🌍 Brain Health 4-1-1

Brain health research is evolving fast, and I’m often asked, “Where can I go to stay updated?” With so much information out there, it can be overwhelming to know where to start. That’s why I created the Brain Health 4-1-1—a simple, weekly update to help you stay in the know.

Each edition delivers:
✅ 4 key insights on brain health
✅ 1 expert or resource to explore
✅ 1 thought-provoking idea or myth to consider

What is my goal? To make brain health knowledge clear, accessible, and actionable—so you can focus on what matters most. I’m grateful that you’re here and I look forward to sharing this journey with you!

The first two major studies highlighted this week are hot off the press from the AAIC conference in London! I selected ones that focused more on a brain-healthy lifestyle. This is the largest, global conference that focuses on Alzhiemer’s disease.

— The largest cross-national study of its kind finds that a one-size-fits-all approach to dementia prevention won't work across the globe

Most of what scientists know about preventing dementia comes from research conducted in wealthy countries — the United States, the United Kingdom, and Western Europe. A major new study published in The Lancet Healthy Longevity and presented this week at the Alzheimer’s Association International Conference (AAIC) 2026 in London set out to ask a critical question: do those same patterns of dementia risk hold true everywhere?

The short answer: sometimes yes, sometimes no — and the differences matter enormously.

Review the FULL Research Article

Led by researchers at the University of Southern California, Brown University, and Johns Hopkins University, the study combined harmonized survey data from 214,000 older adults across 14 countries and regions, collected between 2009 and 2023. The countries included the United States, England, Ireland, Northern Ireland, four regions of Europe, Korea, Mexico, China, Malaysia, Brazil, and India. Researchers analyzed 12 of the modifiable risk factors identified by the Lancet Commission on dementia — including low education, high blood pressure, obesity, smoking, physical inactivity, depression, hearing loss, diabetes, and social isolation — comparing how common each was, how they varied by age, sex, and education level, and how often multiple risk factors clustered together in the same person.

The differences between countries were striking. Low education — one of the most significant modifiable risk factors for dementia — affected 85.6% of older adults in China but only 12% of older adults in the United States. High BMI affected 44.9% of Americans compared to just 13.3% of people in India. The picture of who carries the greatest dementia risk burden, and why, looks dramatically different depending on where in the world you are standing.

But the similarities were equally — and perhaps more — surprising. Certain risk factors consistently clustered together in similar patterns across countries, regardless of income level or geography. Cardiovascular risks such as high cholesterol and hypertension tended to appear together. Behavioral risks such as smoking and heavy alcohol use also co-occurred in predictable patterns. As the lead author, Emma Nichols, noted: “I was less surprised by the differences and more surprised by some of the similarities, particularly in the ways these risks are patterned across settings.”

Those consistent clusters have direct implications for prevention design. A program that connects people to care for diabetes, for example, could be intentionally redesigned to address the entire cluster of related cardiometabolic risks — high cholesterol and hypertension — at the same time, and that approach may translate meaningfully across very different countries and contexts.

This study is a global reminder of something we talk about constantly in brain health: dementia is not random, and it is not inevitable. The risk factors are real, modifiable, and operate across the lifespan — often for decades before any symptoms appear.

What this research adds is a critical layer of nuance. The list of modifiable risk factors is not one-size-fits-all. Where you live, what resources are available to you, and what conditions shape your daily life all influence which risks matter most for you specifically. Access to education — one of the strongest and most consistent protective factors for brain health across cultures — is not equally distributed. Neither is access to healthcare for managing blood pressure, cholesterol, or hearing loss.

For the average person reading this newsletter, the takeaway from the study’s lead author is worth holding onto directly: “Risk for these late-life outcomes isn’t predetermined. These are risk factors you experience over the life course, and you can have an impact on changing your own risk — while also recognizing the ways broader societal factors shape that risk, too.”

That is the balance this research asks us to hold: personal agency and structural awareness at the same time.

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• Know your numbers. Blood pressure, cholesterol, blood sugar, and BMI are among the most consistently modifiable risk factors across every country in this study. Getting them checked — and managing them — is one of the most direct things you can do for your long-term brain health.

• Treat hearing loss. Across nearly every country in this study, untreated hearing loss appeared as a significant modifiable dementia risk factor. If you or someone you love has been putting off addressing hearing changes, this research is a compelling reason not to wait.

• Stay physically and socially active. Physical inactivity and social isolation appeared as consistent risk factors across multiple countries in this study — two areas where daily choices make a real difference.

• Advocate for equitable access to brain health resources in your community. This study makes clear that low educational attainment is one of the heaviest drivers of dementia risk globally — and that the burden of preventable dementia falls most heavily on people in low- and middle-income settings. Brain health is a public health issue, not just a personal one.

