Brain Health Treatment Guide | Cleveland Clinic

Overview

Your brain determines every aspect of your life – your thoughts, emotions, movement and memory. Your brain works tirelessly for you 24 hours a day, 7 days a week. Keeping your brain healthy is essential to your well-being.

Today we live longer, and we live healthier. Our heart, our joints and the rest of our bodies can outlive our brain. In other words, our life span may be longer than our brain span. Brain disorders and conditions, such as Alzheimer’s disease, Parkinson’s disease and stroke, become more common as we age. Maintaining brain health can help to preserve memory and lower risk for brain disease.

This guide provides a roadmap for your journey to the best possible brain health. Where supportive evidence is available, recommendations are based on the most current clinical, epidemiological and nutritional data. Read on to learn how to protect, maintain and boost your brain health.

Brain Health & Aging

Your brain is a truly unique, one-of-a-kind organ. It is a three-pound supercomputer that processes 70,000 thoughts per day using 100 billion neurons (a type of nerve cell) that connect at more than 500 trillion points, or synapses. The signals that travel through these synapses move at a speed of 300 miles/hour and form the basis of memories, thoughts and feelings.

When you learn or experience something new, your brain’s structure, functions and connections can change. This process, known as neuroplasticity, allows your brain to grow, adapt and change throughout your life as well as compensate for injuries and diseases. The more you use your brain, the better and stronger it gets.

As we get older, our brains tend to slow down. It is normal and expected to experience temporary lapses in memory and take longer to learn new information or perform certain tasks. However, if you start forgetting things more frequently or cannot remember or do something you normally could, it can be a sign of a brain disorder.

If you experience a slight, but noticeable, decline in your mental abilities, you may be experiencing mild cognitive impairment (MCI). There are multiple causes of MCI and it doesn’t always get worse, but sometimes MCI is an early stage of dementia.

Dementia is a general term for conditions that permanently impact thinking, memory, reasoning, personality, mood and behavior. There are several types of dementia that have different origins and their own set of unique symptoms, such as:

Sometimes dementia is caused by another health condition, such as:

It’s not clear what directly affects whether or not you will develop dementia, but certain factors can increase your risk.

There are risks you cannot change, such as advanced age and a biological family history of dementia. Your risk of developing dementia increases as you get older, especially once you turn 65, and if you have family members who had dementia. In addition, those who are Black and Hispanic are at a higher risk.

However, there are risk factors that you can change, such as diabetes, hypertension (high blood pressure), obesity, high cholesterol, smoking, brain injuries, stress, and lack of physical and mental activities. Your lifestyle plays a significant role in your brain health. Incorporating the lifestyle tips in this guide into your daily routine can help you manage the risks and stay sharp well into your golden years.

Women and Brain Health

Dementia is more common in women and gender-diverse individuals. While is it not clear why they are at an increased risk for dementia, there are likely multiple contributing factors, such as menopause, birth control medications, female hormones (estrogen and progesterone), genetics, and even how stress impacts them differently.

While further research is needed to fully understand these differences and inform prevention and treatment, these individuals may be able to reduce their risk of Alzheimer’s disease and related dementias through lifestyle changes – many of which are highlighted in this guide.

The Women’s Alzheimer’s Movement at Cleveland Clinic (WAM at Cleveland Clinic) is working to address and reduce the risk for Alzheimer’s disease and other neurological disorders in women and gender-diverse people by advancing research, treatment, prevention and education for Alzheimer’s disease and other conditions involving the nervous system.

WAM at Cleveland Clinic builds on an existing collaboration between the Women’s Alzheimer’s Movement, a non-profit established by award-winning journalist and leading Alzheimer’s Advocate Maria Shriver, and Cleveland Clinic. In 2020, the two opened the nation’s first Alzheimer’s disease prevention center for women and gender-diverse individuals, located in Las Vegas, Nevada.

Lifestyle Tips for Brain Health

Your lifestyle has a profound impact on your brain health. Unlike aging and genetics, you have control of your lifestyle choices: what you eat and drink, how much exercise and sleep you get, the way you socialize and deal with stress, the hobbies you develop and the medications you take to control your blood pressure or diabetes. Read on to learn how you can create a lifestyle that will help your brain span match your life span.

Physical Fitness

What’s good for your heart is good for your brain. People who exercise regularly may have a lower risk of developing Alzheimer’s disease. Exercise improves blood flow and memory; it stimulates chemical changes in the brain that enhance learning, mood and thinking. Building muscles, staying flexible and practicing balance can improve posture and reduce the risk of falls. Exercise also helps to reduce stress and improve sleep quality, both of which are important to your brain health.

