Losing the Car Keys or Losing Your Mind?

When my mother’s intelligent, perspicacious best friend began to utter incoherent sentences at her weekly bridge game, all her friends were alarmed. It turned out that she had UTI dementia, a temporary condition that often accompanies urinary tract infections in the elderly. After a course of antibiotics, her symptom disappeared, but it was a lesson in elder care for all of us.

Cognitive decline can take many forms, say Susan Methal, RN, the corporate director of day care services at the Bainbridge Adult Day Health Center, who is herself a sharp, vigorous senior. “The term dementia is an umbrella term for many diseases, of which Alzheimer’s is just one of them,” she clarifies. “People see them as interchangeable, but you can have just one kind or more than one kind. Alzheimer’s patients can live as long as twenty years after diagnosis, for example, while Lewy body dementia has a shorter prognosis.”

Cognitive decline progresses in stages. People in middle-age and beyond may find themselves increasingly subject to “senior moments” in which they cannot find a word or remember an event.

“Forgetting where you put your keys is part of the aging process,” says Dr. Arnold Berlin, a clinical professor at NYU, a physician at ODA Health Center in Williamsburg, and the founder of a soon-to-be-released dementia prevention website, minminders.ai. He is himself a vibrant, physically fit senior citizen. “But with age, some people will start to show mild cognitive impairment. Even when it becomes dementia, the disease might progress slowly from mild to moderate to severe stages.”

Brain abnormalities often develop so slowly that no one picks up on them for many years. “You could compare it to osteoporosis in women,” Dr. Berlin says. “We ideally should start to address osteoporosis beginning at age thirty-five to reduce problems later on. Similarly, the amyloid plaques and tau tangles in the brain that are a symptom of Alzheimer’s begin to form fifteen or twenty years before we may notice any symptoms.”

All people start to lose some cognitive function as they age because our brains, like our muscles, lose mass over time. “Our brains shrink five percent every ten years starting at age forty,” says Dr. Marc Milstein, a brain researcher and the telegenic author of The Age-Proof Brain. “They also become less efficient in getting rid of ‘trash,’ meaning the byproducts and buildups of its functioning.”

I have seen this kind of gradual shrinkage in Susan, an older woman and former guidance counselor who was my Partner in Torah for over 20 years. As she passed from her sixties to her seventies to her eighties, she’s become increasingly forgetful and has trouble finding words. Mostly confined to home because of knee issues, and having a hard time reading due to vision loss, she sometimes has to stop and remember who I am when I call (all of which, obviously, saddens me deeply).

Does all this mean we are doomed, during an era where life expectancy has increased into the eighties, to watch our mental capacity fade slowly away? Dr. Milstein, who is himself 47 years old, encouragingly says no. “There are many ways we can keep the brain nourished and ‘plump,’”he says.

While the brain is only two percent of body mass, it consumes 20 percent of the body’s energy. Its centrality to our existence means that other organ systems contribute to its optimal functioning.  Quoting her mentor, Dr. Dale Bredesen, Dr. Sandison describes the brain as a country called “Brain-istan.” She explains that like any country, Brain-istan needs infrastructure (think the nervous system, its neurons, and other components). It needs a sanitation system to eliminate waste products. A nation needs nourishment for its inhabitants, which means proper blood circulation, nourishment, and imports from abroad (the five senses, hormones, and neurotransmitters). Brain-istan must also defend itself from threats from outside, such as toxins, stress, diseases like Lyme and Covid, infections (which can cause brain inflammation), and chronic pain.

In other words, mens sana in corpore sano — a healthy mind in a healthy body — is more than a catch phrase. The overall health of the body contributes greatly to the health of the brain. So does emotional well-being, social connectedness, and staying intellectually stimulated. Let’s take a peek at some of these key factors that help keep your brain vital and healthy at any age.

Keep Moving!

We’ve all been told a gazillion times how important it is for our health to exercise. Aerobic exercise builds heart and lung power, produces endorphins to keep us happy, and maintains muscle mass. But if you assume brawn and brain have little to do with each other, think again.