🧭 Dementia risk is not fixed, and it is not the same everywhere — but the tools for reducing it are more consistent across cultures than we might expect. What you do throughout your lifetime and what your community makes possible both matter for your brain.

— The Alzheimer’s Association just launched a $100 million study to find out

One of the biggest announcements to come out of the Alzheimer’s Association International Conference (AAIC) in London this July was not a new treatment — it was a new question. And it may be one of the most important questions in brain health research right now…

The Alzheimer’s Association announced the launch of the PROTECT-Cog Study — Prevention of Risk for Cognitive Decline through Combined Therapy — a first-of-its-kind, $100 million global clinical trial that will test whether combining a structured lifestyle program with a GLP-1 receptor agonist medication can reduce the risk of cognitive decline, mild cognitive impairment, and dementia in older adults who are already at elevated risk.

GLP-1 receptor agonists are a class of drugs — including medications like semaglutide, widely known by brand names used for diabetes and weight management — that have attracted significant attention in recent years for their effects far beyond blood sugar control. Emerging data from large real-world healthcare datasets suggest that GLP-1 drugs may reduce dementia risk by 40 to 70% compared with other diabetes medications, particularly in people with obesity or a high BMI. Mechanistic studies suggest these drugs may reduce brain inflammation, support vascular health, and improve brain metabolism — all processes directly relevant to dementia risk. But observational data and mechanistic studies are not the same as a rigorous clinical trial, and PROTECT-Cog is designed to fill exactly that gap.

The lifestyle component of the study builds directly on the U.S. POINTER study — this may look familiar from previous editions of the Brain Health 4-1-1 — a large Alzheimer’s Association-led trial that tested a structured multidomain lifestyle program covering physical activity, nutrition, cardiovascular health management, sleep, and social engagement. POINTER showed that participants who followed the structured program experienced cognitive benefits equivalent to approximately one to two years of cognitive advantage, along with reductions in frailty and sleep apnea and improvements in blood pressure regulation.

PROTECT-Cog now asks the next logical question: is lifestyle alone enough, or does adding a metabolism-targeting drug on top of an already-strong lifestyle intervention produce even greater protection for the brain?

The study will enroll older adults at increased risk for cognitive decline and compare two versions of the lifestyle program — a structured intensive version with coaching and support, and a lighter-touch version with the same core content but fewer participant touchpoints — with and without the addition of a GLP-1 or similar drug. Participants will be followed for three years, with comprehensive cognitive and health evaluations every six months. Results are years away, but the launch of this study represents one of the largest and most ambitious investments in dementia prevention science to date.

As the Alzheimer’s Association’s chief science officer and principal investigator noted: “By testing a combined approach that targets both lifestyle and biology, we have the opportunity to better understand how to meaningfully reduce the risk of cognitive decline before symptoms begin.”

This study matters for a few reasons. First, it reflects where the field is heading — away from single-intervention approaches and toward combining the best of what we know about lifestyle with emerging pharmacological tools. That is a significant shift in how dementia prevention research is being designed.

Second, the GLP-1 connection is something many of you are likely already hearing about. These medications are everywhere in the news right now — for weight management, diabetes, and increasingly for cardiovascular protection. The possibility that they may also protect the brain is a conversation worth having with your healthcare provider, even before clinical trial results are available.

Third, this study reminds us that the lifestyle habits at the center of everything we talk about in brain health — movement, nutrition, sleep, social connection, and cardiovascular health management — are not being replaced by new drugs. They are being combined with them. The foundation still matters. This study is built on it.

• Stay engaged with the brain health behaviors that are the foundational pillars of the POINTER study — physical activity, a healthy diet, managing blood pressure and blood sugar, quality sleep, and social connection. These are the same behaviors PROTECT-Cog is testing in combination with medication.

• If you or someone you love takes a GLP-1 medication for diabetes or weight management, this is a timely conversation to bring to your healthcare provider — not to make treatment decisions based on preliminary data, but to stay informed about emerging evidence.

• If you are interested in participating in dementia prevention research, visit alz.org to learn more about the PROTECT-Cog study and other Alzheimer’s Association trials as enrollment details become available.

• Remember that this study is just launching — results are years away. What we have right now is a promising signal and a rigorous study designed to test it. That is exactly how good science is supposed to work.

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🧭 The next frontier in dementia prevention may not be lifestyle or medication — it may be both, working together. PROTECT-Cog is the study that will help us find out.

