As the population of older Americans grows, cognitive aging—the gradual decline in abilities that affects everyone to some extent in the later stages of life—will place increased burden on individuals, their families, the healthcare system, and other social service networks.

Unlike Alzheimer’s disease and other dementias, cognitive aging is not a disease. It is a process of slow and steady, yet highly variable, changes in a number of cognitive functions that occur as people get older. However, there are simple protective measures—such as controlling high blood pressure—that may slow down this process.

A decline in cognition means more than forgetfulness. It covers a broad range of abilities including decision making, mental processing speed, memory, attention, and problem solving, each of which can decline at their own pace. These abilities are called upon for everyday living activities—including buying groceries, paying household bills, and driving to health care appointments—and a serious deterioration in these abilities can have an impact on an individual’s capacity for independent living.

As a person gets older, changes occur in all parts of the body, including the brain.

• Certain parts of the brain shrink, especially those important to learning and other complex mental activities.
• In certain brain regions, communication between neurons (nerve cells) may not be as effective.
• Blood flow in the brain may decrease.
• Inflammation, which occurs when the body responds to an injury or disease, may increase.

These changes in the brain can affect mental function, even in healthy older people. For example, some older adults may find that they don’t do as well as younger individuals on complex memory or learning tests. However, if given enough time to learn a new task, they usually perform just as well. Needing that extra time is normal as we age. There is growing evidence that the brain maintains the ability to change and adapt so that people can manage new challenges and tasks as they age.

Talk with your doctor if you’re concerned about changes in your thinking and memory. He or she can help you determine whether the changes in your thinking and memory are normal, or whether it could be something else.

There are things you can do to help maintain your physical health and that may benefit your cognitive health, too. Learn more about cognitive health and take steps to help you stay healthy as you age.

The brain controls many aspects of thinking — remembering, planning and organizing, making decisions, and much more. These cognitive abilities affect how well we do everyday tasks and whether we can live independently.

Some changes in thinking are common as people get older. For example, older adults may:

• Be slower to find words and recall names
• Find they have more problems with multitasking
• Experience mild decreases in the ability to pay attention

Aging may also bring positive cognitive changes. For example, many studies have shown that older adults have more extensive vocabularies and greater knowledge of the depth of meaning of words than younger adults. Older adults may also have learned from a lifetime of accumulated knowledge and experiences. Whether and how older adults apply this accumulated knowledge, and how the brain changes as a result, is an area of active exploration by researchers.

Despite the changes in cognition that may come with age, older adults can still do many of the things they have enjoyed their whole lives. Research shows that older adults can still:

• Learn new skills
• Form new memories
• Improve vocabulary and language skills

As we age, our brains change, but Alzheimer’s disease and related dementias are not an inevitable part of aging. In fact, up to 40% of dementia cases may be prevented or delayed. It helps to understand what’s normal and what’s not when it comes to brain health.

Normal brain aging may mean slower processing speeds and more trouble multitasking, but routine memory, skills, and knowledge are stable and may even improve with age. It’s normal to occasionally forget recent events such as where you put your keys or the name of the person you just met.

Symptoms of Dementia or Alzheimer’s Disease

In the United States, 6.2 million people age 65 and older have Alzheimer’s disease, the most common type of dementia. People with dementia have symptoms of cognitive decline that interfere with daily life—including disruptions in language, memory, attention, recognition, problem solving, and decision-making. Signs to watch for include:

• Not being able to complete tasks without help.
• Trouble naming items or close family members.
• Forgetting the function of items.
• Repeating questions.
• Taking much longer to complete normal tasks.
• Misplacing items often.
• Being unable to retrace steps and getting lost.

Conditions That Can Mimic Dementia

Symptoms of some vitamin deficiencies and medical conditions such as vitamin B12 deficiency, infections, hypothyroidism (underactive thyroid), or normal pressure hydrocephalus (a neurological condition caused by the build-up of fluid in the brain) can mimic dementia. Some prescription and over-the-counter medicines can cause dementia-like symptoms. If you have these symptoms, it is important to talk to your health care provider to find out if there are any underlying causes for these symptoms.

How is Dementia Diagnosed?

A healthcare provider can perform tests on attention, memory, problem solving and other cognitive abilities to see if there is cause for concern. A physical exam, blood tests, and brain scans like a CT or MRI can help determine an underlying cause.

What To Do If a Loved One is Showing Symptoms

Talk with your loved one about seeing a health care provider if they are experiencing symptoms of Alzheimer’s dementia to get a brain health check up.

Be Empowered to Discuss Memory Problems

More than half of people with memory loss have not talked to their healthcare provider, but that doesn’t have to be you. Get comfortable with starting a dialogue with your health care provider if you observe any changes in memory, or an increase in confusion, or just if you have any questions. You can also discuss health care planning, management of chronic conditions, and caregiving needs.

Many people worry about becoming forgetful as they age. They think it is the first sign of Alzheimer’s disease. But some forgetfulness can be a normal part of aging.

Many people can become more forgetful as they age. How can you tell the difference between mild forgetfulness and serious memory problems like Alzheimer's disease? See what's typical and what's not:

• Normal aging
  • Making a bad decision once in a while
  • Missing a monthly payment
  • Forgetting which day it is and remembering later
  • Sometimes forgetting which word to use
  • Losing things from time to time
• Alzheimer's disease
  • Making poor judgments and decisions a lot of the time
  • Problems taking care of monthly bills
  • Losing track of the date or time of year
  • Trouble having a conversation
  • Misplacing things often and being unable to find them

Although some forgetfulness comes with age, don't ignore changes in memory or thinking that concern you. Talk with your doctor if you notice you have more serious memory problems than normal.

