From prevention to precision care, a new wave of research is reshaping what it means to protect your memory and thinking
For generations, a diagnosis of dementia or Alzheimer’s disease signaled a one-way journey of irreversible decline that slowly eroded memory, independence, and identity. Over the last decade, though, scientific understanding has expanded dramatically. Today, a combination of lifestyle interventions, biomarker testing, and targeted therapies has radically injected hope into the diagnosis and treatment of cognitive disorders in older adults. Perhaps most remarkable: research now suggests that up to 45% of dementia cases may be preventable. “Dementia is not an inevitable part of aging,” says Amy Sanders, MD, a highly respected dementia neurology expert now at Sunday Health, a preventive cognitive neurology practice.
A similar evolution occurred in cardiology decades ago. As with heart disease, which was once considered unavoidable, and oncology, where one-size-fits-all treatments have given way to precision medicine, scientific discovery is reframing what’s possible in dementia care. “This field, once static, is now full of energy and promise,” says Maria Thomas, co- founder and CEO of Sunday Health. “By focusing on prevention, early detection, and individually tailored treatments, we are moving toward a future where cognitive decline can be delayed, managed, and increasingly, prevented.”
Prevention Takes Center Stage
New drugs and diagnostics often make the news, but clinicians consistently note that managing modifiable risk factors is central to good health. For older adults, this includes new approaches to delay and/or prevent dementia. A robust body of evidence, anchored internationally by the landmark FINGER study and its counterpart, the U.S. POINTER study, shows that targeted lifestyle changes can significantly reduce cognitive decline.
The original FINGER trial, published in The Lancet in 2015, demonstrated that a multimodal program combining diet, exercise, cognitive training, and cardiovascular risk management helped preserve memory and executive function in older adults at risk for cognitive decline. Its global expansion, the World-Wide FINGERS Network, now spans more than 60 countries. The U.S. POINTER study produced similarly compelling results. Participants who received structured lifestyle support, including personal coaching, nutrition guidance, and regular social engagement, showed greater cognitive stability and improved emotional well-being.
These findings and others have led experts to reconsider the long-held belief that dementia simply happens with age. Instead, they highlight the extraordinary adaptability of the brain. Thomas notes that prevention must start earlier than most people realize. “We’ve long understood how to protect our heart health, but attention to brain health has lagged. Today, we know the same evidence-based behaviors that support cardiovascular health also contribute directly to maintaining cognitive health,” says Thomas.
Dr. Sanders underscores this lifespan approach: “It’s never too early to think about brain health, optimally beginning in your mid-30s when cognitive aging starts. But it’s never too late either.” She points to findings from the Rush Memory and Aging Project, which showed that adults well into their 70s and 80s experienced slower cognitive decline simply by adopting new activities.
*Newly added to the 2024 per Lancet Commission report.
Brain Health Through the Lifespan
Sources: Sunday Health, Lancet
Why Lifestyle Matters: Connecting the Dots
Why do lifestyle interventions make such a difference? Today’s research paints a clear biological picture.
Physical activity increases blood flow, reduces inflammation, and promotes the growth of new neural connections.
A nutrient-rich diet helps counteract oxidative stress and supports metabolic health.
Social interaction and cognitive engagement strengthen neural networks and build cognitive reserve, defined as the brain’s capacity to withstand age-related change.
Advances in Early Detection
For decades, investigating a diagnosis of Alzheimer’s disease required invasive spinal taps or costly imaging. But recent advances, especially in biomarker testing, have changed the landscape. In May 2025, the FDA approved the Lumipulse G pTau217/β-Amyloid 1-42 Plasma Ratio, the first-ever blood test that can identify Alzheimer’s-related proteins well before symptoms appear.
Dr. Sanders cautions that its purpose is specific: “The Lumipulse test is intended for people age 55 or older who are already showing symptoms. An abnormal ratio does NOT mean someone definitely has Alzheimer’s, and a normal result doesn’t guarantee they don’t.”