When you exercise, Dr. Berlin explains, your muscle tissue produces a chemical called BDNF, or brain-derived neurotrophic factor. “It’s responsible for the growth of brain cells, especially in the hippocampus and precuneus,” he says. [The hippocampus helps retain short-term memories into long-term memories and helps with learning, emotion, and cognitive maps; the precuneus is an area involved in episodic memory, spatial imagery, and other cognitive functions.]  A study cited in Neurology found that among a group of 50-year-old women, those who were the least fit had the highest probability of developing Alzheimer’s ten years later (45 percent), while those who were in the best shape had only a five percent chance.

Dr. Milstein calls BDNF “an elixir of youth for your brain.” It promotes the survival of developing neurons and helps them specialize. Producing more BDNF correlates with the size of the hippocampus and with better performance on learning, memory, and spatial memory.

Milstein cites a study from Cardiff University in the UK that was reported in the Journal of Alzheimer’s Disease, in which 50-year-old women were asked to either stretch or do aerobic exercise every day for a year. The group that did aerobic exercise showed a 47 percent average increase in memory scores after a year, while the other group showed no such improvement. But Milstein says that even walking 30 minutes a day lowers the risk of dementia by 35 percent.

Susan Methal adds a brief note of caution: “If you are older, speak to your doctor before you start with a very active form of exercise,” she says. “But walking and swimming are generally very good.”

More than 40 Winks

Dr. Sandison, who founded the Solcere Health Clinic to promote healthspan, is an optimist who believes that simple adjustments to lifestyle can greatly impact brain health. One of these is getting a good night’s sleep. Packing in somewhere between seven and nine hours, she says, can theoretically prevent or delay a whopping 40 percent of worldwide dementias.

“Sleep is crazy important,” agrees Dr. Berlin. “It’s when the glymphatic system of the brain works to take out the ‘trash.’ But the quality of the sleep is very important! You need at least two hours of REM sleep [the deepest sleep, and the stage in which we dream], and a significant amount of slow wave sleep. You can lie in bed for ten hours and still be sleep deprived if you miss minimum REM and slow wave sleep.”

But many people are kept awake by stress, and as we get older, we produce fewer of the hormones that help us fall asleep. Older people may wake frequently due to prostate or bladder issues. Nevertheless, Dr. Sandison discourages the use of sleeping medications such as Ambien and Xanax, claiming they do more harm than good in producing quality sleep (ditto for alcohol).

The biggest danger to quality sleep is apnea, in which people wake up repeatedly because of difficulty breathing, usually due to a narrowed or obstructed airway. “Without treatment, sleep apnea is essentially repeated micro brain damage each night,” Dr. Sandison states. Apnea treatment generally involves surgery, the use of a CPAP machine at night, or lifestyle changes such as losing weight or quitting smoking.

Good sleep can be encouraged by making sure the room you sleep in is on the cool side, and by making the room as dark as possible. Dr. Milstein cites the example of pro tennis player Peter Sampras, who made sure that, on the night before a competition, his room was completely pitch-dark. He even taped over the small red lights on appliances or televisions that were turned off but still plugged in.

Darkness is important for better sleep, but so is sunlight. Researchers recommend getting out in sunlight every day for at least ten minutes to regulate the body’s internal clock, not to mention to breathe fresh air and see people. Another option is bright light therapy, which involves sitting in front of a box that provides 30 times more light than the average office light, for a prescribed amount of time.

Eat Your Veggies

We’ve been hearing for years about the benefits of a Mediterranean diet: lots of vegetables and fruits, whole grains, nuts, and not too much animal protein. “What’s good for the body is good for the brain,” Dr. Berlin says, and recommends adhering to this diet to help both the heart and brain.

He offers two other pieces of food-related advice. The first is to consume fish oil, as the omega-3s in fatty fishes appear to boost brain health. (Grandma was right: Fish really is brain food!)

The other eitzah is to go on a ketogenic diet, in which your nutrition should be derived exclusively from fats (60 percent of calories) and protein (40 percent). By depriving the body of carbohydrates and glycogen, it sends the body into ketosis, meaning that it begins to burn fat instead of carbohydrates for energy. “Ketone bodies [produced by the liver during ketosis to fuel the body] seem to clean out amyloid plaques from the brain,” he says. If genetic testing shows that you are at risk for Alzheimer’s, then you should seriously consider both a ketogenic diet as well as exercise to boost BDNF.