Genetic, environmental, and lifestyle factors are all thought to influence cognitive health. Some of these factors may contribute to a decline in thinking skills and the ability to perform everyday tasks such as driving, paying bills, taking medicine, and cooking.

Genetic factors are passed down (inherited) from a parent to child and cannot be controlled.

But environmental and lifestyle factors can be changed, particularly those you can control yourself. These factors include:

• Health problems, such as heart disease, diabetes, stroke, and depression
• Brain injuries
• Some medicines, or improper use of them
• Lack of physical activity
• Poor diet
• Smoking
• Drinking too much alcohol
• Sleep problems
• Little social activity and being alone most of the time

Health Problems

Many health conditions affect the brain and pose risks to cognitive function. These conditions include:

• Heart disease and high blood pressure—can lead to stroke and changes in blood vessels related to dementia
• Diabetes—damages blood vessels throughout the body, including the brain; increases risk for stroke and heart attack; associated with increased risk for Alzheimer's
• Alzheimer's disease—causes a buildup of harmful proteins and other changes in the brain that leads to memory loss and other thinking problems
• Stroke—can damage blood vessels in the brain and increase risk for vascular dementia
• Depression—can lead to confusion or attention problems; has also been linked to dementia
• Delirium—shows up as an acute state of confusion, often during a hospital stay, and is associated with subsequent cognitive decline

It's important to prevent or seek treatment for these health problems. They affect your brain as well as your body!

Brain Injuries

Older adults are at higher risk of falls, car accidents, and other accidents that can cause brain injury. Alcohol and certain medicines can affect a person's ability to drive safely and increase the risk for accidents and brain injury. Learn about and deal with risks for falls, and participate in fall prevention programs. Wear helmets and seat belts to help prevent head injuries as well.

Medicines

Some medicines, and combinations of medicines, can affect a person's thinking and the way the brain works. For example, certain drugs can cause confusion, memory loss, hallucinations, and delusions in older adults.

Medicines can also interact with food, dietary supplements, alcohol, and other substances. Some of these interactions can affect how your brain functions. Drugs that can harm older adults' cognition include:

• Antihistamines for allergy relief
• Medicines for anxiety and depression
• Sleep aids
• Antipsychotics
• Muscle relaxants
• Some drugs to treat urinary incontinence
• Medications for relief of cramps in the stomach, intestines, and bladder

Physical Activity

Lack of exercise and other physical activity may increase your risk of diabetes, heart disease, depression, and stroke—all of which can harm the brain. In some studies, physical activity has been linked to improved cognitive performance and reduced risk for Alzheimer's disease. More research in this area is needed, however.

Diet

A number of studies link eating certain foods with keeping the brain healthy—and suggest that other foods can increase health risk. For example, high-fat, high-sodium foods can lead to health problems, like heart disease and diabetes, that harm the brain.

Smoking

Smoking is harmful to your body and your brain. It raises the risk of heart attack, stroke, and lung disease. Quitting smoking at any age can improve your health.

Alcohol

Drinking too much alcohol affects the brain by slowing or impairing communication among brain cells. This can lead to slurred speech, fuzzy memory, drowsiness, and dizziness. Long-term effects may include changes in balance, memory, emotions, coordination, and body temperature. Staying away from alcohol can reverse some of these changes.

As people age, they may become more sensitive to alcohol's effects. The same amount of alcohol can have a greater effect on an older person than on someone who is younger. Also, some medicines can be dangerous when mixed with alcohol. Ask your doctor or pharmacist for more information.

Sleep Problems

At any age, getting a good night's sleep supports brain health. Sleep problems—not getting enough sleep, sleeping poorly, and sleep disorders—can lead to trouble with memory, concentration, and other cognitive functions.

Sleep apnea is a sleep disorder that causes short pauses in breathing when a person is sleeping. It can lead to high blood pressure, stroke, or memory loss. Treatment for sleep apnea begins with lifestyle changes, such as avoiding alcohol, losing weight, and quitting smoking. Use of a special device ordered by a doctor may also help.

Social Isolation and Loneliness

Social isolation and feeling lonely may be bad for brain health. Loneliness has been linked to higher risk for dementia, and less social activity to poorer cognitive function.

Older adults who are less likely to detect scams may be at an increased risk for developing dementia, finds a new study from researchers supported by the National Institute on Aging. The study, led by Patricia Boyle at the Rush Alzheimer’s Disease Research Center in Chicago, was published April 16 in Annals of Internal Medicine.

Scam awareness is a complex behavior that requires a variety of social cognitive abilities, including recognition that other people may have different intentions from yours, as well as awareness of others’ personality traits. The complexity of this behavior—particularly the need to integrate multiple abilities while managing a challenging social situation—may be the reason for its apparent status as an early harbinger of Alzheimer’s disease and mild cognitive impairment (MCI).

The researchers measured scam awareness in 935 older adults without dementia who were part of the ongoing Rush Memory and Aging Project using a questionnaire that assessed knowledge of deception tactics and willingness to engage in behaviors that result in scams. Each participant had annual clinical evaluations that included cognitive performance tests, medical history interviews, and in-person neurological examinations.

