After decades of being a dementia doctor to many, many patients, I founded Healthspan Neurology to be a different kind of doctor: the one you see so you minimize your risk of dementia as much as possible and never need a dementia doctor.
One of the biggest obstacles I see is overwhelm. There are so many things you could do for your brain that it's hard to know where to start. You can't throw the whole kitchen sink at dementia prevention. It's too much. The answer is to be systematic. Understand your personal risk first, so you know where to focus, then add strategies as you prioritize over time. I break that down into three simple letters: the ABCs.
A is for Ancestry: family history and genetics
The first step is understanding where you come from. How do you learn your ancestry, family history, and genetics? You ask.
Ask your parents and grandparents.
Go through your siblings, aunts, and uncles.
Write it all down and create a family tree.
Once you have your family tree, look at each generational line and count how many people were affected by dementia. My general rule of thumb: if more than 25% of people on a line were affected, you may be at higher-than-average risk.
A word of caution. Many families are not willing to admit there is a family history of dementia. I've seen it in my own family, as well as with many friends and patients. So ask the harder question: why weren't Grandma, Grandpa, or Aunt Jane cognitively intact into their 70s, 80s, and 90s? We should stay cognitively intact as we get older.
Once you know whether your family history puts you at higher risk, you can decide whether genetic testing makes sense for you.
B is for Biology and Biomarkers: your numbers and pictures
B is where things get interesting but it can also be where things get overwhelming. There's little consensus on what testing is appropriate even among neurologists. But it's important to start somewhere and understand that B is looking at the pictures, the numbers, and the data that tell us where we are right now. This includes:
Blood work
Brain imaging
Body composition
Cardiac testing
Fitness testing
Once you know objectively what your numbers and pictures look like, you can ask of each one: is this high risk or low risk? If it's high risk, you focus on it with strategies that target that specific risk. If it's low risk, you can let that one slide for the time being. Once you know the data, you can explore whether the next level of testing (sometimes even those that might be considered "fringe") might be appropriate for your situation and overall risk.
That's the power of risk stratification. It tells you what to do and what to set aside.
C is for Cognition: measuring how your brain is actually working
Cognition sometimes gets missed in all the excitement about advanced testing. Yet cognitive testing measures the very thing we care about in the first place.
If you see a doctor about your memory, you'll probably get a quick screening test such as the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Exam (MMSE), or the Mini-Cog. These tests are quick and simple. But once you see one, you'll realize that for a very high-functioning person to score poorly, they would likely already be in mild cognitive impairment or dementia. (I'll cover how to assess these tests in a future post.)
Regardless, some form of cognitive testing is important. Options include:
Formal neuropsychological testing, done by a neuropsychologist.
Free online screening tests, some of which are not a bad screen but I don’t think they are extensive enough and most importantly, they are hard to track in a systematic way.
Digital cognitive testing batteries. In my practice, I use one that covers 12 domains of cognition, from working memory and visual-spatial memory to inhibition, attention, executive function, and planning.
The key is that your results are compared against people of your own age and sex. I'm 55. I may not be as sharp as I was at 35, so my processing speed shouldn't be compared to a 35-year-old's. It should be compared to other 55-year-old women. Most importantly, it should be tracked over time.
Putting your ABCs together
Once you know your ABCs, you know where to focus, and you don't get overwhelmed. This is exactly what I do with every patient in my Cognitive Longevity and Mind Over Menopause programs. They come to me to minimize their risk of dementia as much as possible, and there are so many things we can do that it can feel overwhelming.
Understanding your risk lets you focus on what's most important, cut through the overwhelm, and put the less important things on the back burner for another day. Advanced diagnostics, matched to a plan built for you, are how we create the best cognitive longevity playbook possible.
Get the guide and join my free strategy session
If you’re ready to put the ABCs into practice, I’ve made it easy to start. The ABCs of Dementia Prevention is my free take-home guide, with worksheets to map your family history, track the key numbers to ask about at your next checkup, and understand your options for cognitive testing. It distills the framework I use with my patients into a form you can fill in and bring with you.
You’ll get the guide when you sign up for my free live strategy session, ABCs of Dementia Prevention, on Thursday, December 3 at 7pm ET. I’ll walk through each letter, explain why midlife is the window of opportunity, and answer your questions so you leave knowing where to focus first. It’s online and open to anyone, wherever you live, so feel free to share it with someone you care about.
Work with me
If you want to work with me on a personalized plan to protect your brain,
Book a Free Discovery Call today.
We'll talk through your risk factors — genetic, lifestyle, and everything in between — and what a personalized Cognitive Longevity plan could look like for you.
Live Long, Be Strong, Stay Sharp,
Dr. Ashanthi
*This article is for educational purposes only and is not medical advice. Please don't stop or change any medication without talking to your doctor.