He admits it’s often hard to get people interested in trying this. “It’s really hard to do,” he admits. “I once tried it for two weeks, but I couldn’t keep it up! I’m a runner, and while I was on the diet, I could only run two of my usual four miles, because the glycogen in my muscles was depleted.

“The diet only allows fifty grams of carbohydrate a day. But you could do a keto diet just two days at a time, from time to time, to get the benefits.” You could also jump-start ketosis after a fast if you continue eating only proteins and fats when the fast is over, as the fast will begin depleting the liver of glycogen.

Dr. Sandison recommends staying on a low-carb, keto-style diet even if you aren’t seeking to put the body into ketosis, a counsel she follows herself. She explains, “Eating a carb- and sugar-heavy diet leads to excessive levels of glucose, which then leads to glycation of your neurons (a process where a sugar molecule bonds with a brain cell and essentially caramelizes it, contributing to cognitive decline).” Bottom line: Don’t overdo the carbs, especially refined flours and sugars.

Here’s yet another reason to eat healthy: Dr. Milstein points out that there are more neurotransmitters in the gut than in the brain, and gut health has been shown to influence brain health. The best way to ensure good gut health, he maintains, is to eat a high-fiber diet. Dr. Berlin puts in, “Cruciferous vegetables such as broccoli, cauliflower, and cabbage are excellent for supporting the intestinal biome.” Eat your cole slaw!

Exercise for the Brain

Your muscles need exercise to stay in shape, and so does your brain. Dr. Milstein recommends what he calls “cross training,” meaning challenging the brain to develop new neural pathways and networks by learning new information and skills (try a new language, pick up a craft, solve puzzles).

Dr. Berlin recommends an app called Elevate, which is brain training through over 40 games of math, word, grammar, vocabulary, and memory puzzles. Similar apps include NeuroNation, Brainwell, and Luminosity.

“It’s great if you try something new, but it doesn’t have to be new,” Mrs. Methal qualifies. “Do what you enjoy! Today, with computers, seniors can take inexpensive online classes through colleges, and Torah classes online. There are language classes and crafting classes. There are even virtual tours you can take of Eretz Yisrael and other countries.”

Leah R.* had two role models while in middle age: her mother-in-law and her grandmother, who lived to 93 and was completely mentally cognizant with a perfect memory until the day she died. Her grandmother read the newspaper and exercised daily, as well as davening daily with tremendous kavanah. Leah’s mother-in-law, meanwhile, did none of that and developed dementia. “When I saw her not recognizing family members and not making sense, it was terrifying enough to make me do the research and change my entire lifestyle,” she says. Today, in her sixties, she exercises daily and plays word games to work on her brainpower.

Leah’s cousin Bassi says her grandparents are in their late eighties and much more “with-it” than a lot of their family and peers. “My grandfather retired from his work as an engineer, but he also enrolled in community college (which is free at his age) and takes tons of classes to get those human interactions and stimulate the brain,” she says. “While my grandmother cut back from regular teaching, she still teaches a special twice-a-week class in order to see her peers and add some purpose to her days.”

While your brain needs exercise, it also needs proper downtime. Dr. Milstein cites evidence that people who practiced 30 minutes a day of mindfulness or meditation experienced growth in the hippocampus and shrinkage of the amygdala (the source of strong emotions). There was also a detectable drop in stress hormones after three days and an increase in anti-inflammation cells that keep the mind and body healthy.

Can prayer be as helpful as mindfulness? Dr. David Rosmarin noted in an interview with the Wall Street Journal that “The research that has been done on prayer shows it may have similar benefits to meditation: It can calm your nervous system, shutting down your fight or flight response. It can make you less reactive to negative emotions and less angry.” (No evidence on its effect on the expansion of the hippocampus, although calming the nervous system would suggest a shrinking of the amygdala.)

