Roughly 10% of U.S. adults ages 65 and older have dementia, while 22% have mild cognitive impairment, according to a Columbia University study. You might have concerns about your own cognitive health or have questions about what you can do to keep your brain healthy, when to seek help from your doctor and what you should expect your doctor to ask when you bring up cognitive concerns. We spoke with John Brady, M.D., who has been a family physician for three decades and is a member of the Board of Trustees for the McKnight Brain Research Foundation, about his experience with patients concerned about brain health.
What questions are you likely to ask a patient with concerns about cognitive health?
Dr. Brady: My first question would be, “Why are you concerned?” Many times, patients come in after something has happened that has made them afraid, so I try to understand the reason for their concern regarding their cognitive health. I also ask patients about their family history and whether their father or mother suffered from dementia.
Drilling down further, I would want to know: Are you having problems at home and/or work? If so, what specific memory or cognitive issues are going on? Are you having difficulty finding words or remembering people’s names? Are you having difficulty trying to solve problems? Those are the questions I would start with.
The McKnight Brain Research Foundation did a study that found that 87% of respondents were concerned about age-related memory loss and experiencing a decline over time, so this is a common concern. The beauty of being a primary care physician is we can evaluate our patients’ concerns from the beginning, address them by looking for other potential causes of memory loss, and either help alleviate the fears or refer the patient for further evaluation and treatment.
What is the most common question patients ask about aging and brain health?
Dr. Brady: The general belief among patients is that normal brain aging equals dementia, and so most patients are concerned that some changes in their cognitive abilities mean they are sliding into dementia. The most common question simply is, “Do I have dementia?” Truth be told, though a lot of people will have changes due to normal cognitive aging, the vast majority of people do not develop dementia. Just knowing that fact can relieve fear, and should encourage patients to have earlier and more open conversations with their doctor.
How do you differentiate normal aging or forgetfulness from a more concerning problem?
Dr. Brady: The brain ages just like the rest of our body, so cognitive aging, or brain aging, is just a part of the developmental process that occurs throughout our lifespan. It begins in utero during formation of the brain itself, and continues through early childhood and adolescence, adulthood, and even into the elderly years. We see things like vocabulary, wisdom and experience increase with age, but as we get later in life, other things—like processing speed, decision making and memory—may decrease. The key point to understand is that cognitive aging is not a disease process in and of itself. It’s just a natural part of aging.
Physicians talk about age-related changes in other organ systems. For instance, with the heart, we know that the maximum attainable heart rate decreases with age. We also know peak lung capacity happens at around age 30, and then lung function begins to decline. Physicians haven’t done a great job describing how the brain changes with age, and how these changes do not necessarily mean that something terrible is happening.
How do we differentiate normal aging from a more concerning problem? Normal cognitive aging might be things like forgetting where you put your car keys or struggling to find the right word in conversation. Forgetting somebody’s name or not remembering it until later also can all be a sign of normal aging. Signs of a more serious memory problem could be things like asking the exact same question over and over again, getting lost in familiar places or not being able to follow simple directions.
I start by getting the patient’s history. Then I do a Mini-Mental Status Exam (MMSE) or a Montreal Cognitive Assessment (MoCA) to determine whether further evaluation through other diagnostic tests or a referral to a cognitive specialist is warranted.
Are rates of dementia and Alzheimer’s increasing, or do we hear about these more because of increased awareness, better diagnosis and more treatment?
Dr. Brady: All of the above. Our population is aging, and it’s estimated that we are going to go from about 550,000 people with dementia to more than one million by 2060.
But there are new biomarkers being developed and new treatments coming out, so there is more advertising regarding early evaluation for dementia and more interest in early detection. This increases awareness. So, I believe the answer is that yes, the incidence is increasing, but there is also increased awareness and earlier diagnosis.
What can younger adults do to keep their brains healthy?
Dr. Brady: That is a great question because it’s all about primary prevention. Many young adults are not concerned about their brain health unless they have a parent who has had dementia. They are more interested in other health issues. The good news is that what is healthy for your heart and what is healthy for the rest of your body is also healthy for your brain. A healthy lifestyle, which includes things like a Mediterranean diet, regular exercise, not smoking and getting a good amount of sleep is great for your brain. Also, protecting your hearing seems to help preserve your cognitive reserves at a younger age and decreases the risk of cognitive decline.
What are some other habits people can build into their routines to keep their brains healthy?
Dr. Brady: In July 2024, there was a great article in The Lancet. It was a compendium of all the research that has been done, and it said that 40% of dementia is basically preventable. The first thing is to remember that the brain is a vascular organ. So, again, anything that is good for your heart will be good for your brain. That includes a good Mediterranean diet, not smoking and exercise.
The brain is an organ that likes to be stimulated, so social interaction is also vital. We learned during COVID how essential social interaction is for continued brain health.
We don’t think about hearing as much, but there’s definitely a correlation between untreated hearing loss and cognitive decline. Sleep is another thing that we don’t think about enough, but as we get older, if we have sleep problems, then we have an increased risk of cognitive decline and dementia, so if you are having issues sleeping, you should visit your doctor.
Lastly, there are certain medications that are known to lead to cognitive changes, and therefore all medications and supplements need to be reviewed regularly with your physician.
What are cognitive health signs or symptoms that warrant someone reaching out to their doctor?
Dr. Brady: If people are experiencing symptoms that make it hard to do everyday tasks like driving or shopping, then it’s important to reach out to the doctor. If they are repeating the same questions over and over again, then it’s important to see the doctor. If they get lost driving or going to familiar places, that is another sign that further evaluation is important.
The reason it is important is not just because there are newer treatments available, but because the cognitive changes may not be due to aging or dementia at all. For instance, somebody might have issues with worsening depression, or they could be having side effects from medication. Things like that can all be addressed by seeing the primary care provider.
In the unfortunate case the diagnosis is dementia, early evaluations and interventions with a cognitive specialist, a physical therapist, a speech therapist or an audiologist may be beneficial, so again, starting with your primary care provider makes sense.
Want more information on cognitive health and how to talk to your doctor about your questions and concerns? Find more resources regarding dementia and Alzheimer’s disease here.