The Centers for Disease Control and Prevention recommends 150 minutes of moderate intensity exercise per week. Moderate intensity means you can talk but not sing while exercising. Aerobic exercises, which increase your heart rate, may have particularly strong benefits for your brain – although it is also important to incorporate strength, flexibility and balance training into your workouts. Consult your doctor before beginning an exercise program, start slowly and gradually build frequency and duration.

Here are examples of exercises you can include in your workouts:

Aerobic Exercises

Brisk walking, hiking or running
Cycling on a bike or stationary bike
Stair climbing on a stepper machine or in your house
Rowing on a machine or waterway
Swimming
Dancing

Strength Exercises

Lifting weights, such as kettlebells
Calisthenics and body weight exercises, such as lunges, squats and push-ups

Flexibility and Balance Exercises

Stretching, yoga and pilates
Balance training

Mental Fitness

Mental exercise is just as critical as physical exercise in keeping your brain fit and healthy. You have something called “brain reserve,” which helps your brain adapt and respond to changes and resist damage. Your brain reserve begins to develop in childhood and gets stronger as you move through adulthood. Mental exercises, such as playing games and learning a new skill or subject, may improve your brain’s functioning and promote new brain cell growth, which could decrease your likelihood of developing dementia.

Activities to enhance brain reserve include:

Playing games, such as crossword puzzles, board games, card games or video games
Studying a new language
Learning to play a musical instrument
Taking classes at a local community college

Food & Nutrition

As you grow older, your brain is exposed to more harmful stress due to lifestyle and environmental factors, resulting in a process called oxidation, which damages brain cells. Foods high in antioxidants can help fend off the harmful effects of oxidation in your brain.

Research shows that a Mediterranean diet, which incorporates antioxidant-rich foods, helps maintain brain health and may reduce the risk of Alzheimer’s disease. This style of eating also allows for versatility and creativity, so that meals can be enjoyed. A Mediterranean regimen is more than just a diet. It’s a lifestyle, a way of living well.

Mediterranean Diet Guidelines

Your healthcare provider or dietitian can help you develop an appropriate diet based on your medical history, underlying conditions, allergies and preferences. In general, if you follow a Mediterranean diet, you will eat:

Lots of vegetables and fruit – Spinach, kale, broccoli and other leafy green vegetables are rich in many brain-loving nutrients, including vitamin K, lutein, folate and beta carotene. Blueberries, raspberries and blackberries are packed with antioxidants.
Lots of beans, lentils and nuts – They are a good source of plant-based protein and are rich in polyphenols, which help your body manage inflammation and reduce oxidative stress.
Lots of whole grains – Brown rice, oats, barley and quinoa are rich in many of the B vitamins that work to reduce inflammation of the brain.
Plenty of extra virgin olive oil (EVOO) – It is a source of healthy fat and antioxidants. It also contains hydroxytyrosol, an organic compound with anti-inflammatory, anti-tumor, antiviral, antibacterial and antifungal properties.
A moderate amount of fish, especially fish rich in omega-3 fatty acids – Salmon, cod, haddock, tuna and halibut are good options. Fish oil supplements rich in DHA (up to 1,000 mg per day), flaxseed and chia seeds are a good alternative for non-fish lovers.
A moderate amount of cheese and yogurt
Little or no meat, added sugar or butter

You can also give your favorite meals and recipes a nutritional boost by swapping in healthier alternatives that taste or perform the same as original ingredients.

Other Antioxidant Sources

Dark chocolate – Dark chocolate contains flavonoids, which are strong antioxidants. They potentially improve blood flow to the brain and reduce inflammation. Unsweetened cocoa powder offers the greatest benefit, followed by dark chocolate with at least 72 percent cocoa solids.
Coffee and tea – Coffee has been shown to improve memory and potentially decrease your risk of dementia. Up to three cups of black coffee a day are recommended. Black and green teas contain brain-boosting antioxidants; give your tea plenty of time to steep before you drink to get the maximum benefit your brain deserves.
Spices – Many herbs and spice, such as turmeric, cinnamon and ginger, are packed with antioxidants that may decrease harmful inflammation in the brain and elsewhere.
Vitamin C and E supplements – A combination of vitamins C (500 mg) and E (400 international units) have shown to be a potential benefit to brain health.

Social Interaction

Studies show those with the most social interaction within their community experience the slowest rate of memory decline. Spending time with others and engaging in stimulating conversation are great ways to reduce stress, protect your mental health and enhance intellectual stimulation. Happy marriages or long-term relationships and having a purpose in life have shown significant protective effects against age-related cognitive impairment.

