proteins and peptides produced, expressed, and released by muscle fibers in response to muscular contractions, also improving cognitive function.  One study had older adults add resistance training twice a week; after several weeks, out of 596 genes tested, 179 showed a reversal in the aging process. 

A minimum of twice weekly strength training sessions is recommended; however, performing leg strengthening 3-4 times a week produces up to a 47% risk reduction for cognitive impairment.  Furthermore, a brisk 25-minute walk performed 5 days a week reduces this risk by a 40% margin.  Clearly, our genes expect for us to move.  And this does not require a gym.

U is for unwind. 

Dr. Ayesha is clear about the deleterious effects of unmitigated negative stress on the brain.  While modern life brings many conveniences our ancestors could not have even imagined, it also brings the complexity of more sophisticated problems, bombarding our brains with more information than they were made to handle and the divided attention that accompanies this. 

Too much cortisol negatively affects the brain by shrinking the hippocampus.  Under stress, with its associated states of fight, flight, or freeze, the body deprioritizes non-essential functions like reproduction, immunity, creativity and learning, and digestion.  When we are too stressed, we tend to experience problems with sleep and are drawn to processed, sugary foods – both of which harm the brain over time. 

Stress + stress = breakdown

Dr. Ayesha is a proponent of making lists of good and bad stressors, taking action to minimize or eliminate bad stressors wherever possible.  We do, however, need “good” stressors, such as exercise, in order to keep our brains and bodies healthy. 

R is for restore. 

Rest and restoration may not be popular activities in a culture that prizes “doing”, but are necessary for health of the body…and the brain.  It is during good quality sleep that 2 critical functions occur: the cleaning of the brain and conversion of short-term memories to long-term memory via the hippocampus. 

Just as the body has a lymphatic system, the brain has a glymphatic system.  During sleep, “janitor” cells called microglia clear the brain of harmful accumulated proteins such as beta amyloid proteins and tau tangles that are associated with dementia. 

In one study, the brains of older adults who reported sleeping better were objectively assessed as being 3 years younger than those who slept poorly.  It was concluded that high quality sleep has a protective effect against "age-related" brain shrinkage.

If you do not sleep enough or well, cortisol levels are higher, blood sugar control is worse, and stress chemistry causes you to be drawn to sugary, processed foods, all of which is harmful to your brain health.  Do you see where this is going??

Stress + rest = growth -Brad Stulberg & Steve Magness, authors of Peak Performance

Circadian entrainment through good habits and exposure to natural light, preferably first thing in the morning, promotes quality sleep.  Rising in the AM and retiring to bed in the evenings at consistently as possible create the conditions for good sleep.  According to research, the bigger the difference with regard to sleep and wake times, the greater the cellular and brain aging.

Sleep apnea and other sleep disorders are an independent risk factor for dementia.  See my post How Sleep Works for more information about optimizing sleep.

According to Dr. Bredesen, we should be aiming for at least 7 hours of total sleep, 90 minutes of REM sleep, and 60 minutes of deep sleep each night.

O is for optimize. 

Optimizing in this context refers to providing our brains with positive stimulation that incorporates complexity, purpose, and challenge.  Activities that offer opportunities for sustained focus and deep thinking are antidotes to the negative stress and fragmentation common in modern-day living.  A few examples are working puzzles, doing some continuing education, learning a new language, volunteering for a good cause, partaking in an artistic pursuit, and engaging in social interactions. 

Kudos to my 80-something dad and mother-in-law in this regard. My dad is building his own car including all wiring, and regularly gets underneath the car to work on it. (I have suggested that he consider offering a class called "Automotive Yoga" at his local fitness center.) My mother-in-law started a volunteer group of women who work closely with Habitat for Humanity to better the lives of people residing in her county. This group has really grown and gained traction over time.

Learning to play an instrument earns 5 stars for this category, especially if involves playing with other people.  These types of activities stimulate neurons (brain cells) to make connections with each other and shore up cognitive reserve, akin to building up a savings account albeit for your cognitive functioning.

A key is to actively engage with whatever pursuits you choose to undertake.

Further, Dr. Bredesen names detoxification as a crucial element of caring for the brain and preventing or even reversing cognitive decline.  He suggests drinking plenty of water, taking a sauna (especially one with infrared light if possible), inducing a good sweat through regular exercise, and including fiber in one’s diet as ways to help the body detoxify.  Having up to 12 hours overnight without eating can be helpful as well if a person's physiology is sufficiently robust to be able to tolerate this. 

He emphasizes the need for support before stimulation.  This means that it will be more effective to address some of the physical aspects of brain care such as good nutrition and sleep before significantly challenging the brain with higher-level stimulation therapies if they are being used. But do not let this stop you from working a Sudoku puzzle!

