What’s Coming Next
Brain Health Through the Lifespan
Prevention Takes Center Stage
From prevention to precision care, a new wave of research is reshaping what it means to protect your memory and thinking
For generations, a diagnosis of dementia or Alzheimer’s disease signaled a one-way journey of irreversible decline that slowly eroded memory, independence, and identity. Over the last decade, though, scientific understanding has expanded dramatically. Today, a combination of lifestyle interventions, biomarker testing, and targeted therapies has radically injected hope into the diagnosis and treatment of cognitive disorders in older adults. Perhaps most remarkable: research now suggests that up to 45% of dementia cases may be preventable. “Dementia is not an inevitable part of aging,” says Amy Sanders, MD, a highly respected dementia neurology expert now at Sunday Health, a preventive cognitive neurology practice.
A similar evolution occurred in cardiology decades ago. As with heart disease, which was once considered unavoidable, and oncology, where one-size-fits-all treatments have given way to precision medicine, scientific discovery is reframing what’s possible in dementia care. “This field, once static, is now full of energy and promise,” says Maria Thomas, co- founder and CEO of Sunday Health. “By focusing on prevention, early detection, and individually tailored treatments, we are moving toward a future where cognitive decline can be delayed, managed, and increasingly, prevented.”
Winter 2025
Sources: Sunday Health, Lancet
New drugs and diagnostics often make the news, but clinicians consistently note that managing modifiable risk factors is central to good health. For older adults, this includes new approaches to delay and/or prevent dementia. A robust body of evidence, anchored internationally by the landmark FINGER study and its counterpart, the U.S. POINTER study, shows that targeted lifestyle changes can significantly reduce cognitive decline.
The original FINGER trial, published in The Lancet in 2015, demonstrated that a multimodal program combining diet, exercise, cognitive training, and cardiovascular risk management helped preserve memory and executive function in older adults at risk for cognitive decline. Its global expansion, the World-Wide FINGERS Network, now spans more than 60 countries. The U.S. POINTER study produced similarly compelling results. Participants who received structured lifestyle support, including personal coaching, nutrition guidance, and regular social engagement, showed greater cognitive stability and improved emotional well-being.
These findings and others have led experts to reconsider the long-held belief that dementia simply happens with age. Instead, they highlight the extraordinary adaptability of the brain. Thomas notes that prevention must start earlier than most people realize. “We’ve long understood how to protect our heart health, but attention to brain health has lagged. Today, we know the same evidence-based behaviors that support cardiovascular health also contribute directly to maintaining cognitive health,” says Thomas.
Dr. Sanders underscores this lifespan approach: “It’s never too early to think about brain health, optimally beginning in your mid-30s when cognitive aging starts. But it’s never too late either.” She points to findings from the Rush Memory and Aging Project, which showed that adults well into their 70s and 80s experienced slower cognitive decline simply by adopting new activities.
The 14 Modifiable Risk Factors for Dementia Prevention:
*Newly added to the 2024 per Lancet Commission report.
The original FINGER trial, published in The Lancet in 2015, demonstrated that a multimodal program combining diet, exercise, cognitive training, and cardiovascular risk management helped preserve memory and executive function in older adults at risk for cognitive decline. Its global expansion, the World-Wide FINGERS Network, now spans more than 60 countries. The U.S. POINTER study produced similarly compelling results. Participants who received structured lifestyle support, including personal coaching, nutrition guidance, and regular social engagement, showed greater cognitive stability and improved emotional well-being.
These findings and others have led experts to reconsider the long-held belief that dementia simply happens with age. Instead, they highlight the extraordinary adaptability of the brain. Thomas notes that prevention must start earlier than most people realize. “We’ve long understood how to protect our heart health, but attention to brain health has lagged. Today, we know the same evidence-based behaviors that support cardiovascular health also contribute directly to maintaining cognitive health,” says Thomas.
Dr. Sanders underscores this lifespan approach: “It’s never too early to think about brain health, optimally beginning in your mid-30s when cognitive aging starts. But it’s never too late either.” She points to findings from the Rush Memory and Aging Project, which showed that adults well into their 70s and 80s experienced slower cognitive decline simply by adopting new activities.
The 14 Modifiable Risk Factors for Dementia Prevention:
- Hearing loss
- Traumatic brain injury
- High blood pressure
- Excessive alcohol use
- Obesity
- Smoking
- Depression
- Social isolation
- Physical inactivity
- Diabetes
- Air pollution
- Untreated vision loss*
- High LDL cholesterol*
- Low education levels
*Newly added to the 2024 per Lancet Commission report.
The treatment pipeline is expanding rapidly. New therapies target multiple mechanisms:
As scientific understanding deepens, one theme has become clear: brain health, like heart health, requires consistent habits, early detection, and lifelong attention. With more accessible biomarkers, evolving therapeutics, and stronger evidence for prevention than ever before, the next decade promises major breakthroughs. Or as Thomas says: “The future of brain health isn’t just hopeful, it’s actionable.”
