Should I be alarmed when I forget a name?
A woman in her early 60s, whom I will call Sonia, came to see me because she was concerned that forgetting peoples’ names indicated something serious, perhaps a precursor to Alzheimer’s disease.
She appeared worried, and I asked her what else was going on in her life. She revealed that she was not sleeping well and was having marital problems. I acknowledged her concerns and told her we would do some basic cognitive testing. I asked her a few more questions and reviewed her medical history. She had no family history of dementia, and, except for mildly elevated blood pressure and cholesterol, she was in excellent health.
There is a continuum of normal brain-related aging and Alzheimer’s dementia. The in-between state is called mild cognitive impairment (MCI) where memory declines more than expected, yet daily functioning remains intact.
I wondered if Sonia had mild cognitive impairment. But even if she didn’t, I hoped to advise her on how to lessen her risk for it. Alzheimer’s is one of many types of dementia but is also, by far, the most common cause of it and is deeply feared.
Brain changes associated with Alzheimer’s can begin 20 years before the first symptoms of cognitive decline. Amyloid plaques, which are aggregates of misfolded proteins, form outside neurons and disrupt nerve communication, while tau tangles, which are other clumps of protein, form inside neurons and cause cell death.
The mainstay of diagnosing any type of cognitive decline, which includes difficulty thinking clearly, learning, remembering or making sound decisions, is through cognitive testing. The Montreal Cognitive Assessment is commonly used. Other tests are available too: An amyloid PET scan visualizes the abnormal plaques, and blood tests check amyloid and tau levels. These tests have good accuracy, but both false positives and false negatives occur.
The main reason to undergo such tests is when you are considering one of the new medications that can slow the progression of mild cognitive impairment or mild dementia (though not stop it completely or reverse it). These new medications, lecanemab, brand name Leqembi, and donanemab, brand name Kisulna, modestly slow the progression of memory decline but have a moderate risk of brain swelling and brain hemorrhages. Patients who take them must be followed closely with MRIs.
Although there may be a cure someday, no prescription medication or over-the-counter supplement has yet been shown to prevent or reverse mild cognitive impairment or Alzheimer’s dementia.
My neurology colleague, Dr. Scott Abramson, says this about over-the-counter supplements: “My own philosophy is that since these products are natural, not manufactured medications, they don’t undergo any rigorous scientific evaluation, so we just don’t have good scientific data about their efficacy. If folks want to try them and as long as they are not too expensive or have harmful effects, I have no objections.”
What does seem to help mild cognitive impairment or mild Alzheimer’s dementia are lifestyle interventions. A 2024 study directed by Dr. Dean Ornish randomly assigned men and women with mild cognitive impairment or early dementia either to an intensive lifestyle-intervention group or to a control group that did not make any lifestyle changes.
The intervention group members were provided meals that were minimally processed and plant-based, personalized instruction of aerobic and strength-training exercises and stress management techniques. They were also enrolled in support groups and encouraged to get adequate sleep. After 20 weeks, the results of the trial were impressive: 71% of the participants in the intervention group improved or were unchanged. None of those in the control group improved, and 68% worsened.
One of the intervention group participants reported, “I feel like I’m me again — an older but better version of me.”
The Alzheimer’s Society of Canada offers a list of healthy habits for your brain: exercise, protect your heart in terms of blood pressure and cholesterol, stay socially active, manage your medical conditions such as diabetes, challenge your thinking, get six to eight hours of sleep each night, treat depression, avoid alcohol excess and don’t smoke, maintain your hearing, find meaning in life, avoid head trauma and adopt health behaviors including good food choices. The latter deserves emphasis. A 2022 Brazilian study found that if 20% or more of daily calories came from ultra-processed food, then cognitive function declined.
Can brain training apps help? While playing specific computer games may lead to improvements in that particular game, it’s better to work toward a genuine skill such as learning a new language or musical instrument or starting what is considered a complex hobby such as chess, pickleball, painting, sculpting, folk dancing or singing in a choir. These work to create new neural pathways and enhance cognitive reserve.
Getting the shingles vaccine is also good for the brain. Stanford researchers found those who received the vaccine appeared to have a 20% lower risk of developing dementia. In addition, a 2026 JAMA study found that drinking two to three cups of caffeinated coffee each day or one to two cups of caffeinated tea each day significantly lowered dementia risk.
Sonia aced her cognitive assessment, and I told her she had normal age-related tip-of-the-tongue word loss called lethologica. Words that we seldom use like proper names are the ones we tend to forget. I suggested that she get marital counseling because ongoing stress increases cortisol levels, which can affect cognition over time.
I ordered blood tests for vitamin B12 and thyroid function because low levels of either one can harm the mind. I reviewed the importance of a healthy lifestyle to maintain brain fitness and shared the adage: “What is good for the heart is good for the brain.” Accordingly, I advised her how to lower blood pressure and cholesterol.
Sonia may have other risk factors for dementia beyond her control, but I reassured her that with healthy living habits, she should have a much better chance of having excellent cognition into her old age.