Who hasn’t walked into their kitchen and then stopped, in a fog of sudden uncertainty, wondering what they came in to get? The spiral is quick to follow. Is this a sign of things to come? Will it only get worse from here?

Cognitive decline, impairment and dementia may be the only things we won’t forget today. And with good reason.

Nearly a third of all Americans 65 or older will experience some level of cognitive decline as they age. And researchers estimate that 42% of all Americans will develop dementia – a serious type of cognitive impairment that interferes with daily function – in their lifetimes.

If these numbers sound high to you, it’s because experts have been revising them upward in recent years. Previously, officials estimated that roughly 11% to14% of men and 19% to 23% of women would experience dementia. But last year, officials at the National Institutes of Health corrected those estimates, finding the earlier numbers deficient due to poor data collection and missed early-stage signs of dementia.

With so much of the population at risk, the subject of memory loss and dementia is a hot one. Social media influencers, celebrities, even the guy checking out your groceries has an opinion. Who’s at risk for memory loss? How can you guard against cognitive decline? And what should you do if you think you or a relative is experiencing signs of dementia or Alzheimer’s?

Considering the swirl of often less-than-informed opinions, we thought it would be wise to check with an expert. We spoke to Dr. Tyson Garfield, an expert in geriatric medicine at the UCHealth Senior’s Clinic at the Anschutz Outpatient Pavilion.

What exactly is cognitive health?

Experts at the National Institute of Aging define cognitive health as the “ability to think, learn and remember clearly.” Cognitive decline is when any of those 3 start slipping.

“Decline is hard to define because it’s one of those things, ‘you don’t know it until you see it,’” said Garfield. “Being a specialist in caring for older adults, my patients have this issue in the forefront of their minds. To make it easier to think about, I split cognitive decline into three buckets.”

What is the first ‘bucket’ or stage of cognitive decline?

“The first bucket is like a hiccup. Things like short-term memory lapse, when you can’t think of the word – it’s right on the tip of your tongue, but you can’t think of it. It will come to you eventually,” said Garfield, who is also an assistant professor of geriatrics at the University of Anschutz Colorado School of Medicine,

This is normal. It is not a sign of dementia. It may not always even be a sign of aging. Emotional processing, stress and lack of sleep can all make us slower – regardless of age – than we would’ve been otherwise. It is also a normal sign of aging. As we get older, we tend to ‘hiccup’ more often.

What is the second ‘bucket’ or stage of cognitive decline?

The next bucket is mild cognitive impairment. This is more than a hiccup.

“The second bucket takes short-term impairment further,” said Garfield. “It’s an inability to recount or recall something just learned. LIke when I have to tell my grandmother the same story a few times.”

Garfield explains that this means the individual has an impaired short-term memory. But he stresses that it still represents a mild cognitive impairment.

“It doesn’t affect the person’s ability to function on a day-to-day level,” he said. “You can have mild cognitive impairment and have very limited short-term memory, but there are work-arounds and you can still live your life fully.”

Those workarounds include everything from autopay on monthly bills to pill boxes labeled with the days of the week. Garfield says he’s seen people leaving themselves written cues or reminders and having checklists that they erase in the evening and fill out starting in the mornings.

What is the third ‘bucket’ or stage of cognitive decline?

The third bucket is the scary one – the dementia one.

“This is a very specific diagnosis,” Garfield said. “This is where our thinking and memory problems are causing impairment in our ability to function day-to-day.”

Commonly, this bucket or stage of cognitive decline is most often caught in the financial realm, with overdrafts at the bank, or an inability to make change at the supermarket. Another way this stage makes itself known is in medication management.

“I’m not talking about missing one pill on one day,” Garfield said. “People with dementia can forget they take a certain pill for months…so they need help setting up their pill boxes.”

This third bucket or stage of cognitive decline usually calls for intervention – a change in the affected individual’s living arrangements. At the least, additional help with remembering medication, eating regularly, handling financial arrangements – at the most, entry into a memory care unit for safety’s sake.

Is there a way to prevent cognitive decline or dementia?

There is a way to prevent or slow cognitive decline.  And it isn’t just doing crossword puzzles.

“I tell my patients to get 150 minutes of moderate aerobic exercise per week, participate in two resistance training sessions per week, and get 7-8 hours of “unassisted sleep” (no sedative or alcohol) per night. Those are the basics,” said Garfield.

