A New, Hopeful Era for Brain Health

Dec 19, 2025 | Healthy Aging, Patient News

From prevention to precision care, a new wave of research is reshaping what it means to protect your memory and thinking

For generations, a diagnosis of dementia or Alzheimer’s disease signaled a one-way journey of irreversible decline that slowly eroded memory, independence, and identity. Over the last decade, though, scientific understanding has expanded dramatically. Today, a combination of lifestyle interventions, biomarker testing, and targeted therapies has radically injected hope into the diagnosis and treatment of cognitive disorders in older adults. Perhaps most remarkable: research now suggests that up to 45% of dementia cases may be preventable. “Dementia is not an inevitable part of aging,” says Amy Sanders, MD, a highly respected dementia neurology expert now at Sunday Health, a preventive cognitive neurology practice.

A similar evolution occurred in cardiology decades ago. As with heart disease, which was once considered unavoidable, and oncology, where one-size-fits-all treatments have given way to precision medicine, scientific discovery is reframing what’s possible in dementia care. “This field, once static, is now full of energy and promise,” says Maria Thomas, co- founder and CEO of Sunday Health. “By focusing on prevention, early detection, and individually tailored treatments, we are moving toward a future where cognitive decline can be delayed, managed, and increasingly, prevented.”

Prevention Takes Center Stage

New drugs and diagnostics often make the news, but clinicians consistently note that managing modifiable risk factors is central to good health. For older adults, this includes new approaches to delay and/or prevent dementia. A robust body of evidence, anchored internationally by the landmark FINGER study and its counterpart, the U.S. POINTER study, shows that targeted lifestyle changes can significantly reduce cognitive decline.

The original FINGER trial, published in The Lancet in 2015, demonstrated that a multimodal program combining diet, exercise, cognitive training, and cardiovascular risk management helped preserve memory and executive function in older adults at risk for cognitive decline. Its global expansion, the World-Wide FINGERS Network, now spans more than 60 countries. The U.S. POINTER study produced similarly compelling results. Participants who received structured lifestyle support, including personal coaching, nutrition guidance, and regular social engagement, showed greater cognitive stability and improved emotional well-being.

These findings and others have led experts to reconsider the long-held belief that dementia simply happens with age. Instead, they highlight the extraordinary adaptability of the brain. Thomas notes that prevention must start earlier than most people realize. “We’ve long understood how to protect our heart health, but attention to brain health has lagged. Today, we know the same evidence-based behaviors that support cardiovascular health also contribute directly to maintaining cognitive health,” says Thomas.

Dr. Sanders underscores this lifespan approach: “It’s never too early to think about brain health, optimally beginning in your mid-30s when cognitive aging starts. But it’s never too late either.” She points to findings from the Rush Memory and Aging Project, which showed that adults well into their 70s and 80s experienced slower cognitive decline simply by adopting new activities.

The 14 Modifiable Risk Factors for Dementia Prevention

1. Hearing loss
2. Traumatic brain injury
3. High blood pressure
4. Excessive alcohol use
5. Obesity
6. Smoking
7. Depression
8. Social isolation
9. Physical inactivity
10. Diabetes
11. Air pollution
12. Untreated vision loss*
13. High LDL cholesterol*
14. Low education levels

*Newly added to the 2024 per Lancet Commission report.

Brain Health Through the Lifespan

Why Lifestyle Matters: Connecting the Dots

Why do lifestyle interventions make such a difference? Today’s research paints a clear biological picture.

• Physical activity increases blood flow, reduces inflammation, and promotes the growth of new neural connections.
• A nutrient-rich diet helps counteract oxidative stress and supports metabolic health.
• Social interaction and cognitive engagement strengthen neural networks and build cognitive reserve, defined as the brain’s capacity to withstand age-related change.

Advances in Early Detection

For decades, investigating a diagnosis of Alzheimer’s disease required invasive spinal taps or costly imaging. But recent advances, especially in biomarker testing, have changed the landscape. In May 2025, the FDA approved the Lumipulse G pTau217/β-Amyloid 1-42 Plasma Ratio, the first-ever blood test that can identify Alzheimer’s-related proteins well before symptoms appear.

