Building resilience against Alzheimer’s disease

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Thomas R. Verny is a clinical psychiatrist, academic, award-winning author, poet and public speaker. He is the author of eight books, including the global bestseller The Secret Life of the Unborn Child and The Embodied Mind: Understanding the Mysteries of Cellular Memory, Consciousness and Our Bodies.

If for some reason you are concerned with slipping into dementia, is there anything you can do now to avoid this fate? What are the risk factors and what builds resilience?

To be clear, dementia is not a single disease like diabetes, but rather an umbrella term that encompasses a range of symptoms characterized by a decline in short-term memory, cognitive abilities and language skills. This leads to increasing difficulties in the performance of normal daily routines.

Of all the dementias, Alzheimer’s disease constitutes approximately 60 to 80 per cent of cases. Currently, about 600,000 Canadians aged 65 and older are affected. It is projected that by 2050, this number will double.

Roughly 40 per cent of dementia cases worldwide are linked to predisposing influences that can, at least in principle, be modified. These include limited education, hearing loss, high blood pressure, obesity, smoking, physical inactivity, diabetes, social isolation and exposure to air pollution. [1, 2, 3]. Other factors that we have little control over but can be successfully treated are stroke, heart failure and depression.

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Now for the good news. Here are my 10 no-nonsense rules that, if observed with some regularity, can significantly contribute to a healthy mind in a healthy body.

Protect your brain from injuries

The brain can be damaged by head trauma such as a fall or body contact sports like boxing, hockey, football or rugby. Even relatively innocuous events if performed frequently, such as heading a soccer ball, cause long-lasting cognitive impairment. [4] You have been warned.

Exercise your body

In a years-long study, researchers at the University of Pittsburgh found that participants who completed 150 minutes of moderate-to-vigorous aerobic exercise weekly showed improvements in fitness, cortisol regulation and emotional resilience compared to controls. Advanced imaging revealed that regular exercise reduced stress-related biological effects and slowed brain aging.

Overall, consistent moderate exercise appears to be a simple, effective strategy for improving brain health. [5]

Sleep

During sleep, the brain consolidates newly acquired information and strengthens neural connections that support learning and memory. Sleep also supports synapsis formation in the hippocampus. At the same time, the brain’s glymphatic system becomes more active, clearing metabolic waste, including beta-amyloid proteins that are thought to be largely responsible for Alzheimer’s disease. The glymphatic system is a kind of nocturnal sanitation service that helps keep neural tissue clean and functional.

Sleep also supports emotional regulation and reduces neuroinflammation. Adequate sleep, preferably seven to eight hours per night, is one of the most powerful and modifiable factors boosting lifelong brain health. [6, 7, 8].

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Your living space matters

It is well known that air pollutants contribute to dementia and Alzheimer’s. [9, 10,11]

At the opposite end of the spectrum, the effect that green spaces have on our minds has been studied thoroughly and the research generally finds that exposure to nature boosts our cognition, creativity and mood. [12, 13] Spending about 120 minutes each week outdoors is the ideal recommended time. [14, 15].

Robert Zarr, a pediatrician and the founder of Park Rx America, encourages doctors to prescribe parks for all their patients. Now there is an idea our health care services should embrace – especially since it’s free. [16].

Treat all illnesses promptly

Many people delay acting on the first symptoms of a disease. For example, gum disease is an inflammatory reaction to bacteria often overlooked. [17]. In that sense, it resembles other chronic inflammatory conditions which gradually damage tissue in many parts of the body, including the brain. [18, 19, 20].

Depression is another case in point. Recent MRI studies have shown that chronic or recurrent depression is associated with smaller hippocampal volume. The hippocampus is critical for memory in the brain. A shrunken hippocampus will adversely affect memory. [21, 22]. Therefore, it is imperative to treat depression as soon as possible and as fully as possible.

Similarly, high blood pressure, elevated cholesterol and diabetes require early and complete treatment.

As William Shakespeare wrote, “In delay there lies no plenty.”

