Over about 30 years of clinical research and teaching, mostly at Johns Hopkins and Harvard Medical School, I built a 12-week brain fitness program. I have used it with patients who have attention deficit disorder, with people recovering from persistent concussion symptoms, and with those dealing with age-related memory loss. Around 80% of our patients improved with it.

I am proud of the program, and I want to make it useful to people who will never set foot in my clinic. So I want to give you one of the first tools we use with every patient: the brain health score. It takes a few minutes; you can do it at home, and you can repeat it week after week to watch your progress.

How the score works

There are ten questions. You rate yourself from 1 to 5 on each, which gives you a total out of 50.

A score of 40 or higher means you are in good shape, and your brain is set up to stay healthy now and in the years ahead. A score down around 15 or 20 means there is real work to do. The good news is that this number moves quickly once you start paying attention to it. Most people can raise it within 12 weeks.

One thing before you begin. You are the judge of your own answers, and you will be the same judge next week and the week after. So it does not matter much whether a given answer is a 3 or a 4. What matters is that you use the same standard each time, so the trend you see is honest.

Here are the ten questions.

1. Exercise

The goal is about three hours a week. If you hit that, give yourself a 5. If you are a couch potato, that is a 1. Anywhere in between earns a middle score.

2. Diet

If you eat a Mediterranean-style diet every day, give yourself a 5. If you eat junk food daily and rarely touch fruits and vegetables, that is a 1. Score 2 to 4 for everything in between.

3. Portion size

If your portions are reasonable and you eat about three times a day instead of grazing five or six times, give yourself a 5. If you eat huge portions and keep going until you are stuffed, that is a 1. The aim is to eat enough that you feel satisfied, without feeling full.

4. Omega-3

Omega-3 fatty acids are one of the most important ingredients for building a stronger brain. This is the one supplement I recommend to everyone, and I take it myself and give it to my own family. I suggest an omega-3 that includes DHA and EPA, at around 1000 mg a day. Take it daily and give yourself a 5. Never take it, and that is a 1. A day or two a week is a 2, and so on up the scale.

5. Stress

Your state of mind shapes how healthy your brain is. Here is something I find fascinating: your brain determines your state of mind, and then your state of mind turns around and affects the health of your brain. You have more control over that loop than you might think. If you stay calm and relaxed through the normal stress of a day, give yourself a 5. If every small thing sets you off, that is a 1. If you are generally steady but still get thrown by a missed bus or a hard moment at work, give yourself a 3, and score around there based on how easily you get stressed.

6. Meditation

Meditation raises BDNF in the brain, increases blood flow, and lowers cortisol. It is one of the best things you can do for yourself. I recommend 10 to 15 minutes a day. If a seated meditation is hard for you, do a simple breathing exercise instead: breathe in for a count of seven, hold for seven, breathe out for seven. Do it daily and give yourself a 5. Never do it, and that is a 1.

7. Attitude

You decide how you look at the world. If you are optimistic and generally expect things to work out, give yourself a 5. If you assume nothing will work and worry over every detail, that is a 1. Your daily outlook has a real effect on how healthy your brain is today and how healthy it will be later.

8. Sleep

Seven to eight hours a night is one of the most important things for your brain. If you sleep well most nights, give yourself a 5. If you struggle to fall asleep or stay asleep, that is a 1. Sleep is a big topic on its own, so if it is a real concern for you, read my separate article on how to improve it.

9. Organization

If you start the day by writing down the three things that must get done, finish them, and handle more as time allows, you are in charge of your day, and that is a 5. If you are always running late and always behind, that is a 1. Staying organized keeps you from feeling overwhelmed, and that protects your brain.

10. Mental challenge

Your brain is a use-it-or-lose-it organ. If you do brain exercises or take on things that genuinely challenge your mind every day, give yourself a 5. If you avoid anything that requires hard thinking, that is a 1.

What your number means

Add up your ten answers.

If you are at 40 or higher, you are in good shape. You do not need to overhaul anything. Keep nudging individual scores up when you can.