Here are ways to stay connected with others:

Get active in your community – Shared hobbies are a great way to meet like-minded people. Get active in sports or cultural activities. Volunteer or join clubs. You’ll be surprised at how easy it is to talk to others in a relaxed setting that you both enjoy.
Create new friendships – When you begin a friendship with someone, show a genuine interest in learning about the person and their interests.
Treasure your loved ones – It can be exciting to form new friendships, but it’s important to cherish the friends you already have by spending time with them.
Consider adopting a pet, if you can take on the responsibility – People aren’t the only source of loving relationships. Pets have proven to be good for their owners’ brain health by calming them down, boosting their immunity, keeping them active and enhancing their social lives

Sleep

Sleep energizes you, improves your mood and your immune system and even reduces buildup in the brain of an abnormal protein called beta-amyloid plaque, which is associated with Alzheimer’s disease. Most adults need at least seven hours of sleep a night.

Keys to a good night’s sleep include:

Practice good sleep hygiene, such as following consistent sleep and wake times and keeping your bedroom cool, dark and free of electronics.
Get exposed to sunlight in the morning to help regulate your sleep/wake cycles.
Exercise regularly. It makes it easier to get to sleep and improves the quality of your sleep.
Limit naps to 30 minutes, early in the day.
Don’t use alcohol as a sleep aid.
Talk to your doctor if you’re experience difficulties sleeping.

Relaxation & Mindfulness

Stress is a given, and you will always have stress in your life. Figuring out how to manage your stress makes a big difference in the health of your brain.

Incorporating these tips and techniques into your daily life can help you keep stress at bay:

Practice mindfulness to help you focus on the present and not worry about what may never happen or what’s already in the past. Meditation is a common way to engage in mindfulness, but you can also practice being in the moment by taking a walk, enjoying a cup of tea or writing in your journal.
Engage in online yoga or tai chi classes from your favorite location.
Practice saying “no” to requests to take on projects you’d prefer to avoid.
Keep a list of what’s bothering you and schedule five minutes a day to review the list.
Focus on your breathing. Try using breathing techniques to help you concentrate on your breath and calm your body and mind.

Caregiving is stressful, too. And individuals with dementia rely heavily on their care partners, who often suffer tremendous stress, particularly when they lack knowledge and experience. The most effective care partners are well-informed and use help and support from all available resources to ensure they don’t sacrifice their own well-being during their caregiving journey. These free programs can help you manage your caregiving responsibilities.

Medical Health

Protecting your medical health is a key part of preventing the decline of brain function. A variety of medical conditions are strongly linked to dementia. Keep your blood pressure and weight at healthy levels, take medication as prescribed, cut down salt and sugar, keep active and stay socially connected and positive. All of this can help you increase the vitality and quality of your life as you enter your golden years.

Talk with your healthcare provider about how to best prevent and treat:

Hypertension (high blood pressure)
Diabetes
Obesity
Depression
Head trauma/traumatic brain injury, such as a concussion
Hyperlipidemia (high cholesterol)
Smoking/Nicotine dependence

Treatments

While we do not yet have a cure for progressive brain diseases, treatments can help manage your symptoms and maintain your quality of life.

At Cleveland Clinic Lou Ruvo Center for Brain Health, we create individualized treatment plans tailored to your stated needs and our observations. Your plan may include recommendations for medications, physical exercise, nutrition, cognitive rehabilitation, behavioral health services (like psychiatry or psychology, when needed) and participating in clinical research and/or support groups.

Neurorehabilitation Therapy

Many individuals experiencing cognitive decline can benefit from targeted, individualized neurorehabilitation therapy. Our board-certified specialists use cutting-edge technology and customized exercises during one-on-one treatment sessions. Our physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP) programs are specifically tailored to your needs and goals, helping you thrive while managing the effects of brain disorders. By incorporating your interests and hobbies and offering socially enriching experiences, we work to increase your mobility and agility while decreasing fatigue and falls. We also work to improve all aspects of communication and cognition.

Medications

Most types of dementia cannot be cured, but there are medications that can treat symptoms and help individuals maintain daily functioning for longer. For Alzheimer’s disease, which is the most common form of dementia, the U.S. Food & Drug Administration (FDA) has approved two types of drugs for symptom management:

Cholinesterase inhibitors, including donepezil (Aricept®), rivastigmine (Exelon^®) and galantamine (Razadyne®).
NMDA receptor antagonist memantine (Namenda^®).

