Five Evidence-Backed Habits to Protect Your Brain (From a Neuropsychiatrist Who Diagnoses Dementia)

People ask me the same question at dinner parties, on flights, and in the fifteen seconds after someone learns what I do for a living.

"What do you actually do to protect your brain?"

They lean in, expecting a secret. A supplement stack. A device. Some proprietary protocol I know about because I diagnose neurodegenerative disease all week and they don't.

Then I tell them, and I watch the disappointment land.

Because the honest answer is boring. It's so boring that a multibillion-dollar wellness industry has spent years dressing it up in better packaging so it feels like news. But the science hasn't changed, and neither has my answer.

Here's the part that should get your attention, especially if you're the kind of person who optimizes everything: nearly half of dementia cases worldwide are potentially preventable. The 2024 Lancet Commission puts the number at 45%, tied to 14 risk factors you can influence.

Not cured. Not reversed. Prevented, or at least delayed, by things you have some control over starting today.

I spend my clinical life on the other side of that statistic, with the families who didn't get the memo in time. So let me give you the memo. No products, no protocols you need to buy, just what the evidence supports and what I do myself.

First, understand what you're actually protecting against

Most people picture dementia as a memory problem. Misplaced keys, forgotten names, the slow fade we've all seen in a movie.

That's the late chapter. The story starts decades earlier, often in your 40s and 50s, in your blood vessels and your sleep and your hearing. By the time memory visibly slips, a lot of the relevant damage has been accumulating quietly for years.

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This is good news, even though it doesn't sound like it. It means the highest-leverage window isn't at 75 when you're worried. It's now, while nothing feels wrong. The busy, healthy, high-performing reader has the most to gain, because you're early enough for it to matter.

The five things I actually do

1. I protect my sleep like it's a load-bearing wall.

Not because it feels nice. Because sleep is when your brain runs its cleaning cycle, clearing metabolic waste that builds up while you're awake.

Here's something most people don't know: for chronic insomnia, the first-line treatment isn't a pill. It's a structured behavioral program called CBT-I, and the major medical guidelines put it ahead of medication because it works as well in the short term and better over the long run. In my own practice, I have yet to meet the patient I couldn't get off sleep medications entirely using CBT-I plus solid sleep habits. The pills are almost never the answer people think they are.

What the habits look like for me:
↳ Cool room, eye mask, earplugs or white noise when needed
↳ No screens after 9pm
↳ In bed and ready to sleep on a consistent 10-to-6 window
↳ When my sleep drifts, I intervene fast instead of hoping it fixes itself

If I do need to reach for something for a patient, I start with the lowest-risk option, and timing matters more than people realize. Melatonin, for instance, works better taken around dinnertime than at bedtime, because it's a timing signal, not a sedative. Only after that would I consider a prescription option, and always as a bridge, not a destination.

One more thing: if you snore heavily or wake up unrefreshed no matter how long you were in bed, get evaluated for sleep apnea. It's common, underdiagnosed, and one of the more fixable things on this entire list.

2. I exercise for my brain, and treat the physique as a bonus.

Physical activity is one of the most consistently protective things in the entire dementia literature. Exercise appears to increase a protein that acts something like fertilizer for brain cells, supporting the growth and survival of neurons.

Here's roughly what I aim for, and I'll be honest that it's a target I hit imperfectly:
↳ At least 150 to 180 minutes a week of zone 2 cardio, the conversational pace where you can still talk but wouldn't want to sing
↳ Strength training most days, four to six sessions a week
↳ Which adds up to around 90 minutes of activity on most days

That volume isn't a magic threshold, and you don't need to start there. There's a lot of nuance in how you build cardio and strength safely, and if you're new to it or coming back from injury, a good physical therapist or trainer is worth their weight. The point is direction, not perfection. The best program is the one you'll still be doing in a decade.

3. I manage my vascular risk factors like my brain depends on it, because it does.

This is the one busy professionals skip, because nothing hurts and the numbers feel abstract.

What's good for your heart is good for your brain. The same vessels that feed your heart feed the organ making your decisions. High blood pressure quietly damages the small vessels in the brain for years without a single symptom, and the 2024 evidence added high LDL cholesterol to the list of major modifiable risks, tied with hearing loss as the single largest contributors.

So I actually look at my numbers, and I go beyond the standard panel. I pay attention to ApoB and Lp(a), which give a clearer picture of cardiovascular risk than a basic cholesterol reading alone. I track blood pressure and aim to keep it in a healthy range. And I watch my blood sugar, because metabolic health and brain health are deeply linked.

I'll deliberately not hand you my personal target numbers as if they're prescriptions, because the right targets depend on your history and belong in a conversation with your own doctor but you're aiming for numbers generally lower than what's considered acceptable range currently. But the move that matters is this: know these numbers, and treat them as brain data, not just heart data. If you get one advanced lipid panel and one honest blood pressure reading out of this article, you're already ahead of most people who consider themselves healthy.

4. I protect my hearing and vision, without vanity.

This is the most underrated item on the list, and the data genuinely surprised people in my own field. Untreated hearing loss is tied with high cholesterol as the largest single modifiable risk factor for dementia.

The likely mechanism is intuitive once you hear it. When your brain has to strain to process degraded sound, that's effort stolen from other work. Struggling to hear also quietly pulls people out of conversations and into isolation, which carries its own risk.

So I check my hearing and vision every year, not just when something feels off. And I'm genuinely excited about where the technology is going. Newer options are emerging that deliver impressive hearing correction through what look like ordinary glasses rather than traditional hearing aids, which removes the vanity excuse entirely. When that fits my needs, I'll use it without a second thought. A hearing aid, in whatever form, is not a fashion statement. It's brain maintenance you happen to wear.

5. I keep real relationships alive on purpose.

Social connection is not a soft, feel-good add-on to brain health. It's structural. Meaningful interaction is one of the richest workouts your brain gets, and isolation is associated with faster cognitive decline.

For me this means:
↳ Actual dinners with actual friends, calendared like anything else important
↳ Real conversations, not just logistics and small talk
↳ Showing up in a community rather than consuming one through a screen

If you've optimized your career by treating relationships as the thing you'll get to later, this is your warning shot from someone who sees where that road ends.

What I don't do (this part surprises people)

I don't do brain-training games or crossword puzzles for my brain health. They make you better at those games. The evidence that they protect against dementia is thin. If you enjoy them, wonderful. Just don't mistake them for insurance.

I don't take supplements marketed for "brain health" without real evidence behind them. Most of that shelf is marketing wearing a lab coat. Your money is better spent on a blood pressure cuff and good running shoes.

I don't try to eliminate all stress. Some stress is normal and even useful for building resilience. The goal is recovery, not a stress-free life that doesn't exist anyway.

The uncomfortably simple bottom line

Here's what I've noticed after diagnosing a lot of dementia. Almost nothing separates my professional knowledge from my personal routine. I do the same unglamorous things I tell my patients to do.

And some days I don't. My sweet tooth wins. I skip a workout. I stay up too late. That's fine. This isn't a purity test, and one bad week doesn't undo years of good ones. You try to do better tomorrow.

The reason these basics get ignored isn't that they're hard to understand. It's that they're boring, they're free, and nobody can sell them to you at a premium. The wellness industry needs you to believe the answer is complicated and purchasable. It mostly isn't.

Sleep well. Move often. Know your numbers. Protect your hearing. Stay genuinely connected to other people.

The brain you'll have in twenty years is being built by what you do this week. The best time to start was in your 40s. The second best time is your next decision.

That one's boring too. It also works.