Outsmarting Alzheimer's: A Playbook for Rewriting Your Brain's Future

For many, the threat of Alzheimer's disease looms as a distant concern, a challenge for the golden years. But what if the script for cognitive decline is written decades earlier, in the choices we make in our 20s and 30s? This Alzheimer's Awareness Month, a new narrative is emerging, one that empowers individuals to become the authors of their own brain health story, starting today.

The statistics are sobering. An estimated 7.2 million Americans aged 65 and older are living with Alzheimer's in 2025. Projections show this number could soar to nearly 13 million by 2050.
The prologue to cognitive decline, however, begins much earlier than most realize. Evidence suggests that the foundations of cognitive decline can be laid in our 20s and 30s. Unhealthy habits such as a high BMI, elevated glucose levels, and hypertension in early adulthood are linked to a more rapid rate of cognitive decline later in life.

This is where the concept of a "playbook for preventing cognitive decline" becomes a game-changer. Manisha Parulekar, M.D., FACP, AGSF, CMD, director of the Division of Geriatrics at Hackensack University Medical Center and co-director of the Center for Memory Loss & Brain Health, has been a vocal champion of this proactive approach.

"In New Jersey, the lifetime risk for Alzheimer’s disease at age 65 is one in six for women and one in 11 for men,” said Dr. Parulekar. “The Center for Memory Loss & Brain Health is a one-stop regional hub for dementia care that will not only benefit today’s older adults, but will ensure that we are ready to provide leading-edge care for the next generation of older adults as well.”

The Center for Memory Loss & Brain Health, an interprofessional hub of specialists, is at the forefront of this preventative movement. They are not just treating memory loss; they are creating a roadmap for lifelong brain health, with a focus on early diagnosis and prevention.

One of the most compelling stories to emerge from the Center is that of Dr. Kamal Wagle, a geriatrician who has taken the playbook to heart. In his early 40s and a father of two, Dr. Wagle and his wife made a conscious decision to rewrite their future. They cut out alcohol; transitioned to a Whole Food (WFPB) diet, which focuses on, minimally processed foods from plants, limiting animal products and highly processed ingredients; make sleep a priority; take measures to control stress levels; and are committed to a daily step count.

"We don't just feel better anecdotally," Dr. Wagle shares with his patients. "We are seeing the results with a decrease in cholesterol and blood pressure and a feeling of being sharper. We're prioritizing our minds so that we don't just live long lives, but healthy ones as well, so we can be around for ourselves and our children." His personal journey is a testament to the power of early intervention, making the playbook's strategies relatable and achievable.

So, what does this playbook for brain health look like for someone in their 20s and 30s? The evidence points to several key lifestyle modifications:

• Get Moving: Taking at least 3,000 to 5,000 steps daily can slow cognitive decline, while 5,000 to 7,500 steps can slow it even further. Regular physical activity increases blood flow to the brain and helps maintain cognitive function.
• Destress and Sleep Well: Chronic stress can be damaging to the brain. As part of the Lifestyle program he leads at Hackensack University Medical Center, Dr. Wagle promotes stress management, restorative sleep, and positive social connection to improve overall health.
• Incorporate brain healthy dietary patterns such as the Whole Food Plant-Based Diet or MIND (short for the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay, which integrates principles from the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets) diet: Both dietary patterns has emphasis in diet rich in fruits, vegetables, whole grains, nuts, seeds and legumes. MIND diet also allows moderate intake of dairy, while restricting red meat, processed meats, saturated fats and sweets. These dietary patterns are believed to supply essential micronutrients, and fiber, as well as minimizing pro-inflammatory diet, thereby slowing cognitive decline by providing antioxidants and anti-inflammatory compounds that protect the brain.
• Rethink Your Drink: While research is ongoing, numerous studies have investigated the link between alcohol consumption and Alzheimer's disease Current understanding is that no amount of alcohol is good for the brain, with the harmful effects being dose-dependent . Dr. Wagle's decision to eliminate alcohol reflects a commitment to minimizing potential long-term risks.
• Prioritize Cardiovascular Health: Managing factors like blood pressure, cholesterol, and BMI in early adulthood is crucial, as they are directly linked to the rate of cognitive decline later in life. What is good for the heart is known to be good for the brain.

Dr. Wagle says while occasional stress is a normal part of life, chronic stress can have a corrosive effect on the brain. It directly damages brain regions essential for memory and higher-order thinking and accelerates the pathological processes associated with Alzheimer's disease. This makes stress management a critical component of maintaining long-term brain health.

To boost your brain health, Dr. Wagle recommends practicing mindfulness by paying attention to the present moment without judgment. This simple technique can lower stress, improve focus, and lead to better sleep. “You can start with just a few minutes each day by trying easy exercises like mindful breathing, a body scan to release tension, or paying full attention during a routine activity like walking,” he explains.

For stressful moments, try the "five senses" grounding technique by naming things you can see, feel, hear, smell, and taste. To make it a lasting habit, start small, be consistent, and consider using a guided app to help you along the way.

The message this November is clear: the time to start protecting your brain is now. By taking a page from this proactive playbook in your younger years, you can significantly influence the narrative of your brain's future, ensuring a life that is not just long, but also vibrant and healthy.