Instead, the test is one tool in a broader diagnostic picture, akin to A1C (blood glucose) tests for diabetes or measuring cholesterol levels for heart disease. “There is no single test that makes a definitive diagnosis of Alzheimer’s disease,” she emphasizes.
Ideally, brain health baselines that include cognitive testing and biomarker measurements will become a standard part of preventive care. “Just as you periodically get a colonoscopy or mammogram, establishing a brain health baseline can help detect any changes early,” says Thomas.
For those with risk factors such as a family history or genetic vulnerability (e.g. the APOE gene), baselines can be particularly informative. “APOE is a risk gene, not a destiny gene,” Dr. Sanders reminds. “It’s even more reason to work on modifiable risk factors if you know you’re at increased genetic risk.”
New Therapies: A Turning Point in Treatment
Two FDA-approved monoclonal antibodies—lecanemab (Leqembi) and donanemab (Kisunla)—have demonstrated that it’s possible to slow disease progression in the earliest stages of Alzheimer’s disease. In clinical trials, these patients experienced a 25–35% reduction in cognitive decline.
“These are the first ever disease-modifying medications for Alzheimer’s,” Dr. Sanders notes.
The Lancet cautions that trial results range from modestly positive to neutral, and the real- world impact is still unfolding. Currently they are appropriate only for early-stage Alzheimer’s patients who have confirmed amyloid buildup and are not on blood thinners. But for many families, even a modest slowing of decline can translate into months or years of meaningful function.
What’s Coming Next
The treatment pipeline is expanding rapidly. New therapies target multiple mechanisms:
Tau-targeting treatments to prevent the spread of tau tangles.
Anti-inflammatory drugs to address the role of neuroinflammation.
Neuroprotective compounds to preserve neurons and synapses.
GLP-1 receptor agonists (commonly used for diabetes and weight loss) are now being studied for neuroprotective effects.
Another accelerating frontier: artificial intelligence. Machine-learning tools can analyze health records, cognitive patterns, and even voice changes to detect decline earlier than human clinicians can. These technologies promise increasingly personalized, predictive brain care.
As scientific understanding deepens, one theme has become clear: brain health, like heart health, requires consistent habits, early detection, and lifelong attention. With more accessible biomarkers, evolving therapeutics, and stronger evidence for prevention than ever before, the next decade promises major breakthroughs. Or as Thomas says: “The future of brain health isn’t just hopeful, it’s actionable.”
Our year was off to a sobering start with the advisory on alcohol and cancer risk issued by the Surgeon General in January. The key points, which were concerning, and for at least half of Americans, seemingly unknown until now, included:
A direct link was reported between alcohol consumption and higher risk for cancers of the breast, colorectum, esophagus, liver, mouth, throat (pharynx), and voice box (larynx).
Four pathways were posited: 1) As it metabolizes, alcohol breaks down into acetaldehyde, a chemical which damages DNA in multiple ways. This can cause a cell to begin growing uncontrollably and create a cancerous tumor. 2) Alcohol induces oxidative stress, damaging DNA, proteins, and cells, and increasing inflammation. 3) Alcohol may alter hormone levels, which can play a role in development of breast cancer. 4) Carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier to be absorbed into the body, and increasing risk for mouth and throat cancers.
Citing a 2019 survey showing that just 45% of Americans recognize alcohol as a risk factor for cancer, a strong recommendation was made to raise awareness by updating the current warning label on alcoholic beverages.
There is no doubt that the Surgeon General can greatly influence recognition of a health issue, as evidenced by the landmark 1964 report on the risks of tobacco, laying the groundwork for public regulations in the decades to follow. Then, 42% of Americans smoked, now just 11% do. The impact of the current alcohol advisory may not be as profound, but it is significant for several reasons.
While the science behind the advisory is not new, as alcohol-related cancer risk has been noted previously by many healthcare organizations, it has grown increasingly stronger over the years. Particularly for women who drink, recent studies have added to the mounting evidence of their higher risk of developing breast cancer, as well as increased susceptibility to liver disease, cardiovascular disease, and neurotoxicity compared to males. A more widespread public campaign with prominent warnings on alcohol-containing products will help underscore these findings.