Andrew Newberg, the director of research at the Jefferson Myrna Brind Center of Integrative Medicine in Philadelphia, has been studying the neurological effects of prayer since the 1990s, writing a book entitled How God Changes Your Brain. Newberg found increased activity in the frontal lobes during prayer (the part of the brain that helps focus attention). Depending on the kind of prayer, it may increase activity in the language, visualization, emotional, and motor centers.

Stay Connected

One of the most identifiable and preventable contributors to dementia is social isolation. The brain stays fresh by interacting with others, by absorbing others’ ideas and thoughts and deriving pleasure and vitality from human relationships.

Michael Fried’s mother had always been vibrant and had many interests, from sculpture to card games to politics. But when his father passed away, his mother became depressed and withdrew from seeing her friends as often as she used to. She had lost the companionship she had enjoyed for 65 years in her home. “The result was that she started to lose words and sometimes say things that didn’t make sense,” he says. “We had to really push her to get out of her apartment and see people to keep her from further decline.”

“Loneliness is a huge risk factor for cognitive decline,” Mrs. Methal states. “Imagine an older person who loses a spouse, and has children living far away. With age, people lose friends as well. But you cannot sit home all day doing nothing! You have to be out and active.”

The importance of connection is why two well-established predictors for Alzheimer’s are hearing and sight loss, as both can isolate people [see sidebar]. Simply getting hearing aids or correcting vision can do much to keep older people connected and vibrant. “People think hearing aids are costly, but you can go to a Costco and buy them for a reasonable price,” Methal says. “In the same vein, older people should not shy away from using a cane or a walker. They are not a bushah! They’re a way to keep you independent and active in society.”

Even a service dog can be helpful to get people out into the world. Having a pet relieves loneliness and isolation for many people, even if animal companionship does not fully replace human contact.

Dr. Milstein encourages post-retirees to find new sources of purpose and connection once they leave the office. He recommends doing small acts of kindness for others as a way to stay connected and find purpose. Goldie Steinberg, who at the time of her passing at age 114 was the oldest Jew in the world, was known for doing acts of kindness for her fellow nursing home residents. “Volunteering is wonderful to keep retirees active and engaged,” Mrs. Methal says.

Many years ago, I interviewed the mayor of Bnei Brak for Mishpacha, who told me that while Bnei Brak has the highest rate of poverty in Eretz Yisrael, it also has the highest rate of longevity! At the time, we speculated on the apparent contradiction being a result of the fact that Bnei Brak residents typically are a part of large families and support networks. Older men never retire from a life of learning Torah, which keeps their minds active, and older women don’t retire from family connections and responsibilities.

“There is even scientific evidence that showing gratitude and complimenting others is life-prolonging,” says Dr. Berlin. He has seen it play out in his own family: “My mother passed away at age 110 and only started showing signs of cognitive decline at 105,” he says, “and she was constantly expressing gratitude and thanking people. She said thank you multiple times in all of her conversations.”

The Right Perspective

At any rate, living into old age should be viewed with gratitude, not dread. “Getting old is a brachah!” Mrs. Methal says firmly. Getting old enough to see children, grandchildren, and perhaps great-grandchildren, and/or to see the fruits of a life of productive activity, is tremendous cause for gratitude.

We aren’t in charge of our lifespan. But by following medical research that points the way to living optimally both physically and mentally, we can be assured that we’ve done our hishtadlus to continue a life of Torah and mitzvos — maybe even until 120!

Alzheimer’s Risk Factors

Alzheimer’s disease was named for Dr. Alois Alzheimer, a German psychiatrist who first identified amyloid plaques (clumps of misfolded proteins) in the brains of dementia patients. But the issue is more complex, says Dr. Marc Milstein, a brain researcher and the telegenic author of The Age-Proof Brain. Amyloid plaques and tangles are found in 98 percent of people, including newborns. They are prominent not only in Alzheimer’s patients but in people with Parkinson’s disease, Huntington’s disease, epilepsy, and traumatic brain injury. “Yet only Alzheimer’s disease has been defined by amyloid plaques,” he writes. While 30 percent of people over 65 have enough of these plaques to qualify for an Alzheimer’s diagnosis, only 10 percent have measurable cognitive impairments.