Over the course of 6 years after the scam awareness assessment, 255 of the participants developed MCI and 151 developed Alzheimer’s disease. Participants with low scam awareness were about twice as likely to develop Alzheimer’s disease and MCI than those with high scam awareness. Those who developed Alzheimer’s also had lower levels of education, lower global cognition, and lower scam awareness than those who did not develop the disease. Further analysis demonstrated that associations between low scam awareness and Alzheimer disease and MCI remained strong even after controlling for global cognition, suggesting that the researchers may be tapping into a construct that is distinct from cognition.

Researchers further found that in a subset of the participants who were deceased and had a brain autopsy performed, low scam awareness was related to a greater load of pathology associated with Alzheimer’s disease—beta-amyloid plaques and tau tangles. The researchers considered this finding to provide strong support for the conclusion that low scam awareness may, in part, be a consequence of accumulating Alzheimer’s pathology and therefore could be an important early sign of adverse cognitive outcomes.

Researchers caution that the measure used in this study cannot predict at the individual level whether a person who is susceptible to scams will develop Alzheimer’s disease or MCI. More research is needed to develop measures that can be used in clinical settings.

Problems managing money and with financial decision making in general may be among the first signs of Alzheimer’s disease. All older persons—even those without MCI or Alzheimer’s disease—could benefit from education on how to avoid scams and fraud and how to protect financial resources. If you or someone you know is being scammed, contact the Department of Justice – Fraud Section.

Did you know that the health of your brain and your heart are connected? By keeping your heart healthy, you also lower your risk for brain problems such as stroke and dementia. Learn more about the connection between the heart and brain and steps to take to keep both healthy.

Your heart pumps blood through vessels to every part of your body, including your brain. Damage to blood vessels can lead to serious health conditions such as heart disease, stroke, and dementia. Keeping your blood vessels healthy can help you have a strong heart and brain.

Unhealthy Heart, Unhealthy Brain

Some health conditions and unhealthy habits can damage blood vessels, putting your heart and your brain at risk for serious problems.

• A heart attack happens when plaque buildup or a blood clot blocks blood flow to the heart.
• A stroke, sometimes called a “brain attack,” happens when a clot or a plaque blocks a blood vessel in the brain or when a blood vessel in the brain bursts. When this happens, brain tissue dies, which can lead to memory loss and disability.
• A type of dementia called vascular dementia can happen as a result of a series of small, “silent” strokes, sometimes called “mini-strokes.” Dementia can cause memory loss, slowed thinking, and personality changes.

Steps to a Healthy Brain and Heart

Did you know that the health of your brain and your heart are connected? By keeping your heart healthy, you also lower your risk for brain problems such as stroke and dementia. Learn more about the connection between the heart and brain and steps to take to keep both healthy.

Heart disease, stroke, and vascular dementia are preventable. Take steps to reduce your risk.

1. Control your blood pressure. High blood pressure is a leading cause of heart disease and stroke. Over time, high blood pressure puts too much stress on blood vessels. Scientists now know that having uncontrolled high blood pressure in midlife also raises your risk for dementia later in life. Know your numbers by getting your blood pressure checked regularly. If your blood pressure is high, work with your doctor, nurse, or health care team to manage it. One way to manage your blood pressure is to take your medicines as prescribed. Learn more ways to manage blood pressure.

2. Eat healthy foods and limit alcohol. Eat plenty of vegetables, fruits, whole grains, and low-fat dairy, and include seafood rich in omega-3 fatty acids (such as salmon) each week. Limit foods with added sugars and saturated fats, and lower your sodium (salt) intake. If you drink alcohol, drink in moderation. Drinking too much alcohol raises blood pressure, which can lead to stroke and increase the risk of some kinds of heart disease.

3. Get diabetes under control. Diabetes causes high blood sugar, which can damage blood vessels and nerves. This damage raises the risk for heart disease, stroke, and dementia.

4. Don’t smoke. Smoking damages blood vessels and makes blood more likely to clot, which can lead to heart disease and stroke. Smoking is the leading cause of preventable death in the United States. If you don’t smoke, don’t start. If you do smoke, learn how to quit.

5. Stay active. Lack of physical activity can lead to high blood pressure and obesity. Most Americans don’t get the 150 minutes of moderate-intensity activity per week the guidelines recommend. Find ways to get your heart pumping for at least 150 minutes per week. Take the stairs, schedule a walk at lunch, or do jumping jacks during commercial breaks. Learn more about how to get enough physical activity.

Regular physical activity is good for your heart, muscles, and bones. Did you know it’s good for your brain too?

Physical activity can help you think, learn, problem-solve, and enjoy an emotional balance. It can improve memory and reduce anxiety or depression.

Regular physical activity can also reduce your risk of cognitive decline, including dementia. One study found that cognitive decline is almost twice as common among adults who are inactive compared to those who are active.

Regular physical activity can help you sleep and feel better, reduce the risk of some common cancers, and add years to your life.

You don’t have to be a fitness guru to reap the benefits. No matter your age or fitness level, any amount of physical activity can help.