Cholinesterase inhibitors manage the chemicals in your brain that allow your brain cells to communicate, which is needed for proper brain function. Memantine works similarly to cholinesterase inhibitors except it works on a different chemical messenger and helps the brain cells survive longer. These drugs may also be used to treat people with some of the other forms of dementia.

The FDA has also approved these disease-modifying therapies for early-stage Alzheimer’s disease:

Lecanemab, aducanemab and donanemab are designed to target and remove the abnormal buildup of amyloid proteins in the brains of people with Alzheimer’s disease. They will not reverse the disease, but they may slow its progression.

As with any medical treatment, appropriateness depends on a variety of factors. Dementia affects everyone differently, so your healthcare provider will work with you to determine the best treatment plan.

Research and Clinical Trials

We are dedicated to investigating the causes of brain diseases and the development of more effective treatments.

Our researchers conduct both pre-clinical and clinical research. Pre-clinical research looks to discover the biological interactions and changes that contribute to the development and progression of brain diseases. Clinical research builds on biological research discoveries to develop new diagnostic tests and treatments.

Learn about our brain health research programs.

Collaboration is key to the research process. Our researchers from different departments and specialties work with each other as well as with researchers at other hospitals and health institutions. Our brain health collaborations include:

Your Role in Advancing Research

One day, you may have the opportunity to help accelerate the translation of research into better prevention and treatment by participating in a research study, such as an observational study or a clinical trial.

Observational studies collect information about a disease by following a group of people over time. No medication or treatment is given. This type of research study helps scientists identify when, where and how things go wrong over time. For example, the Cleveland Clinic Brain Study is collecting data from up to 200,000 neurologically healthy participants yearly for up to 20 years. That data will help uncover the pre-symptomatic causes of neurodegenerative diseases, such as Alzheimer’s disease, and identify targets for preventing and curing these diseases.

Learn more about the Cleveland Clinic Brain Study.

Clinical trials try out a new intervention, such as a medication, procedure or medical device, in people. We don’t know when a cure for Alzheimer’s disease or other brain diseases will be found, but one thing is certain: The first person to experience it will be in a clinical trial.

Access our brain health clinical trials.

Resources

Many resources are available to help you learn about and maintain your brain health. Here are just a few recommended by Cleveland Clinic Lou Ruvo Center for Brain Health .

Cleveland Clinic Sites

Cleveland Clinic Luo Ruvo Center for Brain Health
Learn about brain diseases, treatments and opportunities to participate in clinical research.
Cleveland Clinic Wellness Institute
Programs to prevent illness and foster health through nutrition, exercise and stress management.
Women’s Alzheimer’s Movement at Cleveland Clinic
Learn how WAM at Cleveland Clinic is working to change the future of women’s brain health and get women-specific resources for brain health and Alzheimer’s disease prevention. Follow us on Instagram @womenalzmovement for the latest updates and information about brain health, women’s health, wellness, research and more.
Women’s Alzheimer’s Movement Prevention Center
Learn about the first Alzheimer’s disease prevention center for women in the United States.

Other Resources

Administration on Aging (AOA) Resource Centers
Resource centers providing information and services for older adults, including the National Alzheimer’s Call Center.
Alzheimer’s Association
A resource and education center for Alzheimer’s disease and dementia.
Alzheimer’s Drug Discovery Foundation
Resources on prevention, health management and nutritional supplements that improve brain health.
Alzheimer’s Foundation of America
Resources on prevention, early detection and brain health
American Brain Foundation
A resource center for brain diseases.
Center for Disease Control and Prevention - Healthy Brain Initiative
The public health road map for state and national partnerships to address dementia.
National Institute on Aging Alzheimer’s Disease Education and Referral Center
Alzheimer’s disease-related news, publications and current clinical trial.
NIH Health and Aging
Health and wellness information for older adults.

Stay Connected

Why Choose Us?

We know that memory loss is concerning to the person experiencing it as well as friends and family who observe changes in a loved one. At Cleveland Clinic Lou Ruvo Center for Brain Health, we can help you find answers.

Using the latest evidence-based approaches, we provide diagnosis and ongoing treatment for individuals experiencing cognitive changes. We provide no-cost opportunities to participate in research and education for you and the friends, family and care partners supporting you throughout your journey. We also are working to help women and gender-diverse individuals address their risks for Alzheimer’s disease at the Women’s Alzheimer’s Movement Prevention Center.

Across our four locations — Cleveland and Lakewood, Ohio; Las Vegas, Nevada and Weston, Florida — we take a team approach to neurological care, with physicians, advanced practice providers and nurses working in an integrated fashion. Our treatment programs are designed to respect your dignity and provide excellent care.