Six strategies recommended by experts on how to reduce risk of cognitive decline

We previously discussed findings from the 2020 Lancet Commission on Dementia Prevention, Intervention and Care, which reported that fully addressing 12 risk factors can prevent or delay up to 40% of dementia cases [1]. In late 2020, UsAgainstAlzheimer’s convened a workgroup of eight clinicians with expertise in the evidence surrounding brain health and strategies for reducing risk of cognitive decline. Recommendations from the workgroup were published in January 2022 [2].

These recommendations are for people over the age of 45 and span six areas of focus: vascular/metabolic risk factors, physical activity, sleep, nutrition, social activity, and cognitive stimulation.

1. If you have high blood pressure or type 2 diabetes, work with your healthcare provider to manage these conditions.

Hypertension and type 2 diabetes during mid-life are strongly associated with increased risk of dementia, including Alzheimer’s disease and vascular dementia [3; 4]. For people with hypertension, the target systolic blood pressure is under 130 mm Hg in midlife [5]. For people with type 2 diabetes, targeting HbA1c levels (a measure of blood glucose levels) under 7% is associated with lower dementia risk [6]. Milder forms of hypertension or type 2 diabetes may be addressed with a healthy diet, increased physical activity, and weight control, but if lifestyle interventions are not enough, these conditions need to be treated with medications.

2. Aim to get 150+ minutes per week of moderate intensity physical activity. If you are sedentary, start with physical activity that can be incorporated into your lifestyle.

Exercisers are less likely to develop Alzheimer’s disease and other dementias. Exercise improves cardiovascular and metabolic health, reduces chronic inflammation, and increases the release of a protein called BDNF that is good for brain cells [7; 8; 9; 10]. For people who are sedentary or those who are far from meeting the recommended amount of physical activity, gradually increasing physical activity is recommended. To increase physical activity, incorporate more walking, gardening, dancing, and calisthenics into your daily routine [2]. Get the support of family members, friends, and neighbors so this healthy habit can be continued long-term.

3. If you are getting insufficient or poor-quality sleep, aim to get seven to eight hours of sleep daily, including naps. If you suffer from sleep apnea or other sleep disorders, talk to your doctor.

Many studies suggest that not getting enough sleep is associated with increased risks of cognitive impairment, Alzheimer’s disease, and other dementias [11; 12]. Members of the workgroup noted that addressing sleep quality is also important. People with poor sleep quality, more sleep problems, and daytime sleepiness tended to have greater levels of markers associated with Alzheimer’s disease [13]. It is during sleep that toxic proteins are cleared from the brain. In order to create an optimal sleep environment, the workgroup shared some tips, including: 1) make the room dark and quiet, 2) keep the room on the cooler side, 3) avoid using the bed for work, 4) keep electronics (e.g., smartphones, tablets) out of the bedroom, 5) stop watching television at least an hour before bedtime, 6) buy a comfortable mattress with sufficient back support, and 7) use a hypoallergenic pillow and wash bed clothes frequently [2].

Sleep apnea and other sleep disorders have also been linked to increased risk of cognitive decline and dementia [14]. If you suspect you have a sleep disorder, talk to your doctor, and be referred to a sleep clinic for diagnosis and treatment.

4. Eat a brain-healthy diet that includes high levels of vegetables, fruits, beans, nuts, and whole grains, while limiting intake of high-fat dairy products, red meat, fried foods, and processed foods.

We have discussed on numerous occasions the benefits of brain-healthy diets for promoting cognitive functions and slowing cognitive decline, including with the Mediterranean diet, the DASH (dietary approaches to stop hypertension) diet, and the MIND (Mediterranean and DASH intervention for neurodegenerative delay) diet. A higher adherence to the Mediterranean diet is associated with better memory, larger volumes of brain regions important for memory functions, and lower levels of markers associated with Alzheimer’s disease [15]. Tips by the workgroup include increasing intake of leafy green and cruciferous vegetables, berries, beans, nuts, and whole grains, and replacing red meat with fish or chicken [2]. Decreasing intake of high-fat dairy products like butter and cheese, fried foods, processed foods, and sweets is also recommended.

5. If you are socially isolated or lonely, increase social connection and activity by looking into community programs and resources in your area.

Loneliness and social isolation can impair cognitive health and are associated with a higher risk of dementia [16]. Notably, positive social engagement has shown protection against dementia [17]. The workgroup agreed that quality social connections may protect brain health by buffering against stress and challenges [2]. Suggestions by the workgroup include meeting new people by joining clubs or organizations (e.g., book club, local sports team, civic organization, political group, or religious group), volunteering (e.g., at a pet shelter, library, hospital, school, or senior center), and staying connected to family and friends. The workgroup noted that the more connected a person feels, the easier it is to handle stress and remain stress resilient.

6. Keep learning and stimulating your brain.

Lifelong learning is associated with good cognitive health, and higher levels of cognitive activity at mid- or late-life are linked to higher levels of cognitive functions and lower risk of Alzheimer’s disease [18; 19]. The workgroup recommended increasing cognitive activity by acquiring new skills such as cooking, dancing, language, and crafting. Other tips include reading books, watching documentaries or news, making music or art, playing strategy games (e.g., chess or dominoes), practicing mindfulness, and being exposed to nature [2].

These six recommendations are very much in line with our Seven Steps for Brain Health and are good news in that there are concrete evidence-based steps you can take to reduce your risk for cognitive decline.

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