If you are below 40, this is your starting line, and it is a useful one. Repeat the same ten questions every week for the next 12 weeks, and set a goal to reach 40 or higher. Watch which numbers are dragging the total down, and put your attention there first. Most people find the climb easier than they expected, because small, steady changes in sleep, diet, movement, and mindset add up fast.

The reason I like this score is that it turns a vague worry about your brain into something you can see and act on. You stop guessing about whether you are doing enough, and you start working from a number that tells you where you stand.

Frequently asked questions

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

📺 Watch the full video on Dr. Fotuhi’s YouTube Channel.

Test your Brain Power in 7 Minutes

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Most people know that HIV attacks the immune system. Fewer know that HIV can also affect the brain. And here is the part that surprises people most. Even when HIV is very well controlled with medication, some people still have trouble with memory, attention, or thinking speed.

I saw this for myself many years ago, during my neurology residency at Johns Hopkins.

The Patient I Never Forgot

A man in his 40s had been admitted to the hospital because of dizziness. When I sat down to talk with him, I noticed something beyond why he was there. He was awake and alert, but his answers came unusually slowly. He had trouble staying focused on our conversation, and he could not remember the names of his own medications. He was not confused or sleepy. His thinking had simply slowed down.

Then I learned that he had HIV, and that it was very well controlled. His viral load was almost zero, and his immune system was quite strong. So I kept asking myself the same question. Why was his thinking so slow? That question stayed with me for years.

ART Changed Everything, but Not for the Brain Alone

Antiretroviral therapy (ART) has been a lifesaving treatment for people with HIV. It turned a disease that was once fatal into one that many people live with for decades, and controlling the virus is essential.

When it comes to the brain, though, ART is not always the whole story. Even when the virus is under excellent control, some people living with HIV still experience problems with memory, attention, concentration, or slow thinking. Doctors sometimes call this HAND, which stands for HIV-associated neurocognitive disorder.

There is an important point to make here, and it changes how we should respond. Not every memory problem in a person living with HIV is caused by the virus.

The Brain Has Many Things Working on It

Think of your brain as a complicated system, with many things capable of putting stress on it. HIV can be one of them. So can aging, high blood pressure, diabetes, and poor sleep. So can depression, stress, alcohol, head injury, and other medical conditions.

When someone with HIV has trouble with memory or thinking, there are often several of these causes working together. That points to a useful idea. Instead of focusing on one cause, it often makes more sense to care for the brain from several directions at the same time.

Where This Idea Came From

This way of thinking grew out of my own clinical work. For years I treated people who came to me with memory loss and other cognitive difficulties, and I kept noticing the same thing. Rarely did anyone have only one problem. A single person might have poor sleep, high stress, low physical fitness, and a poor diet, along with difficulties in attention and memory, all at the same time.

In 2016, I published a study of a 12-week Brain Fitness Program in 127 older adults with mild cognitive impairment. The program combined cognitive training, biofeedback, and brain coaching built around physical fitness, diet, and stress reduction. After 12 weeks, 84% of the participants showed a statistically significant improvement on cognitive testing. We also looked at brain MRIs in a smaller group who had quantitative scans before and after. Half of them showed either no further shrinkage of the hippocampus or an actual increase in its volume. Those were encouraging findings, and I went on to develop the program for patients with concussion and ADHD as well, with similar results.

That experience led me to the idea at the center of my work. Brain health does not come from doing one thing. It comes from caring for the brain from several directions at once. Over the years, I organized this into what I call the five pillars of brain health: exercise, sleep, nutrition, managing stress with a positive mindset, and brain training through continued learning and challenge. Picture the five as members of a team. You do not have to be perfect at any single one. The goal is to work on all of them together.

A Landmark Study, and Its Limit

This idea was not unique to me. Researchers around the world were asking similar questions. One of the most important studies was a European clinical trial called FINGER, conducted in Finland with more than 1,200 older adults who had an increased risk of cognitive decline. Rather than asking people to do just one thing, the researchers combined several approaches at once: exercise, healthy eating, brain training, and more. After two years, the people in the multi-domain program had better overall cognitive performance than those who received general health advice.