— A study of nearly 3,000 middle-aged adults finds untreated sleep apnea is linked to poorer memory and a higher burden of dementia risk factors

Researchers from Monash University studied 2,795 cognitively healthy adults between the ages of 40 and 70 enrolled in the Australian Healthy Brain Project, published in Alzheimer’s & Dementia. Participants completed online assessments of thinking skills and health, and researchers compared cognitive performance and dementia risk factors between those with and without obstructive sleep apnea (OSA).

Obstructive sleep apnea (OSA) is a common sleep disorder in which the airway repeatedly narrows or collapses during sleep, causing breathing to stop or become shallow for short periods. It is often accompanied by loud snoring, gasping, or choking during sleep — and critically, it is frequently undiagnosed.

The findings were clear and carry an important distinction. Participants with OSA had poorer memory than those without the condition — but this effect was primarily seen in people with untreated OSA. Those who were receiving treatment for their sleep apnea performed similarly to participants without the condition at all. That is a meaningful finding: treatment appears to matter for brain health outcomes, not just sleep quality.

Review the FULL Research Article

Researchers also found that participants with OSA had a significantly greater burden of dementia risk factors, including obesity, high blood pressure, and high cholesterol — three of the 14 modifiable risk factors identified by the Lancet Commission as the most important targets for dementia prevention. While these vascular and lifestyle factors explained some of the relationship between OSA and poor memory, they did not fully account for why people with sleep apnea performed worse on memory tasks. That suggests sleep apnea may be affecting the brain through additional pathways beyond cardiovascular risk alone.

The lead researcher made a point worth repeating: “Sleep apnea is common, frequently undiagnosed, and highly treatable, yet it is not often considered in discussions about dementia risk.”

The researchers are now investigating whether treating sleep apnea and related vascular risk factors together could offer even greater protection for long-term brain health.

This study matters because it focuses on midlife — ages 40 to 70 — which is exactly the window that research increasingly identifies as the most critical period for dementia prevention. Brain changes associated with Alzheimer’s disease begin decades before symptoms appear, and what happens to the brain during middle age sets the trajectory for what comes later.

Sleep apnea is one of those conditions that tends to be normalized or overlooked — especially because the person experiencing it is often asleep when the symptoms occur. A partner may notice the snoring or gasping, but many people who live alone, or whose partners have adapted to the noise, may have no idea. And because it does not cause obvious cognitive symptoms in the short term, it rarely gets connected to brain health in people’s minds.

This research makes that connection explicit and gives it urgency. Treating sleep apnea is not just about sleeping better or feeling more rested — it may be one of the most accessible and impactful things a middle-aged adult can do for their long-term brain health.

• Pay attention to the signs of sleep apnea — loud or disruptive snoring, waking up gasping or choking, morning headaches, excessive daytime sleepiness, or feeling unrefreshed after a full night of sleep. If you recognize any of these, bring them up with your healthcare provider.

• Do not wait for a bed partner to notice. If you live alone or your partner sleeps soundly, consider tracking your own sleep — some wearable devices and smartphone apps can detect irregular breathing patterns during sleep.

• If you have already been diagnosed with sleep apnea, use your treatment consistently. This study found that treated OSA was associated with memory performance comparable to people without the condition. Treatment compliance is not optional — it is brain care.

• Understand that sleep apnea often travels with other dementia risk factors — obesity, high blood pressure, and high cholesterol frequently co-occur with OSA. Managing these together, rather than in isolation, appears to be the most effective approach for protecting long-term brain health.

• Talk to your healthcare provider about a sleep study if you have concerns. Sleep apnea is highly treatable, and this research suggests the window for intervention — midlife — is precisely the time when addressing it may matter most.

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🧭 Sleep apnea is common, frequently undiagnosed, and directly connected to memory and dementia risk — especially in midlife. If you are snoring, gasping, or waking up tired, your brain is asking you to pay attention.

— A Finnish registry study finds early-onset dementia was associated with significant productivity losses up to 15 years before anyone knew something was wrong

When we talk about early-onset dementia — defined as a diagnosis before age 65 — we tend to focus on what happens after the diagnosis. A new study published in Neurology shifts that lens to what was happening years before, with findings that are both sobering and important for how we think about brain health in midlife.

Review the FULL Research Paper

Researchers from the University of Eastern Finland tracked 793 people diagnosed with early-onset dementia — defined as diagnosis before age 65 — comparing them to 7,926 healthy, age- and sex-matched peers using national health records linked to tax data. The study measured actual income and productivity trajectories in the years before a dementia diagnosis was ever made.

The findings are striking. People later diagnosed with early-onset dementia showed progressively worsening productivity losses up to 15 years before their diagnosis. The total average loss per person was approximately $86,000 USD, averaging around $13,800 per year in lost earning potential — all while the underlying brain changes went unrecognized.

