How To Prevent Cognitive Decline After Middle Age: A Science-Based Approach
"Brain health is not just about staying sharp; it’s about staying functional. Keeping mentally active, socially connected, and physically healthy all play crucial roles."
—Dr. Richard Isaacson
Forget the adage "You can't teach an old dog new tricks." While some memory decline is a natural part of aging, research shows it's far from inevitable. Studies reveal that over 50% of people mistakenly believe cognitive decline is simply a function of getting older. This misconception can lead to a self-fulfilling prophecy, causing people to disengage from mentally stimulating activities, physical activity, and socialization.
The good news? Your brain is more adaptable than you might think. By incorporating specific strategies into your life, you can significantly boost cognitive function and prevent decline in midlife. This article explores practical methods, backed by science, to keep your mind sharp and resilient for years to come.
Why Cognitive Decline Happens
While aging itself doesn't guarantee cognitive decline, it undeniably plays a significant role. The brain, much like any other organ, requires consistent stimulation to function optimally. Without adequate stimulation, proper circulation, and sufficient nutrition, it can begin to atrophy. Factors such as irregular blood sugar levels and high inflammation also contribute significantly to cognitive deterioration.
When people say, "I'm just getting older, my brain doesn't work in the same way it used to," there is some truth to this statement. The brain's performance typically peaks around the end of formal education, whenever that may occur for each person. During these school years, the brain is constantly stimulated, similar to progressive overload in exercising. You aren’t the athlete training for a specific sport, you’re the well-rounded athlete who can do it all.
After formal education, most people tend to specialize in their careers, focusing intensely on a narrower range of tasks. This shift from a broad, stimulating education to a specialized routine reduces the variety of mental exercises the brain encounters. While specialization is beneficial for professional expertise—like a surgeon becoming highly skilled at a specific procedure—it limits overall cognitive engagement. Here, you’ve become the athlete who is focused on one sport. You can be an incredible marathoner or powerlifter but you can’t be both. You must sacrifice abilities in some areas of the brain to specialize in your job which reduces mental challenge and leads to a decline in cognitive function.
Retirement then tends to exacerbate this issue. The various stimuli provided by work—social interaction, time management, and the cognitive demands of the job—diminish sharply. This steep decline in mental stimulation contributes significantly to cognitive decline in older adults. This is the retired athlete who lacks purpose and challenge. I see this trend often in the clinic with patients coming to me within a few years of retirement to address their ailing mind and/or body.
This is backed by researchers who studied specific professions, tracking these specific brain changes due to cognitive demands. For example, London taxi drivers, who navigate the city's complex streets, have larger hippocampi due to extensive spatial memory requirements, but this volume decreases after retirement. Similarly, mathematicians show greater gray matter density in areas associated with numerical thinking. This supports Hebb's Law, which states that synaptic connections strengthen with use and weaken with disuse, the ol’ “use it or lose it” phenomenon.
Biologically, the brain relies on neuroplasticity—the ability to form and reorganize synaptic connections in response to learning and experience. Without continuous stimulation, the brain's plasticity diminishes, leading to a decline in cognitive abilities. Anatomically, this lack of stimulation can result in reduced gray matter density, particularly in regions responsible for memory and executive function.
It's important to note that cognitive decline isn't solely due to aging. It's often more about how we use our brains. Stopping cognitive engagement due to perceived memory decline is akin to avoiding the gym because of weakened muscles. The worst approach is to assume you can't improve because you're not as sharp as you once were.
How to Prevent Cognitive Decline
The good news is that cognitive decline isn't a one-way street! By incorporating these science-backed strategies into your daily life, you can significantly boost your cognitive health and prevent decline in midlife:
1. You Must Learn (and you can’t rely on “Brain Games”)
Engaging in new activities like learning a language, picking up a musical instrument, or dancing have profound cognitive benefits, especially in preventing cognitive decline. Just as in dieting or exercising, the initial phase of learning presents the most significant cognitive gains. These activities, particularly challenging at first, stimulate the brain in ways that being an expert in a familiar field does not, providing robust protection against age-related cognitive decline.
While “Brain Games” ranging from crosswords and Sudoku to apps are increasingly popular, they’re not going to give your brain the comprehensive benefit it needs. These activities neglect the complex motor and perceptual skills crucial for overall brain health. Suppose you look at the homunculus picture, illustrating the brain’s somatosensory and motor cortices. In that case, you realize that so much of our brain is dedicated to different areas, particularly those related to survival and reproduction given our evolutionary roots, such as complex movements, socialization, and forethought. Brain health, therefore, doesn't just mean numbers and words on paper or a screen. These can help, but only as much as doing bicep curls in the gym can help you become fit.
Importantly you also need to embrace being an amateur and work really hard at whatever it is you choose to do. You will fail and learn; this failure and learning process is a critical component to brain development.