FINGER mattered because it showed that protecting the brain may require more than one strategy at a time. But there is an important limit for our purposes. FINGER did not study people living with HIV, so we cannot assume the same approach will work the same way in this group. It has to be tested.

The Gap I Found in the Research

While preparing a lecture I recently gave at Johns Hopkins on this topic, I looked at the research with a simple question in mind. What happens when we use lifestyle changes to protect thinking in people living with HIV?

The answer surprised me. A 2026 systematic review, commissioned by the World Health Organization and published in The Lancet Healthy Longevity, screened almost 6,000 scientific papers. Only five met the strict criteria for the review, and all five tested medications. Not one tested a lifestyle program built on exercise, healthy eating, better sleep, stress management, and brain training.

That is a real gap in the science. We know a great deal about how to control HIV. We know a great deal about the value of lifestyle for brain health in the general population. We know much less about whether a comprehensive brain-health program can help people living with HIV who have cognitive problems. That is the question worth answering now.

Back to the Man at Johns Hopkins

So let me return to the patient I met all those years ago.

I cannot tell you exactly why his thinking was so slow. HIV may have played a part. Other things may have too. Most likely several factors were involved at once. But if I saw him again today, here is what I would say to him. Controlling the virus is essential. Let us also take care of your brain. Let us work on your exercise, look more carefully at your sleep, talk about your nutrition, manage your stress, and keep your brain active.

The brain is not a passive victim of disease. It is an organ that responds to how we live. We have made remarkable progress in treating HIV. I think it is time to ask a new question. How can we help people living with HIV keep their brains healthy for the rest of their lives?

We do not have all the answers yet. But we know enough to start asking, and to start looking. For now, my recommendation is simple. Control the virus. Take care of your body, your sleep, your mind, and your brain, because your brain is your biggest asset, and it is worth protecting, with or without HIV.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

📺 Watch the full video on Dr. Fotuhi’s YouTube Channel.

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I want to tell you about myself, and about how I came to practice medicine the way I do.

I graduated from Harvard Medical School in 1997, and by then I was already deeply interested in Alzheimer’s disease. When I began my neurology residency at Johns Hopkins, I chose to focus on age-related cognitive decline. The more patients I saw, the more one thing troubled me. People who arrived carrying a diagnosis of Alzheimer’s usually had a whole mix of different problems feeding their decline, and many of those problems could be treated.

So I began writing review articles making a case for a different approach. Rather than labeling everyone with memory trouble as having Alzheimer’s and sending them off to a nursing home, we should treat the medical conditions pulling them down, and work directly on improving their brain function through diet, sleep, and mental challenge. I kept writing about this after I became an assistant professor of neurology at Johns Hopkins. Then one day I realized I needed to stop writing about it and start doing it. In 2012, I opened my own neurology practice and built a program I called the Brain Fitness Program.

Carol

One of my very first patients was Carol, a woman in her 70s with serious cognitive decline.

Her sister was the one who brought her in, and she had a clear purpose. She wanted me to confirm Carol’s Alzheimer’s diagnosis so she could obtain power of attorney, sell Carol’s house, and pay for a nursing home. She told me Carol just sat in front of the television all day and did nothing at all.

I asked her to wait a moment. Because when I looked at Carol, I saw a long list of conditions that could be treated. She had high blood pressure, diabetes, obesity, sleep apnea, and depression, and she was taking multiple medications for pain.

So we went to work. We reduced her pain medications, treated her depression, addressed her back problems, and worked on her diet. She began coming to our brain center twice a week to work with our brain coaches, who are trained to encourage patients to do more, to eat better, and to challenge their brains.

Little by little, Carol came to life. She started walking five minutes a day, then ten. She stayed with the program, and by the time she finished she was a different woman, full of energy, as though she had woken up. I finally got to meet the real Carol, and she turned out to be warm and funny and a pleasure to talk to.