The timeline varied significantly by dementia type, and that variation tells us something important about how different diseases affect the brain.

People with frontotemporal dementia (FTD) showed productivity drops 11 years before diagnosis. FTD attacks the frontal lobes first — the regions governing behavior, personality, social judgment, and executive function. Early changes often look like personality shifts, poor judgment, or interpersonal difficulties, and frequently get misattributed to stress, burnout, or a mental health condition before anyone considers a neurological explanation.

People with Alzheimer’s disease showed productivity losses beginning 6 years before diagnosis. Because Alzheimer’s starts in memory areas first, high-functioning individuals often compensate with notes and routines for several years — which is why the losses emerge later and the diagnosis comes later still.

People with alpha-synucleinopathies — including Lewy body dementia and Parkinson’s disease dementia — showed losses only at the time of diagnosis, likely because visible motor symptoms prompt immediate clinical attention.

The lead researcher noted that these financial deficits are significantly driven by diagnostic delays. Because early-onset dementia is rare in younger adults, patients often spend years struggling before receiving accurate specialized screenings. Important note: this is an observational study showing association, not cause and effect.

This is also an observational study — it shows association, not cause and effect. But the patterns across dementia types are consistent and compelling.

This research matters for several reasons — and they extend well beyond the individuals directly affected.

First, it reframes what brain health in midlife actually looks like in practice. The brain changes associated with dementia do not begin at diagnosis. They begin silently, years or decades earlier, and they show up in real life — in our work, our relationships, our decision-making, and our financial trajectories — long before anyone understands what is driving them.

Second, it challenges the assumption that a mid-career productivity drop, a sudden personality change, increasing social difficulties, or uncharacteristic professional struggles are purely motivational or psychological in origin. For some people — particularly those in their 40s, 50s, and early 60s — these may be early signals of something neurological that deserves clinical attention.

Third, it speaks directly to the urgency of earlier brain health conversations. We do not start talking about brain health when symptoms appear. We start now, decades before. The window for intervention — lifestyle, risk factor management, and early detection — is wide open during the years these changes are quietly accumulating.

• Pay attention to gradual shifts in cognitive function in yourself or people you care about — particularly changes in personality, social judgment, decision-making, or executive function. These are not always about stress or burnout. Sometimes they are the brain asking for help.

• If you or someone you know is experiencing unexplained professional struggles — difficulty managing complex tasks, behavioral changes, memory issues, or a noticeable and sustained drop in performance — bring it up with a healthcare provider. Ask about cognitive screening. Early evaluation can open the door to earlier support.

• Know the difference between dementia types (there are over 110+). Frontotemporal dementia in particular is frequently misdiagnosed as depression, bipolar disorder, or a personality disorder before the correct diagnosis is made. Awareness matters.

• Support research and policies that reduce diagnostic delays in early-onset dementia. The gap between symptom onset and diagnosis is not just a clinical problem — it is a financial, social, and human one, measured in years of lost income, strained relationships, and missed opportunities for support.

• And continue investing in the brain health habits that matter during midlife: movement, sleep, social connection, managing cardiovascular risk factors, and staying cognitively engaged. The data suggests this is exactly the window when those habits shape the trajectory of what comes later.

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🧭 Dementia does not announce itself. For people with early-onset dementia, the brain was already changing — quietly, invisibly, and expensively — years before anyone knew to look. Starting brain health conversations earlier is not optional. It is the whole point!

Just released on July 15, 2026 — the World Health Organization issued its first updated dementia risk-reduction guidelines since 2019, and they are worth bookmarking. (Download below. ⬇️)

The core message: up to 45% of dementia risk is attributable to modifiable factors — meaning there are real, actionable things individuals and communities can do.

The updated guidelines cover the full picture, including physical activity, tobacco and alcohol reduction, healthy diet, cognitive training, social engagement, hearing aids, and management of blood pressure, diabetes, and high cholesterol. For the first time, the guidelines also include a formal recommendation to reduce exposure to air pollution as a dementia risk-reduction strategy.

One notable addition: the WHO specifically does not recommend supplementation with omega-3 fatty acids, vitamins B and E, or multivitamins/minerals for dementia prevention in the absence of a diagnosed deficiency — consistent with what the latest clinical trial evidence shows.

The full guidelines document is freely available and designed to help countries translate the evidence into action at a systems and policy level — but the recommendations are just as relevant for individuals and healthcare providers navigating brain health conversations every day.

Read the Full Guidelines

“World Brain Day 2026 focuses on one of the defining challenges of our time: making brain health accessible to everyone, everywhere,”

says