Early-onset Alzheimer’s, which typically begins between the ages of 40 and 60, has a clear genetic component, and scientists have also identified genes that predispose people to develop Alzheimer’s later in life. According to Dr. Arnold Berlin, a new test called tau 217p42 is 97 percent accurate in predicting the onset of Alzheimer’s disease. The test picks up on pathologies in the brain even before symptoms are present, and may be worthwhile if there is a history of Alzheimer’s in the family so that preventive steps can be taken.

The medical journal The Lancet has identified 14 modifiable risk factors for Alzheimer’s. This means the following list includes risks that can be minimized or eliminated by changing our behaviors or living conditions.

• Low educational attainment
• Hearing loss
• Hypertension
• Obesity
• Smoking
• Physical inactivity
• Diabetes
• Excessive alcohol consumption
• Traumatic brain injury
• Air pollution
• Social isolation
• Depression
• Untreated vision loss
• High LDL cholesterol

A Few Random Hacks

While Dr. Berlin bemoans the fact that many patients are unwilling or unable to make crucial efforts to maintain brain health, such as exercising or changing their diets, he has seen evidence of a few simple, easy modifications that seem to help the brain.

One surprising hack is aromatherapy. “Smelling essential oils such as lavender or mint have been shown to expand the hippocampus in laboratory animals,” he says. He suggests putting menthol crystals in a one-ounce jar and taking a sniff from time to time throughout the day.

If you have ever contracted a virus in the herpes family, such as chicken pox or cold sores, taking an antiviral such as Valtrex seems to be associated with a reduction in rates of Alzheimer’s, says Dr. Berlin. The newer vaccines for flu, RSV, and shingles also seem to stimulate the immune system to lower the buildup of amyloid plaques.

Coffee drinkers rejoice! Your daily cup of joe may help keep your brain young as well as alert. According to one study cited by Dr. Milstein, women 65 and older who drank more than 261 mg/day (two large mugs of coffee or five of tea) were 36 percent less likely to develop dementia ten years down the line.

Dr. Milstein also urges patients to maintain good oral hygiene. He states that the bacteria P. gingivalis has been found in the brains of Alzheimer’s patients, and can trigger brain inflammation and misfolded amyloid proteins.

According to the National Institutes of Health and other sources, curcumin — the active ingredient in turmeric — has been shown to reduce amyloid plaques in Alzheimer’s patients and improve their cognitive function. Consult your doctor about supplementation, and in the meantime, you might want to sprinkle turmeric liberally into your cooking!

According to Dr. Sandison, there is some evidence that plasmapheresis — the exchange of plasma in the bloodstream — may, over the course of a year, reduce cognitive decline by 60 percent. Perhaps refreshing the blood with younger cells helps keep the body and brain in better shape.

Drinking is not good for brain health, not even the much-vaunted daily glass of red wine. David Hochman, writing for AARP Magazine (July 2025), says, “A sweeping analysis of 107 studies spanning four decades found that no amount of alcohol is truly safe for the aging brain… just two drinks a week may trim nearly a week off your life on average.”

Be Prepared

Mrs. Methal’s tips for those with aging brains:

• Do your best to prevent brain injury by avoiding falls! Older people should have non-skid mats in bathrooms and kitchens.
• When you go to the doctor, write a list of questions in advance. Doctors’ time is limited, and this will allow you to make the most of a brief appointment.
• Think ten or 20 years into the future, and make sure to have your documents such as power of attorney and a halachic living will in place before you have any cognitive challenges. “Halachic wills are state-specific, so if you move out of state, make sure to address this,” she warns. “These documents will give more choices to people with cognitive deficits.”
• Do not take supplements without asking your doctor, including natural supplements for memory or brain function. They may duplicate or interact with your existing medications. “I had elderly Russian patients who kept ending up in the hospital because they were taking Russian medications on top of what they were prescribed,” she relates. “But they were prescribed digitalis, and that’s exactly what was in the Russian pills they were taking, so they overdosed! Make sure the supplements have a hechsher, and be aware that not all supplements are the same dosage or formula.”

(Originally featured in Family First, Issue 970)