Other Factors Affecting Cognitive Health

No discussion of brain health would be complete without mentioning the following factors.

-       Hearing loss. It is well-known that hearing loss is correlated with the development of dementia.  Please do your loved ones a favor: have your hearing tested, and obtain & actually use the hearing aids that you need.  Or encourage that older adult in your family to do so.  Losing one’s ability to hear leads right into the next concern.

-       Social isolation.  We are social and emotional beings, even the introverts among us. Engaging in positive social interaction stimulates the brain.  Our genes expect us to interact.

-       Depression.  This is more than just “feeling down”. Depression results in disengagement and self-neglect, both of which negatively impact brain health.

-       Smoking.  Smoking decreases blood flow to the brain and raises blood pressure, both of which increase the likelihood of dementia.

-       Alcohol and drugs.  Alcohol permanently and irreversibly kills brain cells, reducing our cognitive reserve to handle other factors that we may not be able to control so readily.

-       Head injury.  Traumatic brain injury or concussion increase the risk of dementia.  Protect your brain by staying away from dangerous sports and properly wearing a good helmet for cycling.  Seek medical attention quickly if you do sustain a head injury and follow medical recommendations to the letter.

-       Caregiving.  Caregivers of people with dementia have a higher risk of developing dementia themselves.  This is due to the stress of caregiving demands combined with a lack of time for caregivers to meet their own needs and typically sharing the same lifestyle habits as the loved one e.g., poor diet and lack of exercise.  It is also notable that the preponderance of caregivers are women, who are still unfortunately taxed with the lion’s share of caregiving already.

-       Female gender.  She is often the primary caregiver for a partner or parent with dementia, in the “sandwich generation” with caregiving responsibilities for both children and parents. Typically, she is in midlife during this age of responsibility, so brain-promoting hormone levels are naturally declining as well.  If this is you, please seek support, delegate, talk to your doctor about hormone therapy, and TAKE TIME FOR YOURSELF WITHOUT GUILT.  

Beliefs and Expectations

Finally, beliefs and expectations have been shown to play a pivotal role in our cognitive function as we age.  If you expect to experience declining health and believe “it’s all downhill from here”, this is what you will experience.  There are societies in which elders are just as active and sharp as their younger counterparts, and even wiser with the experience of the extra years.

The Counterclockwise Study

One 1979 experiment by Harvard researcher Ellen Langer looked at the health markers of a group of men in their 70’s and 80’s both before and after a weeklong retreat in which they were immersed in an environment that resurrected the year 1959. The news, environment, and conversation reflected that of 20 years earlier. The subjects had to take their own belongings upstairs and perform other, similar activities without extra help. Astonishingly, after this retreat, marked improvements were seen in their cognitive abilities, memory, vision, hearing, blood pressure, arthritis, gait, dexterity, and physical speed. One man even stopped using his cane!

It should be clear by now that each thought has its corresponding neurochemical state.  While we cannot and should not try to suppress all negative thoughts (it is important to feel genuine emotions), we can choose which thoughts to engage with. 

What you can absolutely do is visualize yourself as functional and sharp over time.  Endeavor to cultivate a playful attitude towards life to whatever degree that you can.

We do not stop playing because we get old; we get old because we stop playing. -George Bernard Shaw

What If…?

Lifestyle choices are so instrumental in our aging process and brain health!  This is not meant to lay blame for a dementia diagnosis, but rather to empower individuals with information they can apply from this point forward. There is no one miracle supplement that prevents cognitive decline.  Do not be taken in by gimmicks that promise to “cure Alzheimer’s”.  

You might also ask yourself, what if I can get better with age?  What might that look like?  What is a new skill set that I can master?  Then believe you can, and take action to do something about it! 

Much of this information has been gleaned from the following podcast episodes:              

#1 Neurologists: 5 Habits to Boost Brain Health & Prevent Alzheimer’s (4/9/26 episode of The Mel Robbins Podcast)

These 5 Things are Proven to Slow the Aging Process (5/12/26 episode of The Model Health Show with Shawn Stevenson)

The 7 Lifestyle Habits That Can Protect Your Brain at Any Age with Dr. Dale Bredesen (11/4/25 episode of the Feel Better Live More Podcast with Dr. Rangan Chatterjee #592)

The New Science of Preventing Dementia: Protect Your Brain, Boost Your Focus, Resist Cognitive Decline with Dr. Tommy Wood (3/17/26 episode of the Feel Better Live More Podcast with Dr. Rangan Chatterjee #638)