While any new learning is good, these three areas have been shown to have the most significant impact.
Dancing: Dancing may be the most powerful activity for cognitive health. Research shows it can reduce the risk of dementia by 76% and a meta-analysis showed it to improve memory, cognitive flexibility, visuospatial function, balance, and attention, thanks to the triumvirate of physical movement, mental challenges, and social interaction.
Language: Research indicates that bilingual individuals are less likely to develop Alzheimer's disease and other forms of dementia, with studies showing up to a 4.5-year delay in symptom onset compared to monolinguals.
Instrument: Similarly, learning to play an instrument enhances memory and spatial-temporal skills, with evidence suggesting improved neural plasticity.
2. Be Physically Active
I've never met someone experiencing significant cognitive decline who was also physically fit, nor have I met anyone with sharp cognitive abilities who didn't have some form of structured physical activity built into their daily routine. In other words, you must be physically active to be cognitively sharp. The brain and body are tightly interwoven and staying physically active is neuroprotective. The study Preventive Strategies for Cognitive Decline and Dementia: Benefits of Aerobic Physical Activity, Especially Open-Skill Exercise says it all: “Physical inactivity is highly associated with an increased risk of developing dementia.”
This research finds that aerobic physical activity, particularly open-skill exercises (OSE) like tennis and badminton, provides more significant cognitive benefits than closed-skill exercises (CSE) like running and swimming. The mechanisms include improved cardiovascular health, increased neurotrophic factors, enhanced amyloid-β turnover, better cerebral blood flow, and reduced inflammation. Exercise has been shown to increase hippocampal volume, a brain region crucial for memory and learning. While any movement is better than none, make sure you are at least hitting the Minimum Effective Dose of Exercise. Bonus points if you can include the open skill exercises and make it a social event.
3. Embrace More Socialization
This doesn’t have to be the standard coffee date, although it can include that. Maintaining strong connections with friends and family can consist of everything from joining clubs or groups, volunteering, regular family dinners with extended family, or getting on a sports team. Social interaction not only provides emotional support but also stimulates the brain, promoting neurogenesis (the birth of new brain cells) and strengthening existing neural pathways. One study demonstrated that older adults aged 65 and above who had robust social connections at the 90th percentile saw their cognitive decline decrease by 39% over 5 years.
Another study found lonely individuals showed a 54% higher risk of developing dementia over 10 years. Specifically, this risk tripled in adults with initially low baseline risks due to age and genetic factors, which represent much of the aging population. As a bonus, the longest study on human happiness revealed that strong social relationships are the single most important factor in living a happy life.
4. Prioritize Quality Sleep
Aim for 7-9 hours of high-quality, uninterrupted sleep each night. During sleep, the brain undergoes a process called synaptic pruning, where weak connections are eliminated and strong ones are strengthened. This process is essential for memory consolidation and overall cognitive function. Research suggests that chronic sleep deprivation can disrupt synaptic pruning and lead to cognitive decline.
Be sure to rule out sleep disorders, particularly the two most common: sleep apnea and restless leg syndrome. Sleep apnea, in particular, can cause significant memory issues that are reversible with treatment. Research has found that sleep apnea is associated with impaired working memory, executive function, and attention.
5. Be Aware of Mood Disorders and Depression
Mood disorders and depression can present like dementia, with common signs including restricted affect, low mood, crying episodes, and a lack of motivation to engage in previously enjoyed activities. Addressing these mood disorders can often lead to significant improvements in cognitive function. Psychological support, therapy, and, in some cases, medication can help manage these conditions effectively.
6. Manage Your Blood Sugar and Insulin Resistance
Insulin resistance is a condition where your body's cells become less responsive to insulin, a hormone that regulates blood sugar levels. This can lead to a cascade of problems, and interestingly, it appears to be closely linked to Alzheimer's disease. Virtually everyone with Alzheimer's also has insulin resistance. Because of this strong association, Alzheimer's is sometimes referred to as "type 3 diabetes."
Signs of insulin resistance include:
Abdominal fat
The inability to fast
Hypoglycemic episodes
A BMI greater than 25 (calculate yours here)
Fasting glucose greater than 114
Fasting insulin greater than 5.5
HbA1c (hemoglobin A1C) greater than 5.7
If you have any of these symptoms, address insulin resistance immediately. Find specific strategies for how to do that in this article.
7. Get Your Nutrients
What you eat impacts your brain function just as much as your physical health. Focus on a balanced diet rich in fruits, vegetables, and high-quality protein sources. These foods are packed with antioxidants and essential nutrients that can help protect brain cells from damage. Additionally, consider incorporating omega-3 fatty acids, found in fatty fish and walnuts, which have been linked to improved cognitive function.