The advisory may also add impetus to the cultural shift around alcohol use that’s been occurring over the last decade. As noted, the percentage of Americans who agreed that 1-2 drinks per day is bad for one’s health is low at 45% in the most recent Gallup poll but still reflects a marked improvement compared to 26% in 2016. Most promisingly, the younger generation is leading the charge, with 65% of adults aged 18 to 34 agreeing that alcohol consumption negatively affects health vs. 38% on average of their elders.
Highlighting the risk of disease associated with alcohol requires a more nuanced approach than tobacco, where no consumption is considered safe. Instead, alcohol consumption is viewed along a continuum where risk for most people remains relatively low at 2 standard drinks or less per week, and moderately low at 3 to 6 standard drinks per week – yet fully acknowledging that individual risk is determined by a complex interaction of biological and environmental factors. As long-time researchers wrote in the Harvard Public Health Journal, while heavy drinking is indisputably harmful at every age, the data may not justify sweeping statements about the effects of moderate alcohol consumption. They point to research with mixed results e.g. studies showing decreased mortality, lower risk of cardiovascular disease in moderate drinkers, and a widely cited UK study of one million women that reported higher rates of breast cancer among drinkers but lowerrates of thyroid cancer, non-Hodgkin lymphoma, and renal cell carcinoma. Recognizing that a gold-standard randomized control study would be well-nigh impossible to conduct, the most reasonable approach is to equip people with information that allows them to understand why less alcohol is better, and zero risk is only possible at zero consumption.
Our recommendations:
If you don’t drink, don’t start, as benefits are unproven, and the downsides are clear. Avoid alcohol completely if you are pregnant or trying, have a personal or family history of alcohol use disorder (AUD), have a medical condition that alcohol can aggravate (e.g., liver disease, precancerous conditions of the digestive tract), use medication that can cause interactions, or operate potentially dangerous machinery. However, if you are debating whether you can enjoy an occasional glass of chardonnay, please talk to us. We’ll help you make an informed decision based on multiple factors, including age, gender, medical history, diet, fitness, and lifestyle.
Symptoms of Alcohol Use Disorder (AUD)
What defines a heavy drinker, or a person with AUD? If you’ve experienced two or more of these symptoms in the past year, you may benefit from professional guidance to help you decrease or stop alcohol consumption:
Had times when you ended up drinking more, or longer, than you intended?
More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
Spent a lot of time being sick from drinking, or getting over other aftereffects?
Wanted a drink so badly you couldn’t think of anything else?
Found that drinking—or being sick from drinking—often interfered with taking care of your home or family, or caused job troubles?
Continued to drink even though it was causing trouble with your family or friends?
Given up or cut back on activities important to you to drink?
Gotten into unsafe situations while or after drinking e.g., driving, walking in a dangerous area?
Continued to drink even though it was making you feel depressed/anxious or after an alcohol-related memory blackout?
Found that your usual number of drinks had much less effect than before?
Experienced withdrawal symptoms when the effects of alcohol were wearing off e.g., trouble sleeping, shakiness, restlessness, nausea, sweating?
There will be a tsunami of aging dependents in the coming decade.”
These oft-used phrases may sound inoffensive but they’re actually examples of ageism, perhaps the only stereotype in America yet to be banished, or even fully recognized. Raising awareness of ageist beliefs as inaccurate at best, and physically and psychologically harmful at worst, is the work of a lifetime for a diverse group of medical and scientific advocates. Why is changing the narrative so important?
Research shows that ageism can influence health through three pathways: psychological, behavioral and physiological. Negative age stereotypes can increase biological markers of stress and may predict detrimental brain changes decades later, while also spurring worse health behavior, such as noncompliance with prescribed medications. A national poll on healthy aging showed those who regularly experienced three or more forms of ageism were less likely to rate their mental health as excellent or very good (61% vs. 80%) and more likely to report symptoms of depression (49% vs. 22%) than those who did not. Additionally, ageism can lead to inequities in healthcare, with age-based exclusions common in clinical trials, and older adults more apt to be left out of screenings, investigations and treatment for mental health issues.