Dr. Sanders cautions that its purpose is specific: “The Lumipulse test is intended for people age 55 or older who are already showing symptoms. An abnormal ratio does NOT mean someone definitely has Alzheimer’s, and a normal result doesn’t guarantee they don’t.”

Instead, the test is one tool in a broader diagnostic picture, akin to A1C (blood glucose) tests for diabetes or measuring cholesterol levels for heart disease. “There is no single test that makes a definitive diagnosis of Alzheimer’s disease,” she emphasizes.

Ideally, brain health baselines that include cognitive testing and biomarker measurements will become a standard part of preventive care. “Just as you periodically get a colonoscopy or mammogram, establishing a brain health baseline can help detect any changes early,” says Thomas.

For those with risk factors such as a family history or genetic vulnerability (e.g. the APOE gene), baselines can be particularly informative. “APOE is a risk gene, not a destiny gene,” Dr. Sanders reminds. “It’s even more reason to work on modifiable risk factors if you know you’re at increased genetic risk.”

New Therapies: A Turning Point in Treatment

Two FDA-approved monoclonal antibodies—lecanemab (Leqembi) and donanemab (Kisunla)—have demonstrated that it’s possible to slow disease progression in the earliest stages of Alzheimer’s disease. In clinical trials, these patients experienced a 25–35% reduction in cognitive decline.

“These are the first ever disease-modifying medications for Alzheimer’s,” Dr. Sanders notes.

The Lancet cautions that trial results range from modestly positive to neutral, and the real- world impact is still unfolding. Currently they are appropriate only for early-stage Alzheimer’s patients who have confirmed amyloid buildup and are not on blood thinners. But for many families, even a modest slowing of decline can translate into months or years of meaningful function.

What’s Coming Next

The treatment pipeline is expanding rapidly. New therapies target multiple mechanisms:

• Tau-targeting treatments to prevent the spread of tau tangles.
• Anti-inflammatory drugs to address the role of neuroinflammation.
• Neuroprotective compounds to preserve neurons and synapses.
• GLP-1 receptor agonists (commonly used for diabetes and weight loss) are now being studied for neuroprotective effects.

Another accelerating frontier: artificial intelligence. Machine-learning tools can analyze health records, cognitive patterns, and even voice changes to detect decline earlier than human clinicians can. These technologies promise increasingly personalized, predictive brain care.

As scientific understanding deepens, one theme has become clear: brain health, like heart health, requires consistent habits, early detection, and lifelong attention. With more accessible biomarkers, evolving therapeutics, and stronger evidence for prevention than ever before, the next decade promises major breakthroughs. Or as Thomas says: “The future of brain health isn’t just hopeful, it’s actionable.”

Sources: Alzheimer’s Association, Finnish Geriatric Intervention Study, Mayo Clinic.

Keeping Up with Apps

Jul 22, 2025 | Healthy Aging, Patient News

Exercise coach, meditation guru, calorie counter, hearing amplifier, mood lifter, EKG monitor, always-available walking buddy…with 350,000+ apps flooding the marketplace there’s quite literally a virtual assist for every goal you can envision. Health apps offer software to diagnose, track or treat disease, such as continuous glucose monitors which can be worn on the arm to track blood sugar levels, or biometric rings. Wellness apps are designed to motivate people to make and sustain healthy lifestyle changes, with fitness, food and sleep tracking, mental health support, and more.
The sheer magnitude of choices can appear overwhelming, and we hope the blend of time-tested and newly promising apps below will help you get started. All can be found in your smartphone’s app store (Google Play Store for Android phones, Apple App Store for iPhones). One caveat: while many apps are listed as free to download, they may require a monthly or annual fee to unlock full capabilities. And please remember that these apps are intended only to support and complement – never replace – a visit or call to our office.