What You Can Do

For the most benefit, adults need at least 150 minutes of moderate-intensity physical activity weekly or 75 minutes of vigorous-intensity activity. It doesn’t have to happen in one stretch. For example, moderate-intensity activity could be broken into 30 minutes a day, 5 days a week, or smaller bouts that add up.

All adults also need muscle-strengthening activities two or more days a week. And adults 65 and older need balance activities about three days a week.

Here are four activities  to help you become healthier:

1. Turn up the music at home and dance.
   Twisting and turning can be a fun way to be physically active.
2. Take active breaks.
   Break up your sedentary time with physical activity. For example, squat or march in place between programs while you’re watching television. Or stand on one leg to improve your balance.
3. Add physical activity to your daily routine.
   When shopping, park at the back of the parking lot and walk to the shop. Inside, walk around the perimeter of the store before getting what you need. Use the stairs instead of the elevator. Get off transit one stop sooner and walk to your destination. If you already walk routinely, start carrying hand weights on your treks.
4. Walk the dog.
   Dogs are great walking companions and can help you have an active lifestyle. One study found that dog owners on average walk 22 minutes more every day compared to people who don’t own a dog. You can even try going a little further on walks with your dog.

Remember that some activity is better than none, and every little bit counts. Even some chores such as raking and bagging leaves, using a lawn mower, or vacuuming can help you get active.

Get started by keeping track of your daily activities for one  week with this diary. Think about  times throughout the day you could be physically active and make those times a regular part of your daily or weekly schedule. 

Your brain handles a lot. It sends instructions to move muscles, makes sure organs are working, remembers information, has creative ideas, and powers every system in your body. We often eat foods that help strengthen our muscles or give us more energy—but brains need nutrition too!

There are a wide variety of foods that can help you concentrate in your day-to-day routine. Many of the nutrients and foods that help your brain, also protect your heart and blood vessels. That means when you eat healthy foods you are giving your brain a boost and will be on your way to full-body health!

Be on the lookout for foods that include brain-healthy nutrients like:

• vitamin B
• vitamin K
• vitamin E
• coenzyme Q10
• Lutein
• Folate
• beta carotene
• omega-3

Green, Leafy Vegetables

You’ve heard how important vegetables are for your health—because it’s true! When it comes to brain health, green, leafy vegetables can boost cognitive function and slow age-related cognitive decline. Translation: leafy green vegetables can help clear your mind and keep your brain healthy as you age! When planning your meals, include at least one serving of greens per day.

Leafy vegetables that boost brain health include:

• Kale
• Spinach
• Collards
• Broccoli
• Romaine lettuce

Healthy Fats

Not all fats are bad! Healthy fats are important for both your heart and your brain. When you’re looking at fat content in food, you want to see ‘unsaturated fats’—or monounsaturated and polyunsaturated fats. Healthy fats have many benefits. They give long-term energy to the brain. This helps you concentrate longer while increasing your memory!

Find healthy fats in:

• Olive, Peanut, and Canola Oils
• Avocados
• Almonds
• Hazelnuts
• Pecans
• Seeds
• Fish

Berries

Research suggests that eating berries can have positive effects on the brain and can help prevent memory loss with their ability to reduce brain inflammation. Not to mention they are delicious!

Some of the berries that are the best for brain health include:

• Blueberries
• Blackberries
• Strawberries

Fish

A protein source linked to a great brain boost is fish—rich in omega-3 fatty acids that are key for brain health. They have the ability to combat damaging beta-amyloid blood levels that are associated with Alzheimer’s disease. The omega-3s found in fish play a vital role in enhancing your memory. Try to include fish in your diet at least twice a week.

Choose these fish varieties that are low in mercury:

• Salmon
• Cod
• Canned light tuna
• Pollack
• Walleye
• Perch
• Bass

Nuts and Chocolate

Nuts—particularly walnuts—and seeds are good sources of the antioxidant vitamin E, which is linked to less cognitive decline as you age. Dark chocolate also has other powerful antioxidant properties. It contains natural stimulants like caffeine, which can enhance focus. Enjoy up to an ounce of nuts and dark chocolate a day for the benefits you need without excess calories, fat, or sugar.

Some of the best nuts for your brain are:

• Walnuts
• Pecans
• Cashews
• Almonds
• Flax Seeds
• Pumpkin Seeds
• Sunflower Seeds

Caffeine

There’s no magic bullet to boost IQ or make you smarter—but certain substances, like caffeine, can energize you and help you concentrate. Commonly found in coffee and chocolate caffeine gives you that unmistakable wake-up buzz, though the effects are short-term. As if you needed another excuse to eat chocolate, dark chocolate has powerful antioxidant properties, and it contains natural stimulants like caffeine, which can enhance focus.

CAUTION: Be careful with caffeine. Too much caffeine can make you jittery and uncomfortable. Energy drinks have become popular but can also have yucky withdrawal effects such as mood swings and headaches. Caffeine intake—especially for children and teens– should be limited because it can lead to higher blood pressure, sleep deprivation, and can make anxiety worse.

Healthier caffeinated food and drinks can include:

• Coffee
• Black Tea
• Green Tea
• Dark Chocolate

Fiber

Every organ in the body depends on blood flow, especially the heart and brain. A diet high in fiber can cut the risk of heart disease and lower bad cholesterol. This reduces your risk of plaque buildup and enhances blood flow, offering a simple, tasty way to fire up brain cells.