Ageism: A Mental and Physical Toll
What may be most important to appreciate is how the internalizing of age stereotypes by older adults themselves can be an important determinant of health and well-being. Experts have found that negative self-perceptions of aging are associated with a higher prevalence for many of the most frequently seen health conditions among Americans, including heart disease, lung disease, diabetes, musculoskeletal disorders, and injuries, and tend to show more shrinkage of hippocampal volume in the brain. They may also show poorer memory performance and start to walk slower, reinforcing the negative loop around their aging process.
The Power of Positive Aging
Flipping the narrative, however, can result in dramatically improved outcomes. As reported in the Gerontologist, those who have more positive age beliefs live on average 7.5 years longer than those who harbor negative age beliefs. As the researchers noted: “If there were a pill that gave people an extra seven years of life in relatively good health, we would encounter very long lines at the pharmacy.”
The reasons for optimism around aging are based on science, not magical thinking. Consider that steep declines in physical and cognitive abilities are not inevitable parts of aging. According to the Administration on Aging, 80% of adults over 65 are not experiencing a physical or cognitive disability such as hearing impairment or memory loss that impacts their function, and 60% report only moderate or small impairments in their mobility. Procedural memory (e.g. how to ride a bike) is maintained in normal aging, and there is evidence suggesting abstract thinking and metacognition improve.
Challenging the Aging Myth
Despite the stereotype of people becoming more curmudgeonly with age, Manfred Diehl, PhD, a lifespan developmental psychologist, reports the opposite: “The conclusion from several meta-analyses is that in the personality area, we see quite a bit of positive development in terms of becoming socially more mature, with improved coping strategies and more regulation of emotions. Conscientiousness tends to increase at least until the mid-60s, possibly early 70s.”
Most remarkably, ongoing research at the Yale School of Public School by epidemiologist Dr. Becca Levy pointed to the conclusion that beliefs about aging rather than aging itself help explain why some older adults thrive while others do not. Her studies found that adults briefly primed with positive statements about aging showed improvements in their memory, gait speed, and balance that were measurable months later, and further generated increasing confidence in their abilities that endured over years. Additional studies suggest that positive beliefs about aging may protect against dementia, even among those with a high-risk gene.
Changing the Conversation Around Aging
How can we help shift the conversation? Start by increasing awareness of the culture of ageism around us and recognize how it can impact health rather than the actual aging process, encourages Levy.
You may also want to explore how to get involved in organizations that focus on bringing generations together, including:
Generations Over Dinner – A free global initiative to create meaningful experiences and conversations by hosting in-person or virtual multi-generational dinner events.
Generations United– A nonprofit network with a comprehensive database of intergenerational programs across the country.
CoGenerate –A nonprofit organization aiming to bridge generational divides and foster intergenerational collaboration.
When to seek help for mental health
Remember: it is not normal for older adults to be unhappy as they age. Seek help for these treatable medical conditions:
Anxiety
Panic disorder: Panic attacks or sudden feelings of terror that strike repeatedly
Obsessive-compulsive disorder: Repetitive, unwanted thoughts or rituals
Post-traumatic stress disorder (PTSD): Nightmares, depression after a traumatic event
Phobias: Extreme fear of something that poses little real danger
Generalized anxiety disorder: Chronic worry about everyday activities
Depression
Feelings of intense sadness that last for weeks or months. Symptoms include:
No pleasure in everyday activities
Poor sleep
Rapid weight gain or loss
Low energy
Unable to focus
While grieving a loss may look similar to depression, there are differences. A mix of good and bad days is common when grieving. With depression, feelings of emptiness are constant and don’t improve over time.
