Steps To Help Have A Healthy Brain In Your Later Years

By Dr. Thomas Chin

Virginia native Dr. Thomas Chin MD attended William and Mary, the Medical College of Virginia, and now practices family medicine in Washington State. This is an excerpt from his 2025 Christmas newsletter to friends and family.

To have a healthy brain throughout adulthood, start early to make those cognitive health investments. During the teenage years take challenging classes in high school and go to college. In the early 20s, continue to graduate school and/or professional school. Beginning in adolescence, be intentional about lifestyle habits, such as exercise, nutrition, sleep, stress management, and social engagement. See the doctor yearly, get the appropriate lab tests, procedures, and/or imaging tests done, and act on those results. Even for those who are 60 years or age and more benefit from such brain investments, including regular physical exercise, cognitively stimulating activities, social activities, and healthy dietary patterns (particularly Mediterranean-style or MIND diets).

Neurology is starting to emphasize prevention. Neurologists have been thought of as specialtists to turn to in crisis, like when a stroke or seizure occurs. But as neuroscience furthers the understanding of the underpinnings of a host of neurologic conditions, neurologists are seeing greater possibilities to help patients stave off disease.

“Most neurological conditions have a [prolonged preclinical phase, which include decades without any symptoms or signs] and a prolonged prodromal phase [a lengthy period of years of early symptoms, or warning signs that happen before a more noticeable or severe condition fully develops]. . .“This unique nature of neurological diseases signifies the strong need for equally effective primary and secondary prevention strategies and focus on brain health before brain diseases occur.” For example, Alzheimer’s disease, which affects 60 to 70 percent of people with dementia, has a 20 year preclinical phase and a 3-4 year prodromal phase. While stroke, Alzheimer’s disease (AD), and other forms of dementia seem to be the most obvious targets of prevention, a long list of complex neurological diseases, from Parkinson’s disease to multiple sclerosis, are now being discussed in terms of prevention. (1) For example, Alzheimer’s disease, which affects 60 to 70 percent of people with dementia, has a 20 year preclinical phase and a 3-4 year prodromal phase.

Your chance of developing dementia at some point is uncomfortably high. Forty-two percent of Americans older than 55 will develop the condition during their lifetime, a recent Nature Medicine study estimates. It’s also on the rise: More than 500,000 had it in 2020; by 2060, that’s expected to double. But research increasingly suggests that dementia is not an inevitable part of aging.2

Evidence is increasing and is now stronger than before that tackling the many modifiable risk factors for dementia reduces the risk of developing dementia. Modifying 14 risk factors might prevent or delay nearly half of dementia cases. Be ambitious about prevention. Actions to decrease dementia risk should begin early and continue throughout life. What are the risk factors?

Ensure good quality education is available for all and encourage cognitively stimulating activities in midlife to protect cognition. [Education increases cognitive reserve, which is the brain’s ability to adapt and to compensate for damage due to aging and / or disease.]

1. Finish college. If possible, get more schooling beyond college. Individuals with graduate or professional degrees generally have a lower risk of developing dementia compared to those with only undergraduate degrees, reflecting a dose-response relationship where each additional year of education provides more cognitive more protection. The protective effect follows a linear dose-response pattern across the entire education distribution. Each additional year of education reduces dementia risk by approximately 7 percent.
2. Work in an intellectually engaging occupation with high job complexity, autonomy, and decision-making control while minimizing high-strain work environments (high demand, low control).
3. Enroll and complete free, globally accessible massive open online courses (MOOCs) and e-learning programs.

Make hearing aids accessible for people with hearing loss and decrease harmful noise exposure to reduce hearing loss. The American Speech-Language-Hearing Association recommends screening every 3 years after age 50, or more frequently in those with known risk factors.

Treat depression effectively

Encourage use of helmets and head protection in contact sports and on bicycles

Encourage exercise because people who participate in sport and exercise are less likely to develop dementia

1. Moderate-to-vigorous aerobic exercise for at least 150 minutes per week is the standard recommendation and muscle-strengthening activities on two or more days are recommended.
2. Step-based metrics show maximal dementia risk reduction at approximately 10,000 steps daily, though substantial benefit occurs at around 4,000 steps per day.
3. Exercise type matters: resistance training shows the highest benefit on cognitive function, while multicomponent exercise (combining aerobic, resistance, and balance training) improves executive function.

Reduce cigarette smoking. Even better is never smoking.

Prevent or reduce hypertension and maintain systolic blood pressure (top blood pressure number) of 120 mm Hg or less from age 40 years. Normal blood pressure is greater than 90/60 and less than 120/80. First available in Switzerland in 2018 and later expanding to other European countries, the Hilo Band for the wrist is the first over-the-counter, clinically validated cuffless wearable blood pressure monitor cleared by the FDA in 2025 and should be available in the US in 2026.. (Apple Watch and Whoop band are not FDA approved for blood pressure monitoring.)

Detect and treat high LDL cholesterol (LDL-C) from midlife. Aim for LDL-C of 70 mg/dL or lower. Keep apolipoprotein B at 60 mg/dL or lower. Get triglycerides under 100 mg/dL. Get lipoprotein (a) tested at least once after age 18. A lipoprotein (a) value of 75 nmol/L or higher warrants seeing a cardiologist, ideally a preventive cardiologist, to manage this problem. Get high sensitivity c-reactive protein (hsCRP) or cardiac c-reactive protein measured whenever cholesterol is measured. The goal is a hsCRP of 1 mg/L or lower.

Maintain a healthy weight and treat obesity as early as possible, which also helps to prevent prediabetes and diabetes.

Reduce high alcohol consumption. Even better is abstaining from drinking any alcohol.

Prioritize supportive community environments and housing and reduce social isolation by participating in activities and living with others.

Make screening and treatment for vision loss accessible for all. The American Academy of Ophthalmology recommends comprehensive eye examinations every 1–2 years for adults 65 and older, every 1–3 years for ages 55–64, and every 2–4 years for ages 40–54.

Reduce exposure to air pollution. (3)

Reduce ultra-processed foods. Ultra-processed foods have long ingredient lists with items not used in home cooking. With healthy eating, the single most important change you can make is reducing your consumption of highly processed products, which are laden with chemicals such as emulsifiers, preservatives and thickeners. A 2024 study in Neurology shows why: Increase the amount of these products that you eat by 10 percent, and your risk of developing cognitive impairment jumps 16 percent. A 2025 study in the Journal of Prevention of Alzheimer’s Disease reported a specific link with Alzheimer’s: Each daily serving of ultra-processed foods was linked to a 13 percent greater risk. Those who consumed 10 or more servings per day had a 2.7-fold increase in risk, even after adjusting for other factors in their diet. (2)

References:

1. Susan Fitzgerald. Should Preventive Neurology Become Its Own Subspecialty? Experts Weigh the Pros and Cons, September 16, 2021.https://neurologytoday.aan.com/doi/10.1097/01.NT.0000794168.52923.ab
2. Leana Wen, MD. Want to lower your risk of dementia? Here’s what the science says. The Washington Post. Jun 10, 2025.https://www.washingtonpost.com/opinions/2025/06/10/dementia-prevention-research-studies/
3. Prevalence of Dementia After Age 90: Results From the 90+ Study. Neurology. 2008. Corrada MM, Brookmeyer R, Berlau D, Paganini-Hill A, Kawas CH., and care: 2024 report of the Lancet standing Commission. Livingston, Gill et al. The Lancet, Volume 404, Issue 10452, 572 – 628