Brain Health: Practical Strategies for Cognitive Wellbeing

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ICYMI 👉

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This Friday’s LIVE Q&A is all about AGING & BRAIN HEALTH 🧠 : Practical Tips for Cognitive Wellbeing! Join me HERE on Friday May 9 at 3 pm ET.

Paid subscribers can submit their questions for me to answer live, right here!

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"Dr. McBride, I keep forgetting people’s names. Should I be worried about dementia?"

Sarah (not her real name) sat across from me, her eyes brimming with tears. At 51, she was a busy mother of two teenagers and a daughter to a father recently diagnosed with Alzheimer’s. She'd come in for her annual physical, but something was troubling her.

She was naturally distressed about misplacing her keys and sometimes struggling to find words. “I'm terrified I'm heading down the same path as my dad."

Sarah's fears are ones I hear daily in my practice. The specter of cognitive decline looms large for many of us, especially those with family histories of dementia. But what I shared with Sarah—and what I want to share with you today—is that emerging neuroscience offers tremendous hope. Your brain's story isn't written in stone or solely determined by your genes. It's being actively shaped, every single day, by the choices you make.

Photo by Олег Мороз on Unsplash

Beyond Genetics: The Power of Everyday Choices

The science confirms that everyday choices significantly influence cognitive function, with up to 40% of dementia cases potentially preventable through modifiable lifestyle factors.

A groundbreaking 2023 study published in the Journal of Neurology, Neurosurgery, and Psychiatry identified 17 modifiable risk factors shared among stroke, dementia, and late-life depression. This represents a paradigm shift in understanding brain health—moving from viewing these conditions as separate, inevitable diseases to recognizing them as interconnected and often preventable.

The study found that addressing even one risk factor could reduce the likelihood of developing all three conditions. High blood pressure emerged as the most significant modifiable factor, followed by severe kidney disease, high blood sugar, and high cholesterol. Other key factors included alcohol use, poor diet, hearing loss, physical inactivity, lack of purpose, poor sleep, limited social engagement, and stress.

This research informs the Brain Care Score developed at Massachusetts General Hospital's McCance Center for Brain Health—a tool that helps people gauge and manage their risk for brain disorders. The message is clear: small changes matter, and you don't need to address all factors simultaneously. Starting with just one to three realistic modifications can significantly impact your brain health.

The Six Pillars Framework: Your Cognitive Blueprint

When Sarah asked me for concrete guidance, I shared what I call the six pillars of brain health—a comprehensive framework supported by robust scientific evidence.

Let's explore each pillar and what it means for your day-to-day life:

Pillar 1: Physical Movement

Your brain loves when you move. Physical activity improves blood flow to the brain, stimulates growth factors, supports neural connections, and may promote neurogenesis—the creation of new brain cells. A 2024 Penn State study found that even everyday movement provides immediate benefits, with participants showing improved cognitive processing speed equivalent to being four years younger after daily activity.

What this means for you:

• Aim for 150 minutes of moderate-intensity aerobic activity weekly

• Include strength training 2-3 times weekly

• Add balance exercises, especially important as you age

• Break exercise into smaller sessions if needed (three 10-minute walks count!)

• Choose activities you enjoy—adherence matters more than perfection

Recent research shows even household chores benefit brain health. The goal isn't marathon training (unless that brings you joy); it's consistent movement integrated into your life.

Pillar 2: Mental Stimulation

Your brain thrives on novelty and challenge. Mental stimulation builds cognitive reserve—your brain's ability to compensate for age-related changes or injury. Learning new skills creates neural pathways and strengthens existing ones.

What this means for you:

• Learn skills that challenge different brain regions (musical instrument, language)

• Engage in activities requiring focus and problem-solving (puzzles, strategic games)

• Read broadly across different topics

• Take classes in unfamiliar subjects

• Pursue creative hobbies (painting, writing, photography)

The key here is stretching beyond comfort zones. When something feels difficult, that's your brain building new connections.