Sources:Aging Research Reviews; Breaking the Age Code; Contemporary Clinical Trials, NCOA, Helpguide.org
It’s not yet possible to stop the passage of years, but it might well be within our sights to combat the effects of aging, according to Michael Greger, MD, internationally recognized lifestyle medicine physician, author and nutritionist. Synthesizing years of research on the essential pathways of aging, Dr. Greger believes the process can be slowed down with lifestyle changes, and without pharmaceutical interventions. Below are some of his most interesting findings … please note that we always encourage you to check with your physician for individual guidance before adopting new health recommendations.
Plant-based eating holds one of the most important keys to slowing biological aging, emphasizes Dr. Greger. Borne out in large studies from the National Institutes of Health/AARP and Harvard, replacing just 3% of daily calories from animal protein with plant protein was associated with a 10% decrease in risk of overall mortality. It may also help prevent Alzheimer’s dementia, an incurable disease. “There is a growing consensus that what is good for our hearts is also good for our heads, and high levels of blood cholesterol are recognized to be a major risk factor for Alzheimer’s. Switching to a healthy, whole foods diet lower in animal fats, eggs and dairy can help prevent arteries in the brain from becoming clogged with atherosclerotic plaque, which is thought to play a role in Alzheimer’s,” he explains. “It may even trump genetics, as seen in Nigeria, where the plant-predominant diet may be the reason for very low rates of Alzheimer’s disease among a population with some of the world’s highest rates of the Alzheimer’s gene. Genes may load the gun, but lifestyle pulls the trigger.” In studies of older adults, the benefits of a diet rich in dark green, leafy vegetables continues to emerge, associated with improvements in the brain’s processing speed and working memory, muscle mass and strength, and potentially helping prevent age-related macular degeneration.
Activate autophagy, the body’s cellular recycling system, with regular aerobic exercise of moderate intensity, and daily consumption of spermidine, a compound found in foods including: beans, tempeh (made from fermented soybeans), white button mushrooms, mangoes, edamame, green peas, lentil soup, and in its most concentrated form in wheat germ. Also given the green light by Dr. Greger is coffee, for its abundance of polyphenol chlorogenic acid, an antioxidant thought to have a protective effect that is contained in all types of the beverage (decaffeinated, instant, and especially when brewed with a paper filter).
Avoid French fries and chips, urges Dr. Greger, as the toxin acrylamide formed during the frying process may cause inflammation and inhibit autophagy; air fry potatoes instead. Also, put down the salt shaker and opt for salt-free seasonings or substitutes. “Cutting back on sodium appears to effectively make people more than a decade younger in terms of risk of premature death,” he says.
Minimize fish. Long viewed as a healthy choice, fish have become so contaminated with heavy metals, pesticides and other forever chemicals that despite their omega-3 fatty acids, there’s been a failure to consistently observe its beneficial effects, according to Dr. Greger.
Prevent bone fractures by focusing on strength and balance training. “The majority of age-related risk of bone fractures (85%) is due to falling, not osteoporosis, so addressing muscle loss may be more effective than the current focus on increasing bone mineral density with drugs,” says Dr. Greger. He cites multiple randomized trials showing a combination of resistance exercise to improve lower limb muscle strength and balance training can cut fracture risk nearly in half. And although boosting protein intake has been touted by others, Dr. Greger cautions: “If you put together all the randomized, controlled trials of adding extra protein to the diets of older men and women, you find no evidence that it increases muscle mass or strength, even in those with sarcopenia (excessive age-related muscle loss).”
Finally, he points to the reassuring fact that adopting just a few simple lifestyle behaviors – a diet rich in fruits and vegetables, maintaining a healthy weight, not smoking – adds years of life no matter when you begin. “A Harvard analysis of more than 100,000 men and women followed over decades showed that starting to eat and live more healthfully at age 50 appeared to translate into 12 to 14 years of extra lifespan, at age 60, an extra 8 to 9 years, and even starting at age 80 added more years. We all have the power to turn back the clock, starting right now.”
Eight Lessons from the Blue Zones
Blue Zones are areas across the globe in which populations live longer and better than average, identified by National Geographic fellow Dan Buettner, who explains: “There’s no magic bullet or pill, but rather a cluster of mutually supporting factors common to these centuries-old cultures whose people are making it to ages 90-100 without disease.”
