Promoting Successful Cognitive Aging: A Ten-Year Update

J Alzheimers Dis. 2021;81(3):871-920. doi: 10.3233/JAD-201462.


A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.

Keywords: Cognitive aging; cognitive decline; cognitive reserve; dementia; healthy aging; healthy lifestyle; mild cognitive impairment; preventive medicine; risk reduction.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cognition / physiology*
  • Cognitive Aging / physiology*
  • Diet, Healthy
  • Exercise / physiology
  • Exercise / psychology
  • Healthy Aging / physiology*
  • Healthy Aging / psychology
  • Healthy Lifestyle / physiology*
  • Humans