Weight management

• Wellos. Created by nutritionists and behavior change experts; contains a robust library of educational content, large recipe database, interactive support from health coaches, and food and exercise logging functions.
• Weight Watchers (WW). A well-known name continues to evolve its offerings with individual or group coaching, food and exercise logging, point system tracking, and access to the extensive WW community.
• Way. Focuses on intuitive nutrition and behavior science to help users develop a healthy relationship with food; 73% of app users think differently about their diet or actually eat differently in the first week.
• Fooducate. Helps you make healthier food choices by scanning barcodes, providing detailed information (including added sugars, artificial sweeteners and trans fats), and assigning grades based on nutritional content; also offers personalized nutrition tips.

Mental health

• Breathwrk. Hundreds of breathing techniques to help you feel calmer, prepare your body for sleep or meditation, focus, increase stamina, and reduce cravings. Uses science-based breathwork practices, including box breathing (inhale, hold, exhale, and hold, each for a count of four), pranayama (yogic breath control techniques), tummo (a mix of breathing and visualization exercises) and Wim Hof (breathing exercises to increase the amount of oxygen in your body).
• Headspace. Founded by a former Buddhist monk, this popular app has mainstreamed meditation with hundreds of sessions designed to reduce stress, improve focus and enhance well-being. Instead of exhorting you to ‘empty your mind,’ Headspace helps you get in touch with your brain and body and cultivate a regular practice of mindfulness.
• Healthy Minds Program. No-frills app that centers on the pillars of awareness, connection, insight, and purpose. Prompts to take a survey for each pillar provide a baseline to improve over time.
• Moodfit. Analytics for tracking mood and activities, with tools to help you change negative thinking patterns.
• MindShift. Interactive app designed to help cope with anxiety using psychotherapy techniques; personalize by categories of concern, such as social anxiety, perfectionism, panic and phobias.
• Happify. Developed by mental health professionals to help improve mood, build resilience and reduce stress using cognitive behavioral techniques.
• The Smiling Mind. Aimed at younger people with simple animations, easy navigation and guided meditation sessions.

Fitness

• Nike Training Club. Completely free, with a wide variety of workout videos developed by professional trainers and athletes covering strength, endurance, yoga, and mobility. Tailor-made training programs based on your goals, fitness level, and schedule.
• Peloton. Although known for its expensive stationary bicycles, Peloton offers a reasonably priced fitness class subscription service, no equipment required. High-energy classes for strength training, cardio, yoga, outdoor running, and more.
• Strava. Great for runners and cyclists, tracking your routes, speed, distance, and elevation; access to personalized training programs to prepare for races or improve performance; a strong social component allows you to share workouts and compete on leaderboards.
• MapMyFitness. Tracks over 600 types of activities, including running, cycling, walking, and gym workouts; enables you to participate in challenges and connect with friends for motivation.
• Sworkit. Stands for “Simply Work It,” with customizable workouts (cardio, yoga, stretching, strength) and instructional videos for all fitness levels; many can be done without equipment.
• Down Dog. Covers fresh, unique yoga practices with a variety of styles; aimed at everyone from beginners to experienced yogis.
• Blogilates. Video workouts with Pilates moves, calisthenics, weights and cardio; includes workout challenges, healthy recipes, a place to log your fitness journey.
• Fitbit. Synonymous with wearable devices, the Fitbit app itself is a powerful tool for monitoring many facets of health (activity, sleep, nutrition, hydration, heart rate, etc.) and can be integrated with other trackers for personalized workouts; participate in challenges with friends and the Fitbit community.

Medication management

• GoodRx. Save money on prescription medications with comparison shopping at over 75,000 pharmacies to find lowest prices in the area, and automatic searches for coupons.
• Medisafe. Turns your smartphone into a “virtual pillbox” that sends alerts to take your medications, imports prescriptions from major pharmacies, and enables you to add prescriptions, vitamins and supplements manually; integrates with GoodRx.

Sleep

• Calm. One of the best-known wellness apps, with over 100 million downloads; offers soundscapes to play as white noise, music playlists and sleep stories to wind you down at end of day. Also includes a full library of guided meditations, breathing programs and master classes on topics related to well-being.
• SnoreLab. Records your sleep so you can understand how much and how loudly you snore on a nightly basis; identifies factors that may contribute to snoring such as drinking or eating close to bedtime, feeling dehydrated during the night, or sleeping on your back.
• Sleep Cycle. An intelligent alarm clock that tracks your sleep patterns throughout the night (deep, light, and REM cycles) to provide insights into your sleep quality, duration, and patterns over time. Wakes you up gently during your lightest sleep phase within a customizable window.