Plant-slant diet, as described elsewhere in this issue. Buettner’s common sense advice: “Sit down with a plant-based cookbook, identify a dozen recipes that you think your family would enjoy and cook them instead of going on a diet or spending money on a program. Also, eliminate soda pop, one of the unhealthiest parts of the American diet.”
Eat until you’re 80% full. “And have your biggest meal first,” advises Buettner, “eat breakfast like a king, lunch like a prince and dinner like a pauper.”
Family-first focus.
Belonging: feeling connected to your community.
Right tribe: surrounded by friends who support healthy behaviors.
Natural movement throughout the day.
Strong sense of purpose.
Ability to de-stress.
The original Blue Zones ranged from Costa Rica to Sardinia. According to new research, these states closer to home are most likely to earn the moniker in the future: California, Minnesota, Utah, North Carolina, Massachusetts, Maryland, Virginia, Connecticut, Rhode Island, Colorado.
Plant-based eating holds one of the most important keys to slowing biological aging, emphasizes Dr. Greger. Borne out in large studies from the National Institutes of Health/AARP and Harvard, replacing just 3% of daily calories from animal protein with plant protein was associated with a 10% decrease in risk of overall mortality. It may also help prevent Alzheimer’s dementia, an incurable disease. “There is a growing consensus that what is good for our hearts is also good for our heads, and high levels of blood cholesterol are recognized to be a major risk factor for Alzheimer’s. Switching to a healthy, whole foods diet lower in animal fats, eggs and dairy can help prevent arteries in the brain from becoming clogged with atherosclerotic plaque, which is thought to play a role in Alzheimer’s,” he explains. “It may even trump genetics, as seen in Nigeria, where the plant-predominant diet may be the reason for very low rates of Alzheimer’s disease among a population with some of the world’s highest rates of the Alzheimer’s gene. Genes may load the gun, but lifestyle pulls the trigger.” In studies of older adults, the benefits of a diet rich in dark green, leafy vegetables continues to emerge, associated with improvements in the brain’s processing speed and working memory, muscle mass and strength, and potentially helping prevent age-related macular degeneration.
Activate autophagy, the body’s cellular recycling system, with regular aerobic exercise of moderate intensity, and daily consumption of spermidine, a compound found in foods including: beans, tempeh (made from fermented soybeans), white button mushrooms, mangoes, edamame, green peas, lentil soup, and in its most concentrated form in wheat germ. Also given the green light by Dr. Greger is coffee, for its abundance of polyphenol chlorogenic acid, an antioxidant thought to have a protective effect that is contained in all types of the beverage (decaffeinated, instant, and especially when brewed with a paper filter).
Avoid French fries and chips, urges Dr. Greger, as the toxin acrylamide formed during the frying process may cause inflammation and inhibit autophagy; air fry potatoes instead. Also, put down the salt shaker and opt for salt-free seasonings or substitutes. “Cutting back on sodium appears to effectively make people more than a decade younger in terms of risk of premature death,” he says.
Minimize fish. Long viewed as a healthy choice, fish have become so contaminated with heavy metals, pesticides and other forever chemicals that despite their omega-3 fatty acids, there’s been a failure to consistently observe its beneficial effects, according to Dr. Greger.
Prevent bone fractures by focusing on strength and balance training. “The majority of age-related risk of bone fractures (85%) is due to falling, not osteoporosis, so addressing muscle loss may be more effective than the current focus on increasing bone mineral density with drugs,” says Dr. Greger. He cites multiple randomized trials showing a combination of resistance exercise to improve lower limb muscle strength and balance training can cut fracture risk nearly in half. And although boosting protein intake has been touted by others, Dr. Greger cautions: “If you put together all the randomized, controlled trials of adding extra protein to the diets of older men and women, you find no evidence that it increases muscle mass or strength, even in those with sarcopenia (excessive age-related muscle loss).”