Simple lifestyle changes to protect against cognitive decline

By Liz Meszaros, MDLinx
Published April 2, 2019

Key Takeaways

It seems—no surprises here—that what’s good for your body is also good for your mind. Getting regular physical exercise, sticking with a healthy diet, drinking in moderation, and getting enough sleep have all been clinically shown to improve physical health and possibly protect the brain from cognitive decline.

The efficacy of lifestyle changes is particularly important in light of the “aging of America,” a shift brought on primarily by the aging of the Baby Boomers, many of whom hit their “golden years” in 2011. Consider that by 2030, the number of older adults living in the United States will increase from about 45 million to 70 million.  

Hand in hand with this, naturally, will be increases in the incidence of dementia and other diseases common in aging bodies. In turn, this will place ever-increasing demands on patients, caregivers, and healthcare systems. With no effective drug-based treatment for reversal or symptom reduction, lifestyle changes have become the focus of many studies as researchers try to uncover how to protect against cognitive decline and dementia with age.

According to results from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), regular physical activity, proper diet, mental challenge, and strong social connections may keep cognitive skills from decline, as well as improve reasoning skills and the speed in performing mental tasks. The FINGER study is the largest and longest randomized controlled trial focused on the effects of lifestyle interventions on preserved mental acuity. Researchers included 1,260 subjects who were followed for 2 years. All were aged 60 to 77 years and had risk factors for future cognitive impairment despite normal scores on mental function tests.

Subjects were randomized to either the study group—which received health interventions, including personal nutritional counseling, exercise instruction from physical therapists, and cognitive training, as well as seven medical exams—or the control group. Cooking classes, cognitive training, and exercise instruction were often carried out in groups among those in the study group. The control group underwent only three medical exams and received none of the interventions the study group did.

In the intervention group, overall scores were 25% higher compared with the control group. It was in processing speed and executive function, however, in which the intervention group excelled compared with controls. For example, measurements of response time were a full 150% higher in the intervention group than in the control group, and in tests of organization and reasoning, 83% higher.

Recall, however, did not improve in either group.

An important note is that the researchers found that the subjects stuck with the study because they enjoyed themselves and became friends with other subjects. The dropout rate was relatively low—only 12%. The intervention group had 3-5 exercise session per week, plus 10-12 nutrition counseling sessions, and 144 cognitive training sessions over 2 years. Attendance was over 85%, researchers reported.

Here are a few lifestyle changes that have been shown to afford protection—even if minimal—against the ravages of age on the brain, including cognitive decline, dementia, and Alzheimer’s disease (AD). 


For adults, the US Department of Health and Human Services recommends at least 150 minutes of moderate-intensity aerobic physical activity every week. Unfortunately, about 80% of Americans don’t do this, and those aged 65 years and older have the lowest rates of physical activity.

Researchers are not yet certain of how exercise affects brain health. They theorize that possibilities include improved cerebral perfusion stemming from positive effects on the cardiovascular system, the promotion of neuro- and synaptogenesis, increases in brain-derived neurotrophic factors, and improved insulin sensitivity and glucose control that may reduce the incidence of amyloid plaque formation that can lead to AD.

And while it’s no secret that exercise is good for you, the data supporting its health benefits in protecting against cognitive decline keep accumulating—rapidly.

In a meta-analysis of 14 randomized, controlled trials, including 1,695 subjects with mild cognitive impairment, researchers found a significant improvement in verbal fluency caused by physical exercise. Researchers of another meta-analysis of 11 studies, comprising 1,497 patients with mild cognitive impairment, found that aerobic exercise improved both global cognitive ability and memory—albeit only very slightly. Finally, in a recent Cochrane review, researchers concluded that regular exercise may benefit older adults with mild-to-moderate dementia in completing the activities of daily living.

Mediterranean diet

The benefits of the Mediterranean diet seem to extend from head to toe. In addition to promoting good cardiovascular health and reducing the risks of certain cancers, this diet can also lower your risk of developing mild cognitive impairment, and, in those with dementia, slow its progression. Many studies have been done to assess the effects of the Mediterranean diet, and all have shown that it is linked to better cognitive function and lower incidence of dementia. Built on a foundation of fruits and vegetables, olive oil, whole grains, nuts and seeds, and beans, the Mediterranean diet consists of limited red meat, and moderate amounts of fish, poultry, and dairy products.


Moderate consumption of alcohol may reduce the risk for cognitive decline and dementia, according to several studies, including one from JAMA. In this analysis of data from the Cardiovascular Health Study, researchers found that those over 65 years old who drank 1-6 alcoholic beverages per week had a lower risk of cognitive decline and dementia compared with nondrinkers.

In another study, resveratrol, a compound found in red wine, successfully broke down beta-amyloid (Aß), a sticky compound that accumulates in the brain and comprises the abnormal protein deposits characteristic of AD.

But, further studies are needed on alcohol’s protective effects, and no one is recommending drinking to fight cognitive decline or AD just yet.


As most people know, adequate sleep is undeniably associated with cognitive function. How many mistakes have you made after a night of tossing and turning? Those who sleep less than the recommended 7-8 hours a night consistently have lower mental function scores, according to research. Sleep may also have a vital role in the upkeep of the brain, which may be due—in part—to the consolidation of learning and memories that occurs during sleep. This association may be especially strong in those who are older.

In a recent review, researchers found that poor sleep is, indeed, a risk factor for cognitive decline and AD. In several of the studies included in their review, previous researchers showed associations between sleep variables and measurements of AD pathology, including CSF measures of Aß and PET measures of Aß deposition. In experimental studies, investigators showed that decreases in slow-wave sleep could actually decrease clearance of Aß from the brain, while others have shown that sleep-disordered breathing may actually increase Aß production.

The take-home message here is: Find an exercise regimen, a diet, or mental stimulation you enjoy, and stick with it. Your brain will thank you later.

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