Garfield’s prescription for an exercise program has the backing of several rigorous clinical trials. The US POINTER clinical trial followed more than 2,000 American adults at risk of cognitive decline for 2 years –  putting one group through structured, rigorous exercise. The other group was given the information about what worked, but then was left to their own devices. The results, published in 2025, were unequivocal. The structured group showed a statistically significant improvement in global cognition as compared to the self-guided group.

Is there anything in particular I should eat to prevent cognitive decline or dementia?

There is! Garfield is a proponent of the MINDS diet. MINDS stands for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay. It combines the Mediterranean diet we’ve heard so much about: fish, leafy greens, veggies, legumes, berries, nuts and small amounts of unsaturated fats with DASH (which stands for Dietary Approaches to Stop Hypertension) which consists of fruits, vegetables, nuts, and low-fat dairy foods.

The combination of the two diets was tested for the first time in 2015 in a study conducted by Rush University using a cohort of more than 1,000 older individuals who lived in nearby retirement communities in Chicago. For ten years, the researchers asked the participants to fill out annual surveys about their eating habits, scored them according to how closely they resembled the MIND diet, and then tested their cognition. The results were astounding. Researchers found a 53% lower rate of Alzheimer’s disease among those participants whose diet most closely adhered to the MIND ideal. And those who weren’t quite as adherent but still stuck to the general idea had a 35% lower rate of Alzheimer’s, compared to those with the lowest scores.

“Basically it’s eat your vegetables, eat fish, don’t eat a lot of red meat and butter,” said Dr. Garfield. “It’s a big intervention, but it has a big payoff.”

Do other health issues add to my risk of dementia or cognitive decline?

Uncontrolled chronic diseases do add to the risk of dementia and cognitive impairment.

“The first thing I do is make sure my patient’s chronic illnesses: diabetes, high blood pressure, sleep apnea, etc. are under control,” said Garfield. “That is priority number one.”

Officials at the U.S. Centers for Disease Control and Prevention (CDC) have unequivocally tied chronic diseases like heart disease and diabetes to an increased incidence of cognitive decline. They point out that cognitive impairment and chronic diseases feed into one another, with the impairment making management of the chronic diseases difficult. It’s hard, for example, to remember to stick to a medication regimen, eat a specific diet, etc., while uncontrolled chronic diseases make cognitive impairment worse. The negative feedback loop leads to a cognitive spiral.

Are there any supplements I can take to decrease my risk of cognitive decline?

“No,” said Garfield. “I don’t recommend any specific supplement for cognition unless I have a specific measurement that I’m trying to improve. If someone is low in vitamin B12, then I will prescribe vitamin B12. I always ask what measurable change I’m trying to accomplish.”

While Garfield is not enamored with general advice to take supplements to stave off decline, taking a multivitamin won’t hurt people and might help. A study in 2024  found something as simple as taking a multivitamin daily helped preserve both memory and global cognition. It was the third major study to confirm the benefits of multivitamins on cognition.

Are there medications that treat cognitive decline or dementia?

There aren’t medications that treat cognitive decline, but medical experts at the U.S. Food and Drug Administration (FDA) have approved a handful of drugs for Alzheimer’s. There are two types: those that target the amyloid proteins in the brain that are associated with Alzheimer’s and others that claim to ‘manage symptoms’. The trouble is, Garfield doesn’t find either kind of drug particularly effective.

“You can remove the plaques from the brain,” Garfield said regarding the medications that target amyloid proteins, “but they don’t really affect the disease.”

And regarding those medications that claim to ‘manage’ symptoms, Garfield is equally skeptical.

“If you and I were both diagnosed with Alzheimer’s, and we both took the MMSE test (the standard memory test for Alzheimers) and we both scored 24, and you took the meds and I didn’t, I might score a 22 in 6 months and you might score a 23. No medication really slows the functional loss.”

He notes that when the first monoclonal antibody drug for Alzheimer’s was approved by the FDA, three of the FDA advisors, who had recommended against that approval, abruptly resigned.

“That should tell you something,” Garfield said.

What about over-the-counter medications that claim to treat or prevent dementia?

Over-the-counter medications for dementia, in Garfield’s expert opinion, are nothing more than snake oil. One of his pet peeves is big businesses that make money off of people’s fears of Alzheimer’s. Over-the-counter medications like Prevagen are especially troubling to him.