Chronic conditions

• CareZone. An overall health management tool useful for people with multiple chronic conditions; scan medicine labels to create a digital file of medications, track symptoms, appointments, receive reminders to take medications.
• MySugr. One of a number of apps available for those managing diabetes; helps track blood sugar levels, insulin intake, and carbohydrate consumption; generates detailed reports to share with your physician.
• myCOPD. Provides tools to support people with chronic obstructive pulmonary disease (COPD), including a symptom tracker and a comprehensive library of educational content.
• Hearing loss. Apple’s AirPods Pro 2 introduced a hearing evaluation, and a clinical-grade Hearing Aid feature for people with mild to moderate hearing loss.

Health Hubs

These centralized hubs sync health data information from various apps and devices to provide an overall picture of your activity, heart rate, glucose, weight, sleep, mood, and more: Withings Health Mate, Apple Health (for iOS), and Google Fit (for Android).

Smart Tools for Staying Healthy at Home

The evolution of AI-powered technology for remote monitoring continues at a rapid pace, as evidenced by these latest FDA-approved offerings…as always, consult with our office to discuss what’s best for your individual health situation.
Smart Blood Pressure Monitors. For those with hypertension or at risk for heart disease, Withings BPM Vision and Omron Evolv devices provide clinical-grade readings of systolic/diastolic pressure and pulse rate.
Sleep Apnea. Withings Sleep Rx Mat, a home device to diagnose sleep apnea, measures respiratory rate, body movement, continuous heart rate, sleep cycles, duration and interruptions, snoring and breathing disturbances. Newer watches from Apple and Samsung Galaxy offer an approved sleep apnea detection feature.
Heart Health. Wearable devices and trackers enable mobile electrocardiograms, continuous heart rhythm monitoring, detection of arrhythmias, atrial fibrillation (AFib), and heart rate variability. Available on Apple Watch Ultra and Series 4 or later, KardiaMobile 6L by AliveCor, Galaxy Watch 7 and Ultra, and Fitbit Sense 2.
Fall Detection & Emergency Alert Systems. Devices that detect sudden movements or lack of motion and trigger alerts to family or emergency services are valuable tools for seniors living alone or people with mobility and balance issues. Available on Apple Watch with Fall Detection, and LifeFone Smart Watch, a subscription service with GPS tracking and two-way calling.

Sources: The DO, CNET, VeryWell, Apple

New Advisory Brings the Alcohol-Cancer Connection to the Forefront

Feb 25, 2025 | Healthy Aging, Patient News

Alcohol and Cancer Risk

Our year was off to a sobering start with the advisory on alcohol and cancer risk issued by the Surgeon General in January. The key points, which were concerning, and for at least half of Americans, seemingly unknown until now, included:

• A direct link was reported between alcohol consumption and higher risk for cancers of the breast, colorectum, esophagus, liver, mouth, throat (pharynx), and voice box (larynx).
• Four pathways were posited: 1) As it metabolizes, alcohol breaks down into acetaldehyde, a chemical which damages DNA in multiple ways. This can cause a cell to begin growing uncontrollably and create a cancerous tumor. 2) Alcohol induces oxidative stress, damaging DNA, proteins, and cells, and increasing inflammation. 3) Alcohol may alter hormone levels, which can play a role in development of breast cancer. 4) Carcinogens from other sources, especially particles of tobacco smoke, can dissolve in alcohol, making it easier to be absorbed into the body, and increasing risk for mouth and throat cancers.
• Citing a 2019 survey showing that just 45% of Americans recognize alcohol as a risk factor for cancer, a strong recommendation was made to raise awareness by updating the current warning label on alcoholic beverages.