Sources: Alzheimer’s Association, Finnish Geriatric Intervention Study, Mayo Clinic.
- Tau-targeting treatments to prevent the spread of tau tangles.
- Anti-inflammatory drugs to address the role of neuroinflammation.
- Neuroprotective compounds to preserve neurons and synapses.
- GLP-1 receptor agonists (commonly used for diabetes and weight loss) are now being studied for neuroprotective effects.
As scientific understanding deepens, one theme has become clear: brain health, like heart health, requires consistent habits, early detection, and lifelong attention. With more accessible biomarkers, evolving therapeutics, and stronger evidence for prevention than ever before, the next decade promises major breakthroughs. Or as Thomas says: “The future of brain health isn’t just hopeful, it’s actionable.”
Sources: Alzheimer’s Association, Finnish Geriatric Intervention Study, Mayo Clinic.
Why Lifestyle Matters: Connecting the Dots
Why do lifestyle interventions make such a difference? Today’s research paints a clear biological picture.
Physical activity increases blood flow, reduces inflammation, and promotes the growth of new neural connections.
Physical activity increases blood flow, reduces inflammation, and promotes the growth of new neural connections.
- A nutrient-rich diet helps counteract oxidative stress and supports metabolic health.
- Social interaction and cognitive engagement strengthen neural networks and build cognitive reserve, defined as the brain’s capacity to withstand age-related change.
Advances in Early Detection
For decades, investigating a diagnosis of Alzheimer’s disease required invasive spinal taps or costly imaging. But recent advances, especially in biomarker testing, have changed the landscape. In May 2025, the FDA approved the Lumipulse G pTau217/β-Amyloid 1-42 Plasma Ratio, the first-ever blood test that can identify Alzheimer’s-related proteins well before symptoms appear.
Dr. Sanders cautions that its purpose is specific: “The Lumipulse test is intended for people age 55 or older who are already showing symptoms. An abnormal ratio does NOT mean someone definitely has Alzheimer’s, and a normal result doesn’t guarantee they don’t.”
Instead, the test is one tool in a broader diagnostic picture, akin to A1C (blood glucose) tests for diabetes or measuring cholesterol levels for heart disease. “There is no single test that makes a definitive diagnosis of Alzheimer’s disease,” she emphasizes.
Ideally, brain health baselines that include cognitive testing and biomarker measurements will become a standard part of preventive care. “Just as you periodically get a colonoscopy or mammogram, establishing a brain health baseline can help detect any changes early,” says Thomas.
For those with risk factors such as a family history or genetic vulnerability (e.g. the APOE gene), baselines can be particularly informative. “APOE is a risk gene, not a destiny gene,” Dr. Sanders reminds. “It’s even more reason to work on modifiable risk factors if you know you’re at increased genetic risk.”
Dr. Sanders cautions that its purpose is specific: “The Lumipulse test is intended for people age 55 or older who are already showing symptoms. An abnormal ratio does NOT mean someone definitely has Alzheimer’s, and a normal result doesn’t guarantee they don’t.”
Instead, the test is one tool in a broader diagnostic picture, akin to A1C (blood glucose) tests for diabetes or measuring cholesterol levels for heart disease. “There is no single test that makes a definitive diagnosis of Alzheimer’s disease,” she emphasizes.
Ideally, brain health baselines that include cognitive testing and biomarker measurements will become a standard part of preventive care. “Just as you periodically get a colonoscopy or mammogram, establishing a brain health baseline can help detect any changes early,” says Thomas.
For those with risk factors such as a family history or genetic vulnerability (e.g. the APOE gene), baselines can be particularly informative. “APOE is a risk gene, not a destiny gene,” Dr. Sanders reminds. “It’s even more reason to work on modifiable risk factors if you know you’re at increased genetic risk.”
New Therapies: A Turning Point in Treatment
Two FDA-approved monoclonal antibodies—lecanemab (Leqembi) and donanemab (Kisunla)—have demonstrated that it’s possible to slow disease progression in the earliest stages of Alzheimer’s disease. In clinical trials, these patients experienced a 25–35% reduction in cognitive decline.
“These are the first ever disease-modifying medications for Alzheimer’s,” Dr. Sanders notes.
The Lancet cautions that trial results range from modestly positive to neutral, and the real- world impact is still unfolding. Currently they are appropriate only for early-stage Alzheimer’s patients who have confirmed amyloid buildup and are not on blood thinners. But for many families, even a modest slowing of decline can translate into months or years of meaningful function.
“These are the first ever disease-modifying medications for Alzheimer’s,” Dr. Sanders notes.
The Lancet cautions that trial results range from modestly positive to neutral, and the real- world impact is still unfolding. Currently they are appropriate only for early-stage Alzheimer’s patients who have confirmed amyloid buildup and are not on blood thinners. But for many families, even a modest slowing of decline can translate into months or years of meaningful function.
