For a long time, it was a forgone conclusion: If Alzheimer’s or other forms of dementia were in the cards for you, there was nothing to be done. But thanks to ongoing research, we now know that’s not the full story.

A large clinical trial, known as the U.S. POINTER study, found that a combination of lifestyle changes led to measurable improvements in cognitive function among older adults at risk for dementia. It also offered a “recipe” for protecting brain health. (See this recipe below.)

“There’s no easy fix for brain health,” Dr. Robert Wiggins of Novant Health Neurology and Sleep - Midtown, said. “But small, consistent efforts at any age can go a long way.”

We spoke with Wiggins about how to focus your time and energy where it counts.

What’s the difference between cognitive decline, dementia and Alzheimer’s?

• Cognitive decline is a change in our ability to do certain tasks. Many people think of memory loss, but it can manifest in several ways. You may have a hard time making decisions, struggle to understand speech, or have trouble processing what you see.
• Dementia is when that decline becomes severe enough to interfere with your independent daily functioning.
• Alzheimer’s disease is a type of dementia, but there are several types of dementia.

Can we reduce our chances of getting Alzheimer’s or dementia?

Yes. We all have some risk factors beyond our control, like genetics or any health choices you’ve made in the past. However, there are also risk factors we can control that reduce the chance of having Alzheimer’s disease or dementia.

These are things we can control, like ensuring you’re physically active, eating a brain-healthy diet, getting more sleep, and quitting smoking if you currently smoke. We may not be able to fully prevent dementia or Alzheimer’s in every case, but we can take steps to reduce our risk and support our brains over time.

At what age should we start thinking about taking care of our brain health?

You’re never too young to take care of your brain. When we do get a diagnosis of Alzheimer’s or dementia, the brain has been changing in that direction for five to 10 years. It’s key to make changes that support brain health before you start experiencing symptoms.

Ideally, we’re following the brain health recipe in our 20s and our 30s — or even younger. There’s no age too young to start, but the changes we make at any age matter.

What actually makes a difference when it comes to improving your brain health?

I recommend the brain health recipe from the clinical trial, which studied the impact of several lifestyle changes on brain health.

Go slow. Focus on one part at a time and build it into your life. The goal is to get to a point where you’re doing these habits consistently.

Brain Health Recipe, courtesy of the Alzheimer’s Association and the U.S. POINTER Trial

• Physical exercise: 30-35 minutes of moderate-to-intense aerobic activity four times a week, plus strength and flexibility exercises twice a week.
• Cognitive exercise: A computer-based brain training program three times a week for 30 minutes. Computer-based training aims to improve several cognitive functions, such as memory, language, and executive function, through exercises that challenge the brain. BrainHQ is a common online computer training option if you want to practice brain training at home. Cognitive exercise also includes regular engagement in social activities.
• Nutrition: Adherence to the MIND diet, which emphasizes dark leafy greens, berries, nuts, whole grains, olive oil and fish, and limits sugar and unhealthy fats.
• Health monitoring: Regular check-ins on blood pressure, weight and lab results.

If a patient came to you and said, ‘I want to protect my brain as I age,’ what’s the one thing you would tell them to start doing today?

Figure out a way to start a good exercise program focused on cardiovascular fitness. I would encourage them to start slowly. I tell my patients that if they're exercising zero times a week, to try once a week for one month. Once you’ve built up your momentum, go to two times a week, and so on.

The most important piece is consistency. Small changes you stick with are more effective than big changes that don’t last. Puzzles and brain “exercises” have their place, but they are only a piece of the overall puzzle for building the best plan possible for preserving cognition. Diet, exercise and maintaining social relationships are the foundation.

What about brain supplements that claim to prevent cognitive decline?

I get a lot of questions about whether specific, over-the-counter supplements can help prevent dementia. Ultimately, I say that if you feel something is helping and isn't hurting your overall health, it's fine. It only becomes a problem if you rely on expensive pills and capsules instead of evidence-based approaches that actually help.

I understand that everyone wants an easy way to protect their brain. Unfortunately, there isn’t one.

Is there anything you advise patients not to worry about too much?

Life is about joy. So while I try to encourage my patients to clean up their diets, I also remind them that a cookie or piece of cake every now and then is fine. There are also so many things in our lives that create undue stress. I try to encourage my patients to find ways to reduce stress — and just remind them that we only live once.

If someone notices changes in their cognitive function, what should they do?

Write down what you’re experiencing and take it to your primary care doctor. Don’t wait to be seen and evaluated for cognitive function.

We now have therapies that can slow disease progression. Diagnosis and early detection are even more important for that reason. We can give people more years to attend their grandchild's high school graduation, walk their granddaughter or grandson down the aisle, and live independently, doing the things they want to do.

If I’m worried a family member may have dementia, how can I bring it up with them in a productive way?

If you’ve noticed symptoms of cognitive decline in a loved one, get a cognitive function test scheduled and go with them. It’s not just a show of solidarity — it’s a standard precaution to ensure you’re healthy. You can frame it like that, too: Hey, I’m going to get my annual cognitive function test. Have you scheduled yours?

People worry about what will be taken away from them if they have cognitive decline or dementia. I would focus on the idea that the goal is not to take your independence away, it’s to try and maintain life on your terms for as long as possible — it’s to try and take care of you any way we can.

When you’re ready to talk about brain health with your primary care provider, call them to schedule a specific appointment for this purpose. You don’t want them to have to rush. Let them know exactly what you’d like to discuss. For example, if you want to have your cognitive function tested, say that specifically so the office can prepare ahead of your visit.

Is there one thing that you wish more people understood about dementia and Alzheimer’s?

For so long, we thought that dementia was unavoidable. Now we know that there are ways to try to protect our brains, not only to reduce our chances of dementia and Alzheimer’s, but to live a better life.

Takeaway: “My message to every patient,” Wiggins said, “Is that the changes we make pay dividends in the future. It's never too early to start, but it's never too late to start, either.” Diet, exercise and keeping social connections intact are your best path forward.