Foods that contain high fiber include:

• Beans
• Whole Wheat
• Oats
• Rye
• Buckwheat
• Quinoa
• Brown Rice
• Popcorn
• Chia Seeds
• Avocado
• Cherries
• Grapes
• Dates
• Cabbage
• Broccoli
• Spinach
• Eggplant

Don’t Forget to Start Each Day with Breakfast

Tempted to skip breakfast? Studies have found that eating breakfast may improve short-term memory and attention. Students who eat breakfast tend to perform better than those who don’t. Foods at the top of the brain-fuel list include high-fiber whole grains, dairy, and fruits.

Be careful not to overeat; research has found that high-calorie breakfasts can hinder concentration. That means take it easy on heavy carbohydrate breakfast foods like pancakes and waffles drenched in syrup. Instead, balance with higher protein options like eggs.

Bottom line: If your diet lacks essential nutrients, it can hurt your ability to concentrate. Eating too much or too little can also interfere with your focus. A heavy meal may make you feel tired, while too few calories can result in distracting hunger pangs. Strive for a well-balanced diet full of a wide variety of healthy foods like fruits, vegetables, legumes, whole grains, and protein.

Getting older can bring many changes, both physically and mentally. Even when you’re healthy, your brain and body start slowing down. Maintaining your cognitive health—the ability to clearly think, learn, and remember—is important for your overall well-being.

Many things influence cognitive health. Your genes, lifestyle, and environment can all impact your thinking skills and ability to perform everyday tasks.

“I like to think about the brain as a computer disk for memory and thinking,” explains Dr. Marie Bernard, an aging expert at NIH. “As you get older it gets fuller and fuller. So, it can get more difficult to retrieve data and add data to it. But you’re still able to learn and grow.”

Aging is bound to bring changes. But there are many things you can do to protect your cognitive health as you age. That includes knowing what puts your well-being at risk.

Staying Aware

“Older adults are often targeted by scam artists,” says Dr. Patricia Boyle, who studies the aging brain at Rush University.

Older adults are also more likely than younger ones to pick up the phone without knowing who’s calling, she explains. “Simply by doing that, you’re opening yourself up to a conversation with someone who may be an unscrupulous person trying to steal from you.”

Common scams targeting older adults include identity theft, risky or fake investments, charity scams, and people posing as relatives in distress to ask for money.

Any adult can fall victim to these sorts of scams. But Boyle and her team recently found that low awareness of tactics used by scam artists may be an early indicator of worsening brain function.

In their study, people with low scam awareness were about twice as likely to later develop Alzheimer’s disease as those with high scam awareness.

People should verify any investment proposal or request for money before acting, Boyle explains. Trusted family members or friends may be able to help with this. “Take the time to look into financial propositions and make sure they are legitimate,” she says.

Reversing Changes

If you experience a sudden change in thinking, memory, or mood, it may be caused by a new medication. Some drugs may not cause cognitive changes when taken on their own but can do so when combined with other medications. Even common supplements or over-the-counter remedies can cause these types of interactions.

Sometimes, if you have more than one doctor, one might not know what the others prescribed. “Older adults really benefit from having a list of all their over-the-counter, herbal, and prescribed medications with them whenever they see a health care professional,” says Bernard.

Certain medications can also have dangerous, or even deadly, effects when combined with alcohol. And alcohol alone poses risks for the older brain. It can take less alcohol to alter judgment, coordination, balance, or sleep patterns in an older adult.

Dangerous drinking habits have been rising among older adults in the U.S. A recent NIH-funded study found that 1 in 10 Americans aged 65 or older binge drinks regularly. That means drinking four or more drinks on the same occasion for women and five or more for men.

Older adults may change their drinking habits to cope with the death of a partner or other loved one, or because they’re lonely. But drinking can also be part of social activities for older adults, explains Dr. Edith Sullivan, an alcohol researcher at Stanford University.

“Older adults might feel that ‘well, I’m old now, it’s OK for me to drink,” Sullivan says. But older brains and bodies are especially vulnerable to the effects of alcohol, she adds.

A recent study by Sullivan and her team used brain imaging to see how alcohol affects the brain. They found that older adults who misused alcohol had greater loss of brain tissue compared with their peers who didn’t drink. This was true even if they started misusing alcohol later in life.

The good news, she explains, is that some problems with thinking or memory caused by medications or alcohol misuse can be reversed. “That’s different from classical dementia, which is a one-way street of decline,” says Sullivan.

Building Brain Power

Managing your health conditions is also important. Controlling your blood pressure, for example, reduces the risk of having a small stroke (bleeding from blood vessels in the brain). Small strokes can cause temporary or permanent cognitive problems.

Feeling a sense of purpose in one’s life also seems to help protect older adults from cognitive decline. A study from Boyle and her colleagues found that people who felt more purpose in life had fewer symptoms from brain changes linked to Alzheimer’s disease.

“The aging brain can accumulate Alzheimer’s changes, but if you’re stimulating your brain and strengthening it like a muscle, you may be better able to tolerate those changes,” she says.

Bernard stresses that getting older can also bring cognitive advantages you might not know about.

“Older adults have greater verbal ability than younger adults. They’re better problem solvers. And accumulated experiences are very helpful,” she says.

“Think about the positive things that come with aging,” Bernard says. “It’s a great time to become engaged in meaningful activities, maintain connections to friends and family, develop new connections, and be physically active. And in turn, all of these things can enhance one’s quality of life and one’s aging.”