Pillar 3: Quality Sleep

During sleep, your brain performs essential maintenance—clearing toxic waste products (including beta-amyloid associated with Alzheimer's), consolidating learning and memories, and repairing cells. A 2024 UCSF study revealed that sleep quality, not just quantity, contributes to dementia risk decades before symptoms start.

What this means for you:

• Aim for 7-8 hours nightly

• Maintain a regular sleep-wake schedule, even on weekends

• Create a restful bedroom environment (cool, dark, quiet)

• Limit screen time at least one hour before bedtime

• Develop a calming bedtime routine

Sleep isn't a luxury or sign of laziness—it's essential brain maintenance your body requires. I did a podcast episode about sleep last Friday.

Pillar 4: Stress Management

Chronic stress damages the brain, particularly affecting the prefrontal cortex (responsible for executive function) and the hippocampus (critical for memory). Prolonged stress increases cortisol levels, accelerating brain aging and increasing vulnerability to cognitive decline.

What this means for you:

• Practice mindfulness meditation (even 5-10 minutes daily helps)

• Incorporate breathing exercises throughout the day

• Spend time in nature

• Prioritize activities that bring joy and relaxation

• Set boundaries around work and digital connectivity

Managing stress doesn't eliminate life's challenges, but it changes how they impact your brain.

Pillar 5: Social Connection

Humans are fundamentally social beings, and our brains reflect this reality. Social engagement helps build cognitive reserve through intellectual stimulation, reduces chronic stress, and provides emotional support. Isolation and loneliness are significant risk factors for cognitive decline.

What this means for you:

• Prioritize meaningful relationships

• Schedule regular social interactions

• Join clubs, classes, or community groups

• Volunteer for causes you care about

• Use technology to maintain connections when in-person isn't possible

Recent research found loneliness associated with a 26% increase in premature death risk—comparable to smoking up to 15 cigarettes daily and exceeding risks from obesity or physical inactivity. Social connection isn't just pleasant; it's essential for brain health.

Pillar 6: Brain-Healthy Nutrition

Your brain is metabolically expensive, consuming about 20% of your body's energy while comprising only 2% of your body weight. Dietary patterns significantly influence brain health through inflammation reduction, blood vessel health, and provision of antioxidants.

What this means for you:

• Follow Mediterranean or MIND diet principles (Mediterranean-DASH Intervention for Neurodegenerative Delay)

• Eat plenty of colorful vegetables and fruits, particularly leafy greens

• Include berries regularly (at least 2 servings weekly)

• Consume fatty fish high in omega-3 fatty acids weekly

• Choose whole grains over refined carbohydrates

• Include nuts, especially walnuts, as regular snacks

• Use olive oil as your primary cooking oil

• Limit red meat, processed foods, and added sugars

• Limit alcohol - this is a big one!

Recent research highlights the gut-brain axis and the role of the microbiome in cognitive health, with emerging evidence supporting time-restricted eating patterns.

Small Steps to Big Brain Benefits

When I shared this framework with Sarah, she looked completely overwhelmed.

I reminded her that the goal isn’t perfection—and that small steps matter. We identified three initial focus areas based on her lifestyle and preferences: improving sleep hygiene, adding a 15-minute daily walk, and reducing processed foods. Three months later, Sarah reported feeling mentally a little sharper and emotionally more resilient.

For your own brain health journey, consider these practical approaches:

• Start small and build gradually: Begin with one pillar that seems most accessible

• Create pillar-combining activities: Walking with a friend combines exercise and social connection

• Daily routine integration: Morning meditation, nutritious meals, brain breaks with puzzles, screen-free evenings

The Upshot

Brain health isn't separate from overall wellness but deeply integrated with physical, emotional, and social wellbeing. The same practices that protect against cognitive decline also enhance our capacity for joy, creativity, and meaningful connection today.

By understanding how specific habits protect brain health and implementing even small changes, you're not just investing in your future cognitive health—you're enhancing your experience of life right now.

I'd love to hear which pillar you'll focus on first! Reply here with your thoughts!

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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.