There is no doubt that the Surgeon General can greatly influence recognition of a health issue, as evidenced by the landmark 1964 report on the risks of tobacco, laying the groundwork for public regulations in the decades to follow. Then, 42% of Americans smoked, now just 11% do. The impact of the current alcohol advisory may not be as profound, but it is significant for several reasons.

While the science behind the advisory is not new, as alcohol-related cancer risk has been noted previously by many healthcare organizations, it has grown increasingly stronger over the years. Particularly for women who drink, recent studies have added to the mounting evidence of their higher risk of developing breast cancer, as well as increased susceptibility to liver disease, cardiovascular disease, and neurotoxicity compared to males. A more widespread public campaign with prominent warnings on alcohol-containing products will help underscore these findings.

The advisory may also add impetus to the cultural shift around alcohol use that’s been occurring over the last decade. As noted, the percentage of Americans who agreed that 1-2 drinks per day is bad for one’s health is low at 45% in the most recent Gallup poll but still reflects a marked improvement compared to 26% in 2016. Most promisingly, the younger generation is leading the charge, with 65% of adults aged 18 to 34 agreeing that alcohol consumption negatively affects health vs. 38% on average of their elders.

Highlighting the risk of disease associated with alcohol requires a more nuanced approach than tobacco, where no consumption is considered safe. Instead, alcohol consumption is viewed along a continuum where risk for most people remains relatively low at 2 standard drinks or less per week, and moderately low at 3 to 6 standard drinks per week – yet fully acknowledging that individual risk is determined by a complex interaction of biological and environmental factors. As long-time researchers wrote in the Harvard Public Health Journal, while heavy drinking is indisputably harmful at every age, the data may not justify sweeping statements about the effects of moderate alcohol consumption. They point to research with mixed results e.g. studies showing decreased mortality, lower risk of cardiovascular disease in moderate drinkers, and a widely cited UK study of one million women that reported higher rates of breast cancer among drinkers but lower rates of thyroid cancer, non-Hodgkin lymphoma, and renal cell carcinoma. Recognizing that a gold-standard randomized control study would be well-nigh impossible to conduct, the most reasonable approach is to equip people with information that allows them to understand why less alcohol is better, and zero risk is only possible at zero consumption.

Our recommendations:

If you don’t drink, don’t start, as benefits are unproven, and the downsides are clear. Avoid alcohol completely if you are pregnant or trying, have a personal or family history of alcohol use disorder (AUD), have a medical condition that alcohol can aggravate (e.g., liver disease, precancerous conditions of the digestive tract), use medication that can cause interactions, or operate potentially dangerous machinery. However, if you are debating whether you can enjoy an occasional glass of chardonnay, please talk to us. We’ll help you make an informed decision based on multiple factors, including age, gender, medical history, diet, fitness, and lifestyle.

Symptoms of Alcohol Use Disorder (AUD)

What defines a heavy drinker, or a person with AUD? If you’ve experienced two or more of these symptoms in the past year, you may benefit from professional guidance to help you decrease or stop alcohol consumption:

1. Had times when you ended up drinking more, or longer, than you intended?
2. More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
3. Spent a lot of time being sick from drinking, or getting over other aftereffects?
4. Wanted a drink so badly you couldn’t think of anything else?
5. Found that drinking—or being sick from drinking—often interfered with taking care of your home or family, or caused job troubles?
6. Continued to drink even though it was causing trouble with your family or friends?
7. Given up or cut back on activities important to you to drink?
8. Gotten into unsafe situations while or after drinking e.g., driving, walking in a dangerous area?
9. Continued to drink even though it was making you feel depressed/anxious or after an alcohol-related memory blackout?
10. Found that your usual number of drinks had much less effect than before?
11. Experienced withdrawal symptoms when the effects of alcohol were wearing off e.g., trouble sleeping, shakiness, restlessness, nausea, sweating?