Protecting Your Brain Health

Good overall health can help you maintain your brain health. These tips can help you stay active and healthier physically and mentally:

• Choose healthy foods whenever possible
• Drink enough fluid
• Limit your use of alcohol
• Don’t smoke or use tobacco products
• Get enough sleep
• Make physical activity part of your routine
• Keep your mind active with learning, teaching, and volunteering
• Stay connected with loved ones, friends, and your community
• Manage chronic health problems like diabetes, high blood pressure, and high cholesterol

High blood pressure is the most important risk factor for brain blood vessel disease. High blood pressure has been associated with clinically apparent stroke, diffuse white matter disease, and silent stroke on MRI brain images and brain examination at autopsy. These in turn have been linked to cognitive decline and dementia. For many reasons, treating high blood pressure and keeping it under control is good for the brain.

How stroke prevention promotes healthy brain aging

Throughout life, a person’s mental faculties are in a constant state of change. For example, mathematicians reach their maximum mental productivity in their third decade. Most people begin to experience very gradual decline in mental abilities as a normal part of healthy aging. Normal age-related changes in cognition are in part due to the limited capacity of the brain’s nerve cells to regenerate. Indeed, our brains become smaller with age. However, after our seventh or eighth decade, an accelerated loss of mental function may signify onset of dementia or less severe cognitive decline.

Alzheimer’s disease is the most common cause of dementia. Current research is exploring how brain cells age and the biologic changes that underlie Alzheimer’s disease, with the ultimate goal of developing treatments and preventive therapies. Another common diagnosis is vascular dementia, which is caused by widespread damage to the brain’s blood vessels. Vascular dementia usually occurs due to the cumulative impact of multiple strokes, including small infarcts which go unnoticed over time.

About 20 percent of the blood circulating through our bodies enters the brain where a highly intricate network of blood vessels distributes oxygen and nutrients to billions of brain cells. When high blood pressure pounds vulnerable brain blood vessels year after year, those vessels become scarred, narrowed, and diseased with arteriosclerosis. This can cause ischemic stroke damage due to lack of adequate blood flow and also upset the delicate balance between the nerve cells’ need for nutrients and what the bloodstream can supply. The most well-known consequence of uncontrolled high blood pressure is stroke, and for years scientists have known that stroke increases the risk of developing dementia. The good news is that controlling hypertension can prevent stroke. In fact, a 10-point reduction in systolic blood pressure can result in a one-third reduction in stroke risk.

Some scientists believe that the hypertension-related changes in brain blood vessels that contribute to stroke also make people more vulnerable to Alzheimer’s dementia. Decades of scientific study have shown that controlling high blood pressure reduces the likelihood of vascular disease. This research offers promise that we may be able to reduce the risk of cognitive decline and dementia by employing what we already know about preventing stroke.

High blood pressure may increase the risk of cognitive impairment

Numerous epidemiological research studies have documented that high blood pressure, especially in midlife, is associated with accelerated impairment of cognitive activity later in life. Many researchers believe that long-term damage to the blood vessels in the brain compromises the supply of nutrients to the areas that are critical to our ability to think, reason, and make decisions. In addition to structural changes within the vessels, high blood pressure leads to cellular and molecular dysfunction in the brain tissue. The accumulation of these negative effects over time may impair our brain’s ability to carry out everyday tasks. Studies have demonstrated an association between high blood pressure and lower measures of global cognition as well as poorer performance on executive function tests (our ability to plan and make decisions) as well as our brain’s processing speed. This contrasts somewhat with the typical short-term memory problems of Alzheimer’s disease. Since these effects occur due to sustained exposures over time, controlling blood pressure in midlife, years before most people become concerned about age-related cognitive loss, maximizes the potential for protecting brain function later in life.

Brain scans reveal subtle brain damage that is linked to hypertension and impaired cognition

Changes in brain structure can be seen on MRI scans in the majority of older individuals. Scientists have been trying to understand the causes and consequences of these changes in the bundles of fibers that connect brain regions. Called “diffuse white matter disease” the fibers appear on MRI brain scans as coalescing, multiple bright spots in deep structures of the brain. Disease in the small blood vessels that supply the center of the brain contributes to these changes. These abnormalities are prevalent in senior populations, affecting as many as 80 percent of those over age 80, but their number, size, severity, and rate of progression vary. Research has demonstrated an association between these white matter lesions and blood pressure levels, with higher blood pressure levels over time being linked to more extensive areas of white matter damage. Some studies also suggest a link between severe white matter lesions and enhanced risk of diminished cognitive function or dementia.

“Silent” strokes linked to high blood pressure

Another type of subtle brain damage is the “silent” stroke. Silent strokes (or infarcts) show up as multiple areas of ischemic tissue damage on MRI scans or in brains examined after death. In contrast to strokes that cause immediately obvious consequences, silent infarcts go unnoticed because they are so small, or because they occur in areas that are not directly responsible for movement, speech, vision, or other critical functions. These silent infarcts increase in prevalence as we age, affecting as many as 30 percent of older individuals. Like white matter lesions, silent infarcts can vary in size, quantity, and location. A strong body of evidence links these silent infarcts to high blood pressure and suggests that they contribute to cognitive impairment and dementia. In addition, microscopic strokes, which are not visible on MRI scans but can be detected with microscopic brain tissue examination during autopsy, are even more prevalent and have been linked to poorer cognitive function and dementia.

High blood pressure may increase the risk for dementia

Dementia is a clinically diagnosed condition characterized by significant, sustained decline of overall mental abilities that is severe enough to interfere with normal daily activities. The most commonly diagnosed dementia is Alzheimer’s disease, another very common diagnosis is vascular dementia. Epidemiologic studies have documented an association between high blood pressure and other cardiovascular risk factors in midlife with the onset of dementia at later ages. Data from randomized controlled trials of different blood pressure medications seem to suggest that controlling blood pressure limits cognitive decline and dementia, but it is difficult to design studies that address the question in a definitive way. For decades, research has shown that dementia risk strikingly increases in the years after a stroke, but exactly why remains a mystery. Moreover, population-based autopsy studies have shown that most patients who die with dementia often have a combination of both Alzheimer’s pathology and brain injury due to vascular disease or silent strokes, so-called “mixed dementia.” Experts now believe that the processes that give rise to vascular disease in the brain and Alzheimer’s disease may converge, dramatically increasing the likelihood and severity of dementia more than either condition alone. Ongoing research is exploring the biological mechanisms that underlie the relationship between high blood pressure and other cardiovascular risk factors and development of dementia.

Turning the tide?

Over the past five decades, stroke rates in the United States have decreased by 70 percent as blood pressure control has become the standard of care. If there is a link between vascular diseases, including stroke, and dementia, then it would be expected that dementia rates should exhibit a parallel decrease. In fact, recently a number of studies have reported decreased dementia incidence rates in the U.S. and other developed countries.

Changes in the brain occur many years before the first symptoms of Alzheimer’s disease appear. These early brain changes point to a possible window of opportunity to prevent or delay memory loss and other symptoms of dementia. While nothing has been proven yet to prevent Alzheimer’s, researchers have identified promising strategies and are learning more about what might — and might not — work.

A 2017 review of research looked carefully at the evidence from clinical research on ways to prevent, delay, or slow Alzheimer’s and mild cognitive impairment (MCI) or delay or slow age-related cognitive decline. Clinical trials are often considered to be the “gold standard” for providing the strongest level of evidence that a treatment or medical approach works. Led by a committee of experts from the National Academies of Sciences, Engineering, and Medicine (NASEM), the review found “encouraging but inconclusive” evidence for three types of interventions: blood pressure management in people with high blood pressure, increased physical activity, and cognitive training.

Within the context of this study, this meant that the three areas showed promise, but more results from clinical trials would be needed to determine whether these interventions could help prevent these conditions. Researchers are also continuing to explore other possible preventive and risk reduction strategies, including certain foods and diets, diabetes management, sleep quality interventions, and hearing restorative devices, for which we have some but not as much evidence.

The video below highlights conclusions and recommendations from the NASEM review, and the following sections go into more depth on what we know about the most promising interventions to date.

Blood pressure management

Controlling high blood pressure is known to reduce a person's risk for heart disease and stroke, and it also might help prevent or delay Alzheimer's. High blood pressure, particularly in midlife, is considered a risk factor for later-life cognitive decline.

A large, multiyear clinical trial called SPRINT-MIND (Systolic Blood Pressure Intervention Trial: Memory and Cognition in Decreased Hypertension) looked at the effects of lowering blood pressure in more than 8,000 older adults who were 50 years or older and at high risk for cardiovascular disease. Results showed that lowering systolic blood pressure (i.e., the “top” blood pressure number) to below 120 mmHg, rather than the standard 140 mmHg, significantly reduced the risk of MCI. Further, brain scans also showed that this intensive lowering slowed the buildup of white matter lesions — abnormal changes in the brain associated with dementia.

In a study that reviewed data from six individual community-based cohorts, researchers examined the long-term data (average follow-up between seven and 22 years) from roughly 31,000 adults over age 55 that provided further evidence to support the potential of this strategy. The study results showed that managing high blood pressure with blood pressure medication reduced the risk of dementia to the level of a person with normal blood pressure not on blood pressure medication.

However, an observational study of more than 17,000 adults showed that higher systolic blood pressure (particularly at about 185 mmHg) was associated with a lower risk of dementia among those age 60 to 70, which is inconsistent with the findings from SPRINT-MIND. Among those 75 years and older, data showed what’s called a U-shaped association, in which both high and low blood pressure were associated with lower risk. These findings and others point to the need for further research in how blood pressure levels relate to dementia risk at different ages, as well as cardiovascular risk factors.

While research continues, experts recommend that people control high blood pressure to lower their risk of other serious health problems. Learn more about ways to control your blood pressure.

Increased physical activity

Physical activity has many health benefits, such as reducing falls, maintaining mobility and independence, and promoting heart health. It reduces the risk of depression, diabetes, high blood pressure, and stroke — health conditions that can contribute to age-related cognitive decline.

Years of animal and human observational studies suggest that exercise may help with brain health and cognitive performance, or how well you think, learn, and remember. No clear link between physical activity and preventing Alzheimer’s has been documented. However, preliminary research findings suggest that physical activity may help reduce the risk of age-related cognitive decline.

One study compared cognitive performance in 454 older adults two years prior to death, on average at age 90, and found that higher levels of physical activity were associated with better cognitive function, even after accounting for signs of Alzheimer’s in participants’ brain tissue. In another study of 1,159 adults age 65 and older that included participants with high levels of tau protein (a hallmark of Alzheimer’s), those who engaged in more physical activity had a slower rate of cognitive decline.

While there is not enough evidence from clinical trials to conclude that exercise can prevent or slow MCI or Alzheimer’s, some studies suggest that it may help delay or slow age-related cognitive decline. For example, one study compared aerobic exercise, such as brisk walking or running on a treadmill, to stretching and balance exercises in 65 participants age 50 to 89 with MCI and prediabetes. After six months, the aerobic group had better executive function — the ability to plan and organize — than the stretching/balance group, but not better short-term memory.

Researchers continue to explore physical activity as a possible way to help prevent or delay Alzheimer’s. Many questions remain, including whether physical activity can prevent dementia, which types of physical activity, how much, and how often.

In the meantime, it’s safe to say that experts already encourage exercise for its many benefits.

Cognitive training

There is evidence suggesting cognitive training may help delay or slow age-related cognitive decline. Cognitive training involves structured activities designed to enhance memory, reasoning, and speed of processing.

Studies, such as the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) clinical trial, have shown that specific cognitive training can improve cognitive performance. ACTIVE was a large clinical trial which found that cognitive training improved the abilities of healthy older adults over age 65 (with an average age of 73 years at the start of the study), in the area in which they were trained: memory, reasoning, or speed of processing. Improvements remained in reasoning and speed of processing up to 10 years after the training was completed. It is still unknown whether the long-term benefits of cognitive training can help enable older people to live independently longer.

A separate analysis of 215 cognitive training clinical trials involving roughly 12,500 older adults showed that cognitive training improved cognition in cognitively healthy older adults and in those who have MCI. Additionally, participants who received training in multiple cognitive areas also improved in cognitive areas in which they had not received training. Cognitive training areas included memory, reasoning, speed of processing, executive functioning, everyday functioning, and general knowledge. Despite the promise of cognitive training, important questions remain around what types and aspects of trainings may be effective and how long the benefits last.

Be wary of claims that playing certain computer and online games can improve your memory and other types of thinking. There is currently not enough evidence available to suggest that any of the commercially offered computer-based brain training applications have the same impact on cognitive abilities as those seen in clinical trials. NIA and other organizations are supporting research to determine whether different types of cognitive training may have lasting effects.

Informal or unstructured cognitively stimulating activities, such as reading, may offer cognitive benefits, as well, according to findings from long-term observational studies. For example, a study of nearly 2,000 cognitively normal adults 70 and older found that playing games and engaging in craft, computer, and social activities were associated with a lower risk of MCI. The same research group also found that playing games and engaging in social activities in both midlife and late life and having a higher number of mentally stimulating activities in late life were associated with reduced MCI risk.

Furthermore, an analysis of 19 cognitive leisure activity studies showed a link between participation in unstructured cognitively stimulating activities and a reduced risk of cognitive impairment and dementia.

Many studies are ongoing to explore cognitive training as a possible way to prevent cognitive decline and dementia. For now, experts encourage people to make healthy lifestyle choices for cognitive health.

What does this mean for Alzheimer's prevention?

Alzheimer’s is complex, and the best strategy to prevent it may turn out to be a combination of interventions based on a person’s risk. In the meantime, generally leading a healthy lifestyle, including controlling high blood pressure, being physically active, and making healthy dietary choices, will help reduce your risk of many chronic health conditions and may help reduce your risk of dementia.

Social connections are another important part of leading a healthy lifestyle. Staying connected with friends and family can improve your mental well-being and support healthy aging.

Older African Americans with mild cognitive impairment (MCI) who got help setting goals to be more socially, physically, or cognitively active had slower memory decline than those who did not receive such help, concludes an NIA-funded study published Sept. 10 in JAMA Neurology. The results point to a possible way to reduce dementia risk in African Americans, who are more likely than whites to develop the condition.

Past studies suggest that a more active lifestyle may help prevent cognitive decline, but few of these studies have included African Americans. MCI—a condition in which people have more memory problems than normal for their age—often, but not always, leads to memory loss and other signs of dementia.

In the study by researchers at Thomas Jefferson University, Philadelphia, 221 African Americans age 65 and older with MCI (average age, 76 years; 79 percent female) were randomly assigned to one of two interventions, and 164 completed the trial. One group received “behavioral activation,” in which community health workers helped them choose goals to be more active, then develop step-by-step action plans. Goals included, for example, relearning how to play chess or rejoining a church group. The control group received “supportive therapy,” conversations with community health workers that did not involve setting goals. Both groups had 11 one-on-one, in-home sessions with African-American community health workers, with each session lasting 1 hour, over 2 years.

After 2 years, the behavioral-activation group participated in significantly more cognitive activities, the researchers found. There were no differences in physical or social activity levels. Both groups had memory decline, measured by performance on a standard memory test, but the behavioral-activation group declined by just 1.2 percent, compared with 9.3 percent for the control group. In addition, behavioral activation was associated with stable everyday function and improved executive function.

The study provides evidence that a behavioral intervention can slow memory decline in older African Americans at risk for dementia. Although several factors may influence cognitive decline in this population, it’s possible that planning a more active lifestyle could reduce the disparity in dementia risk between African Americans and whites.