“Despite slick marketing, there are no independent, peer-reviewed studies showing that Prevagen improves memory or prevents cognitive decline,” said Garfield. “Snakeoil has always been sold, and this is just the latest iteration. But in reality, it’s lifestyle that prevents cognitive decline, not a pill.”

Are there any medications that actually can cause cognitive decline?

There are medications that can actually cause cognitive decline, and chances are, you’ve taken them or are taking them on a regular basis.

Drugs like Benadryl are increasingly causing concern among neurologists.

“Anti-cholinergics are very concerning considering lifetime exposure,” said Garfield. “Benadryl, (generically known as diphenhydramine) is everywhere. Some people take it for allergies, some to sleep. You’ll find it in things like Tylenol PM or Unisom.”

These drugs can cause cognitive impairment either acutely or chronically. Other anticholinergics include scopolamine patches for seasickness or nausea, doxylamine succinate for sleep (in Unisom), and amitriptyline for depression.

Garfield also points to other classes of drugs that he considers worrisome, such as benzodiazepines (drugs like Valium and Ativan) as well as the wildly popular gabapentin.

“We’ve always had concerns and suspicions about gabapentin,” said Garfield.

And those concerns are now being validated. A recent study found that people who received six or more prescriptions of gabapentin for low back pain increased their risk of developing mild cognitive impairment by 85% and full-blown dementia by 29%.

Is cognitive decline reversible? Is dementia reversible?

“Dementia is not reversible,” said Garfield. “But some cognitive decline can be reversed.”

Decline caused by low vitamin B12, depression and anxiety can mimic dementia or cognitive decline. By treating the depression or anxiety, the patient can gain greater function.

“When our mind is preoccupied by emotional processing, our short-term memory can be impaired,” said Garfield. “So if you stop ruminating, you have the cognitive bandwidth to remember why you walked into the kitchen in the first place. You are processing the world in a different way.”

Am I too old for lifestyle changes that decrease my risk of cognitive decline or dementia?

“It’s never too late,” said Garfield, who also teaches financial literacy courses for medical students.

He said financial health and cognitive health are similar in that it’s never too late to launch better habits.

“Sure, it would’ve been ideal if you started yesterday, but starting today is the next best thing.

“With longevity and how we are caring for people these days, I would not be surprised if a 70-year-old lives to 95, and if independence matters most to you, then staying proactive in your health care is the best way to maintain that,” Garfield said.

If someone I love has cognitive decline or the beginnings of dementia, what can I do to help?

“The first thing to do to help someone you love is to validate what they are experiencing,” said Garfield.

People want to feel heard and understood. It makes them feel less alone.

Next, Garfield said, determine if what they’re experiencing is subjective or objective. That’s usually done with a visit to your doctor, or provider of choice, to determine if your loved one has measurable deficits that can be seen on a test.

Once you and your loved one understand what is happening, and the extent to which it is happening, you can start making arrangements to help the person function safely in the least restrictive environment possible.

Are older adults — age 65 and older — the only people who are affected by cognitive decline?

No. Older adults are not the only ones affected by cognitive decline. Surprisingly, a recent Yale analysis using CDC survey data found nearly 10% of young adults, aged 18-39, reporting suffering from cognitive disability – driving most of the increase the full study showed among all adults. Incidence of cognitive disability among young adults between 2013 and 2023 rose from 5.1% to 9.7%.

Researchers looked at 4.5 million survey responses, skipping data from 2020 when the pandemic disrupted survey participation.

But researchers caution against taking these statistics to heart. Self-reporting cognitive difficulties is a far cry from objective cognitive impairment. And since, as Garfield cautioned, emotional processing can interfere with short-term memory, it’s possible stress is the major culprit here.

Does using technology cause cognitive decline?

It’s a pretty popular belief that between computers, video games and social media, we are all rotting our brains: “digital dementia,” it’s called. But just because people keep saying it doesn’t make it so.

A new study from researchers at Baylor University indicates the opposite may be true. The study reviewed data that covered more than 400,000 adults over an average of 6 years. The finding? Digital technology engagement is associated with better cognitive aging, not worse.

“I  can see both sides,” said Garfield. “What’s important is the intention and the engagement that involves. There’s a difference between doomscrolling and actively engaging online.”