Sources: Harvard Public Health, Journal of Internal Medicine, Journal of the National Cancer Institute, Surgeon General’s Advisory on Alcohol and Cancer Risk, UptoDate, Rethinking Drinking, National Institutes of Health

Heart Health Update: All Roads Lead to Prevention

Feb 24, 2025 | Healthy Aging, Patient News

Whether you’re a healthy 40-something with a family history of premature cardiac events, a 50-year-old mother who experienced a complicated pregnancy decades ago, or a 65-year-old man whose statin treatment has failed to lower high cholesterol levels, take heart in the growing arsenal of tests and therapies aimed at preventing disease. A long-time advocate for proactive, preventive cardiac care, Dara Lee Lewis, MD, a cardiologist at Boston’s Lown Cardiology Group and Assistant Professor at Harvard Medical School, shares insightful updates in the Q&A below.

Q: What do you see as some of the most promising recent developments in preventive heart care?

A: As a cardiologist, I’m trained to help patients live well with chronic conditions like coronary atherosclerosis, heart failure and atrial fibrillation. But let’s face it – by the time patients are referred to me, their cardiac disease is already established. Wouldn’t it be better to prevent these diseases from developing in the first place? While we can do an excellent job minimizing symptoms and stabilizing disease, I’m just treating the tip of the iceberg.  We know that atherosclerosis, or hardening of the arteries, takes decades to develop. The time for intervention is in the iceberg itself, before that first heart attack, when someone may feel fine but under the surface, disease is brewing. That’s where risk factors such as inflammation, pre-diabetes, high cholesterol levels, and unhealthy behaviors are putting the patient at risk. We have the opportunity to make a huge impact by working with our primary care colleagues to identify high-risk patients at the earliest stages and reduce the chance of having a cardiovascular event in the first place.

Q: In addition to the well-documented factors that can signal a person at high risk for heart disease – unhealthy cholesterol levels, hypertension, diabetes, metabolic syndrome, smoking, lack of physical activity, age, family history – have others been identified?

A: Yes, we’re beginning to better understand the key role inflammation plays in the development of coronary artery disease, and now consider chronic inflammatory conditions such as gingivitis, rheumatoid arthritis and certain autoimmune disorders to be risk factors. Women who experienced a complicated pregnancy history, premature menopause or certain cancer treatments are also at a higher risk of heart disease and require close monitoring and screening throughout their lifetime.  Most notably, elevated levels of lipoprotein (a), known as Lp(a) (a subtype of LDL cholesterol), have been identified as an independent risk factor.

Q: Why is Lp(a) so significant?

 A:   An elevated Lp(a), greater than 30-50 mg/dl, is often present in otherwise healthy people. It is a genetically determined risk factor for heart disease, peripheral artery disease, and ischemic stroke. What makes this challenging is that traditional strategies for lowering cholesterol such as statins or exercise and diet modifications have little to no effect on Lp(a); however, PCSK9 inhibitors (non-statin therapy for lowering cholesterol), hormone replacement therapy and Tamoxifen can work for certain individuals. There are also some promising newer medications currently being studied.

Q: Sometimes statins (e.g. Lipitor, Crestor) don’t work to lower LDL or ‘bad’ cholesterol either…are other options available?

A: A number of non-statin therapies can be prescribed, including:

• Ezetimibe (Zetia), a relatively inexpensive pill that can be used alone or given with statins to reduce cholesterol absorption.
• PCSK9 inhibitors (e.g. Praluent, Repatha), monoclonal antibodies given as a shot every two to four weeks. These inactivate the protein PCSK9 to promote more LDL receptors and help clear LDL from the bloodstream.
• Bempedoic acid (Nexletol), a daily pill that causes the liver to make less cholesterol, but with fewer of the muscle aches experienced by some who take statins.
• Inclirisan (Leqvio), given as a shot twice yearly, blocks production of PCSK9.
• Evinacumab (Evkeeza), a monthly infusion approved only for people with a family history of hypercholesterolemia.

Q: Are there any new tools for calculating an individual’s risk of heart disease?

A: I’ve found the American Heart Association’s new PREVENT calculator to be a convenient resource to assess an individual’s risk of heart attack, stroke or heart failure over the next 10 and 30 years. It’s more comprehensive than earlier versions, as it includes measures of kidney function and metabolic health and can be used to predict risk in patients as young as age 30, which is extremely valuable in terms of early detection.