Get vaccinated

Vaccination remains one of the most effective and cost-efficient public-health interventions ever developed. By priming the immune system to recognize and neutralize pathogens, vaccines prevent illness before it begins. Currently, the influenza vaccine, [23], shingles vaccine [24], pneumococcal vaccine [25] and Tdaph (tetanus, diphtheria, pertussis) [26] have shown intriguing associations with lower rates of Alzheimer’s disease and other neurodegenerative conditions, possibly through immune-system modulation. [27]

Eat wisely

The two most popular health diets are the Mediterranean and the DASH. The former is less of a diet and more of a lifestyle. It blends the basics of healthy eating with the traditional flavours and cooking of the people inhabiting the Mediterranean basin. DASH stands for Dietary Approaches to Stop Hypertension.

Both these “diets” are really very similar. Their advice: eat a diet that is rich in plant protein, dairy, omega-3 fatty acids and whole foods. Reduce the consumption of red meat and increase that of fish, poultry and beans, as well as of fruits and vegetables, nuts, yogurt, vitamins A, C and E and the minerals copper, zinc and selenium. Avoid processed food, refined sugars, salt and saturated fats. [28]

Many versions of the Mediterranean diet include some wine with a meal. Recent studies cast doubt on the notion that even a little alcohol may be good for the heart. [29].

However, enjoying a glass of wine with dinner and good company has its own rewards. Eating should not be a source of stress for you.

Learn to deal with stress

Life is stressful. There are world problems, the boss at work, the child who spends too much time on the computer, a persistent cough, the list is long. You cannot escape stress. What you can learn is not to allow stress to stress you out.

For our purposes here the culprit is cortisol, the body’s primary stress hormone. While brief elevations can enhance attention and do no harm, chronically high levels begin to impair the very systems they were meant to protect. The hippocampus is especially vulnerable. Prolonged exposure to cortisol has been shown to reduce its volume and disrupt its function, leading to measurable deficits in memory.

At the cellular level, stress suppresses neurogenesis, that is the birth of new neurons, and causes destruction of neurons and dendrites, the thin cable-like structures that carry nerve signals from one neuron to the next, weakening the neural networks required for cognition.

Under chronic stress, the amygdala, which processes fear and threat, becomes overactive, while the prefrontal cortex, responsible for rational thought and emotional regulation loses efficiency. This shift makes individuals more reactive, less reflective, and more prone to anxiety and mood disturbances. [30].

I offer two suggestions for dealing with thoughts that keep you awake at night and disturb your waking hours. Firstly, don’t catastrophize. Don’t let a forgotten name become dementia, a lack of response to an e-mail become rejection, a lump in the breast become cancer. When you catch yourself escalating like this, try to ask yourself: What evidence do I actually have? And what else might explain this?

Secondly, picture whatever is causing you stress like one big juicy steak. You want to taste it one bite at a time, not stuff it into your mouth all at once. Approach your problem the same way. Instead of feeling overwhelmed by the magnitude of the task, divide it into smaller units. Let’s say you are worried about the cost of meat. Then drill deeper. Let’s say it’s beef; we can search for cuts of beef that are cheaper than what you have been buying in the past. Or perhaps you can switch to pork or chicken, or even healthier items like fish or vegetables. When you realize that the problem is manageable, stress beats a retreat.

You know what stresses you. Stop minimizing it or, worse, deliberately ignoring it. You can defang this monster.

Stimulate your brain

The brain has one thing in common with muscle: use it or lose it. The best way to keep your brain healthy is by keeping it busy with activities. A large international brain-imaging study found that even brief periods of creative engagement in activities such as dancing, making music, creating visual art, or playing computer games exhibited neural patterns linked to slower brain aging. What these pursuits share is their demand for imagination and novel problem-solving. [31].

Unlike studies focusing on the elderly, a study conducted by Trinity College Dublin reveals that engaging in a diverse mix of social, physical, and mental activities during middle age is one of the most effective ways to build cognitive resilience. The study found that lifestyle interventions in one’s 40s and 50s can actually outweigh the negative impact of the APOE4 gene, the strongest common genetic risk factor for late-onset Alzheimer’s. [32].