Balanced Diet: Focus on a diet rich in fruits, vegetables, and fish with limited processed foods to protect brain cells from damage. A study in Neurology found that individuals following a Mediterranean diet had a 40% lower risk of developing Alzheimer's disease.
Omega-3 Fatty Acids: Include fatty fish like salmon and walnuts, which are linked to improved cognitive function. Research in Alzheimer's & Dementia: The Journal of the Alzheimer's Association showed higher DHA levels improve memory and learning in older adults. My favorite brands of Omega 3’s are PerformanceLab Omega 3. You can find the healthiest types of fish here.
B Vitamins: B6, B12, and folic acid lower homocysteine levels, reducing brain atrophy and cognitive impairment.: A study in PNAS found B vitamin supplementation slowed brain atrophy in individuals with mild cognitive impairment by up to 30%. For a reliable source, consider PerformanceLab NutriGenesis Multi for Men (& Women)
Polyphenols: Berries like blueberries and strawberries act as antioxidants, reducing oxidative stress and inflammation in the brain. A study in Annals of Neurology reported that women who consumed more berries delayed cognitive aging by up to 2.5 years.
8. Review Medications with your Doctor
Certain medications can have hidden effects on the health of your brain. These five types are the most common and impactful offenders:
Antihistamines: Medications like Benadryl can impair cognitive function due to their anticholinergic properties.
Meclizine: Commonly used for vertigo, meclizine also affects learning and memory due to its anticholinergic effects.
Anticholinergics for Overactive Bladder and Allergies: Drugs such as Ditropan work by blocking choline, which helps manage bladder issues but negatively impacts brain function. A 2022 review published in "JAMA Internal Medicine" suggests that regular use of these medications can increase the risk of dementia by up to 50%.
Medications for Depression: Antipsychotics, especially those like Abilify used to treat depression, can cause extrapyramidal symptoms by blocking dopamine transmission. This leads to symptoms similar to Parkinson's disease.
Benzodiazepines and Opioids: These medications are particularly detrimental to cognition, especially in older adults. In fact, in his book The End of Alzheimer’s, Dale Bredesen writes, “Benzodiazepines taken for 3 to 6 months increases the risk of Alzheimer's by 32% and taking them for more than 6 months boost the risk by 84%. Using benzodiazepines for more than a year can cause cognitive impairments that continue beyond cessation of the medication for up to 3.5 years."
Don’t Wait for Symptoms to Present. Start Now.
While cognitive decline may seem like a long time away, the truth is, that your habits today affect you decades from now.
Even though a diagnosis of dementia or mild cognitive impairment (MCI) may seem like the starting point, it doesn't come out of nowhere. The same goes for a heart attack, diabetes, arthritis, and many other conditions. One factor underlying all these conditions, and many more, is inflammation. Inflammation is the body's response to injury or disease, but chronic inflammation can lead to tissue damage and is associated with numerous chronic conditions.
The CARDIA study backs this up. Researchers examined participants from early adulthood through midlife, tracking inflammation levels and their impact on cognitive function. The participants, initially aged 24-38, were followed for 18 years, with C-reactive protein levels (a measure of inflammation) measured throughout this period. By midlife, at ages 47-63, researchers assessed the participants' cognitive performance, finding that those with consistently higher or increasing CRP levels had significantly worse processing speed and executive function.
Even after controlling for various factors, researchers found that higher inflammation in early adulthood was linked to poor executive function and processing speed in midlife, suggesting that cognitive aging begins much earlier than previously thought.
As Ben Franklin said, "An ounce of prevention is worth a pound of cure." Address inflammation today by adopting a healthy lifestyle with regular exercise, a balanced diet, a growth mindset, and limiting exposure to toxins.
How To Measure Your Risk of Dementia
Learn, eat well, exercise, manage your meds, and hang out with people you love. Sounds nice but is there a way to get an objective measure on your risk of developing dementia? Kind of.
The Brain Care Score
There's no test you can have your doctor do on you but there is something called the 21-point Brain Care Score (BCS). A study published in the journal Frontiers in Psychiatry found a notable association between scores on this test and later-life issues.
"Each five-point increase in the baseline BCS was associated with a 27% lower risk of incident stroke or incident dementia or late-life depression when adjusted for age and sex, and this difference was statistically significant "
When factoring in the age of participants, these odds changed. For those under 50 years old, this number went to a 38% lower risk, for 50-59 year olds it was a 36% lower risk; and over 59 years old saw a 22% lower risk of an event. Meaning, that the older you get, the harder it is to lower your risk of developing depression, stroke, or dementia.
I suggest two things:
Take the test now and track it every 3 years (add it to your calendar).
(For my record keeping, I scored a 19 in 2024).
Start getting that number higher today.
Related:
