Brain health is of paramount importance to nearly all Americans, yet few are aware of the latest science on how to nurture it.
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The Alzheimer’s Association released its annual report Tuesday, which included a survey of more than 3,800 adults 40 and older, 99% of whom indicated brain health is at least as important as physical health.
About 88% of the respondents said maintaining brain health is “very important,” but only 9% said they knew “a lot” about how to do it.
Christopher Weber, a clinical psychologist and the Alzheimer’s Association’s senior director of global scientific initiatives, said people generally understand how lifestyle habits, like getting enough sleep, being physically active, eating a balanced diet and staying socially and mentally engaged, can protect the brain. “But the data also show how challenging these habits can be to maintain,” he said.
The Alzheimer’s Association partnered with the University of Michigan National Poll on Healthy Aging to conduct the survey. Among the findings:
- 50% got at least seven hours of sleep most nights
- 39% consistently followed a healthy diet
- 34% were physically active most days
- 42% reported adequate mental stimulation.
“What the science is telling us, more and more with the evidence that we’re seeing, is that it’s the combination of healthy behaviors — sleep, activity, nutrition and mental engagement — working together that is the most supportive of brain health over time,” Weber said.
10 ways to maintain brain health
Dementia risk is partly determined by genetics. For example, research has linked variants of a gene called APOE to an increased likelihood of developing Alzheimer’s disease.
But as Dr. Kellyann Niotis, a preventive neurologist and clinical assistant professor of neurology at Weill Cornell Medicine, likes to remind her patients, much of a person’s risk is modifiable.
“Genes are not your destiny,” Niotis said in an email.
The report highlighted the results of a randomized controlled trial called the U.S. POINTER study, which explored the effects of lifestyle changes on the brain health of more than 2,100 people at high risk of cognitive decline. Compared with the self-guided group, people who had structured interventions, including prescribed diet and exercise regimens, demonstrated cognitive scores similar to those of people up to two years younger. However, both groups showed improved cognitive function after two years.
The 2026 report “makes clear that Alzheimer’s develops as a result of multiple interacting factors, not genetics in isolation,” Niotis said.
The Alzheimer’s Association lists 10 healthy habits that can lower your risk of cognitive decline:
- Challenge your mind
- Stay in school
- Get moving
- Protect your head
- Be smoke-free
- Control your blood pressure
- Manage diabetes
- Eat right
- Maintain a healthy weight
- Sleep well
Despite growing awareness of how these factors influence brain health, Niotis said, “people often underestimate how early and how consistently these factors need to be addressed to make a meaningful impact.”
Midlife is a critical time to prevent dementia
In the survey, 38% of respondents correctly identified midlife, defined here as ages 35 to 64, as an ideal time to take steps to preserve brain health. Research has shown the earliest brain changes associated with Alzheimer’s may start decades before symptoms appear.
“Midlife is critical because that’s when many of the drivers of neurodegeneration are either accelerating or still modifiable,” Niotis said. “It’s also important because the brain still has a large amount of neuroplasticity.”
Jennifer Pauldurai, the medical director of the Inova Brain Health and Memory Disorders Program in northern Virginia, said it helps to think of your brain as a car engine.
When the check engine light appears, “it doesn’t mean the engine broke right now,” Pauldurai said. “It means there were probably several thousands of miles that we were driving that there was something building up, going wrong.”
Just as routine maintenance keeps cars old and new running smoothly, our brains need upkeep, particularly in midlife, she said.
“We need to get our brain health checked, because that’s when things start to break down,” Pauldurai said. “If we can do more monitoring and maintenance of those things early, then we don’t have to wait for the check [engine] light to come on.”
That said, brain health is hard to define, Pauldurai said.
In the survey, 82% of respondents associated “good brain health” with the ability to think clearly and make good decisions. Experts say a healthy brain often starts with managing physical and mental health problems.
For example, if you’re 50 and generally healthy but have sleep apnea, getting that treated now may be your best bet for better brain health 20 years down the road.
Niotis encourages people to address hearing and vision loss, two problems she said are often overlooked but linked to brain health. She stressed that avoiding excessive alcohol use is also essential.
“Don’t wait. The biggest mistake I see is people thinking this is something to worry about later,” Niotis said. “The earlier you start, the better.”
Never too late to prioritize cognitive health
Tamar Gefen, the director of the Northwestern University SuperAging Program, works with people in their 80s and beyond who have the memory capacities of those at least two to three decades younger.
“It is not a lost cause,” Gefen said. “There are modifiable risk factors in late life, and any one of those can be detrimental.”
Social isolation, for instance, is a major dementia risk factor among older adults. It accounts for 5% of dementia cases worldwide, according to a 2024 report by the Lancet Commission on dementia. The other two late-life factors, air pollution and vision loss, account for 3% and 2% of cases, respectively.
“It’s never too late, absolutely not,” Gefen said. “It’s just that the start is much earlier than we think about when we want to take better control.”
Some 7.4 million Americans are living with Alzheimer’s, the most common form of dementia, the Alzheimer’s Association report estimates. This year, health care costs for people living with all dementias are projected to reach $409 billion — not to mention the more than $446 billion in unpaid care provided by nearly 13 million Americans.
“The bottom line is that Alzheimer’s and other dementias remain one of the most urgent and pressing public health challenges the U.S. is facing right now,” Weber said, “one that touches nearly every family in some way, shape or form.”
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