And stay curious. Read newspapers, listen to podcasts, join a book club. The latter will also lead to more socializing.

Socialize

Interdisciplinary studies from the U.K. reported that socially isolated people had lower grey matter volumes of brain regions involved in memory and learning and were 26 per cent more likely to develop later dementia. [33].

Most recently, researchers who used data from the UK Biobank, compared people who are lonely and have few social interactions to people who do. They found specific proteins that are elevated in people who are more lonely and socially isolated that relate to increased inflammation, heart disease, risk for cardiovascular problems, including stroke and immune dysfunction [34].

On the other hand, connecting with people leads to the release of oxytocin, the so-called love hormone, and dopamine, the feel-good hormone. Relating to people and pets heals the brain as well as the body.

The direction our lives take depends on many factors such as genetics, who our parents are, where we are born, world events, and other factors beyond our control. And then there is luck.

Still, many of the ailments that befall us are not purely the products of fate; they are shaped by how we choose to live moment to moment. I believe the most profound approach to total health is cultivating a life that is engaged and purposeful. Become absorbed in something beyond yourself through professional endeavours, involvement in the arts, sports, or community. Look for novelty and diversity. Sustain relationships. Expand your horizons.

References

1. Livingston, G., Huntley, J., Banerjee, S., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413–446.
2. Biessels, G. J., & Despa, F. (2018). Cognitive decline and dementia in diabetes mellitus: Mechanisms and clinical implications. Nature Reviews Endocrinology, 14(10), 591–604.
3. Iadecola, C., Yaffe, K., Gorelick, P. B., … & American Heart Association Council on Hypertension. (2016). Impact of hypertension on cognitive function: A scientific statement from the American Heart Association. Hypertension, 68(6), e67–e94.
4. Tessman, Renee (2026). Repeated Head Impacts, Inflammation and Memory Loss Connected. FeaturedNeurologyNeuroscience
5. Voss, M. W., Oehler, C., Nagarajan, N., & Pierce, G. L. (2024). Exercise effects on brain health and learning from minutes to months (Brain-EXTEND trial).Contemporary Clinical Trials.
6. Zhang, J., et al. (2025). Sleep disorders and risk of cognitive decline: A systematic review and meta-analysis. Journal of Neurology.
7. Dagum, P., et al. (2026). The glymphatic system clears amyloid beta and tau from the brain. Nature Communications.
8. Zavecz, Z., Shah, V. D., Winer, J. R., ... & Walker, M. P. (2023). NREM sleep as a novel protective cognitive reserve factor in the face of Alzheimer’s disease pathology. BMC medicine, 21(1), 156.
9. Cacciottolo, M., Wang, X., et al. (2017). Particulate air pollutants, APOE alleles, and their contributions to cognitive impairment in older women. Translational Psychiatry, 7(1), e1022.
10. Peters, R., et al. (2019). Air pollution and dementia: A systematic review. Journal of Alzheimer’s disease, 70(1), S145–S163.
11. Wang, X., et al. (2021). Air quality improvement may slow cognitive decline and reduce dementia risk in older women. Alzheimer’s Association International Conference. (AAIC).
12. Collins, S. A., McDonnell, A. S., Augustin, L., ... & LoTemplio, S. B. (2025). Nature imagery’s influence on ERN amplitude: an examination of Attention Restoration Theory using EEG. Frontiers in Human Neuroscience, 19, 1567689.
13. England, N. (2014). Monitor of engagement with the natural environment (MENE). Monitor of Engagement with the Natural Environment (MENE)-GOV. UK.
14. White, M. P., Alcock, I., Warber, S. L., ... & Fleming, L. E. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellwell-beingientific reports, 9(1), 7730.
15. Stevenson, M. P., Schilhab, T., & Bentsen, P. (2018). Attention Restoration Theory II: A systematic review to clarify attention processes affected by exposure to natural environments. Journal of Toxicology and Environmental Health, Part B, 21(4), 227-268.
16. Zarr, Robert. Park Rx https://www.parkrx.org/contact
17. Qi, Xiang, Zhu, Zheng, Plassman, Brenda L., Wu, Bei (2021). Dose-Response Meta-Analysis on Tooth Loss With the Risk of Cognitive Impairment and Dementia. Journal of the American Medical Directors Association.
18. Zhang, X. (2025). Association between periodontal disease and Alzheimer’s disease/mild cognitive impairment: a scoping review. Frontiers in Aging Neuroscience.
19. Said-Sadier, N., et al. (2023). Association between periodontal pathogens and dementia or cognitive impairment: systematic evidence. International Journal of Environmental Research and Public Health, 20(6), 4707.
20. Wu, B., Liang, J., Landerman, L., Plassman, B., & Chen, X. (2021). Trends of edentulism and their association with cognitive impairment among older adults: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 22(5), 1090–1097.e2.
21. Schmaal, L., Veltman, D. J., Czisch, M., … Thompson, P. M. (2016). Subcortical brain alterations in major depressive disorder: Findings from the ENIGMA Major Depressive Disorder working group. Molecular Psychiatry, 21(6), 806–812.
22. Monereo-Sánchez, J., de Jong, J. J. A., Backes, W. H., & van Oostenbrugge, R. J. (2021). Hippocampal volume and depression: A systematic review and meta-analysis of MRI studies. Neuroscience & Biobehavioral Reviews, 130, 134–149.
23. Bukhbinder, A. S., Ling, Y., Dhana, K., … & Wilkins, H. M. (2022). Risk of Alzheimer’s disease following influenza vaccination: A claims-based cohort study using propensity score matching. Journal of AlzhAlzheimer’s disease(3), 1061–1074.
24. Taquet, M., Dercon, Q., & Harrison, P. J. (2024). The recombinant shingles vaccine is associated with lower risk of dementia. Nature Medicine, 30(5), 1250–1258.
25. Liu, J.-C., Hsu, Y.-P., Wu, S.-Y., & Tsai, M.-C. (2023). Association between pneumococcal vaccination and dementia risk in older adults: A population-based cohort study. Vaccines, 11(2), 327.
26. Scherrer, J. F., Salas, J., Morley, J. E., & Hoft, D. F. (2021). Lower risk of dementia after tetanus, diphtheria, and pertussis vaccination in older adults. Journal of Gerontology: Medical Sciences, 76(8), 1456–1463.
27. Wang, Z., Li, Y., Zhang, H., & Chen, X. (2025). Vaccine research in cognitive impairment and dementia. Frontiers in Neurology, 16,
28. Two reliable information sources on nutrition are the Mayo Clinic https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801 and The Healthy Eating Plate, created by nutrition experts at the Harvard T.H. Chan School of Public Healthhttps://nutritionsource.hsph.harvard.edu/healthy-eating-plate/
29. GBD 2020 Alcohol Collaborators. (2022). Population-level risks of alcohol consumption by amount, geography, age, sex, and year: A systematic analysis for the Global Burden of Disease Study 2020. The Lancet, 400(10347), 185–235.
30. Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI Journal, 16, 1057–1072.
31. Coronel-Oliveros, C., Migeot, J., Kowalczyk-Grębska, N., Jakubowska, N., ... & Ibanez, A. (2025). Creative experiences and brain clocks. Nature Communications, 16(1), 8336.
32. Cao, B., Qi, Q., Hutchinson, S., Ferguson, D., Malhotra, P., Koychev, I., ... & PREVENT Dementia Investigators. (2026). The relative contribution of modifiable and non‐modifiable factors for determining cognition in mid‐life individuals at risk for late‐life Alzheimer’s disease. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 18(2), e70303.
33. Shen, C., Rolls, E. T.,., Xie, C., ... & Feng, J. (2022). Associations of social isolation and loneliness with later dementia. Neurology, 99(2), e164-e175.
34. Shen, C., et al. (2025). Plasma proteomic signatures of social isolation and loneliness associated with morbidity and mortality. Nature Human Behaviour.