Carol was not a lucky exception. I ran this program for many older patients with mild cognitive impairment or early-stage Alzheimer’s, and 84% of them showed significant, measurable improvement on their cognitive tests. I published those results in the Journal of Prevention of Alzheimer’s Disease.

Lisa

After that, I began offering the same program to younger people dealing with memory and thinking problems. One of them was Lisa.

Lisa was a schoolteacher in her 50s, worn down by both her work and her personal life. She was going through a divorce. She could not keep up at school. Her knees hurt, she had gained 20 pounds, she could not sleep, and she had headaches. She looked at me and said, “I’m a mess.” She was sure she was developing Alzheimer’s disease.

Her evaluation told a very different story. At her first visit, I had her fill out what I call spider-grams, diagrams built from 35 questions that map out exactly where a person is struggling, whether that is memory, attention, concentration, or processing speed, each rated from 0 to 10. Lisa scored as significantly affected across most of those areas.

Then I did formal cognitive testing to see which domains were truly weak. Her memory performance came back at the 5th percentile for her age. Her executive function was also struggling, though her processing speed was still fairly good. Her blood tests showed that her vitamin D was low and her B12 was low. None of that is Alzheimer’s disease, and all of it can be addressed.

When Lisa started the program, she worked with our brain coaches twice a week, 90 minutes at a time. They helped her exercise more, sleep better, take better care of herself, and receive brain training. After six weeks, her results were remarkable. Her memory had improved from the 5th percentile to the 35th, and her processing speed had climbed to about the 99th.

She was thrilled. I remember her telling me that in a way it was a good thing she had gotten so bad, because now she finally had a reason to take care of herself. She became more engaged with her students. By the time she finished the program she was a new person, full of energy and optimism. Her cognitive testing and her spider-grams, which had been mostly in the red when she started, were mostly in the green by the end.

The Pattern Behind the Book

Carol and Lisa were not isolated successes. I went on to see 223 other patients with memory loss or persistent cognitive symptoms, and they improved too. 80% of them showed objective improvement on their cognitive tests.

I want to be clear about what that means, because it is the heart of everything I do. These patients did not simply feel better, sleep better, and report being happier, although they did. Their objective cognitive testing showed real gains in attention, concentration, executive function, and mental speed.

This is the foundation of my book, The Invincible Brain. The lesson I learned from Carol, from Lisa, and from hundreds of others is one I want you to carry with you. A frightening label is not the end of the story. Underneath it there are almost always treatable causes, and the brain has a real capacity to recover when you give it the chance.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

📺 Watch the full video on Dr. Fotuhi’s YouTube Channel.

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When it comes to your brain, size matters. I am talking about one structure in particular, a small seahorse-shaped region called the hippocampus. It sits at the center of learning and memory, and its size has a lot to say about your future.

A great deal of research has shown that the hippocampus can shrink, driven by the way you live and by certain medical conditions. As it shrinks, your risk of Alzheimer’s disease rises. Keep it large and strong, and your odds of staying sharp late into life improve dramatically.

Most of what shapes it is in your hands. Below are six habits that shrink the hippocampus, followed by six that grow it. Read both, then decide which list you want to live by.

The Six Things That Shrink Your Brain

1. Sleeping fewer than six hours a night: Short sleep is hard on the brain, and the longer you live with insomnia, the more the hippocampus tends to shrink. Sleep is not idle time. It is when the brain does some of its most important maintenance.

2. Untreated sleep apnea: If you snore, carry weight around your middle, and feel tired through the day, sleep apnea is worth ruling out. When you have apnea, your breathing stops and starts through the night, and your brain is repeatedly deprived of oxygen. The longer that goes on untreated, the more the brain suffers from the constant shortage.

3. Chronic stress and anxiety: Getting stressed before a deadline now and then is normal and harmless. The damage comes from feeling angry and stressed most of the time. Ongoing stress keeps your cortisol high, and cortisol is especially toxic to the hippocampus. Protecting your brain means finding ways to bring those levels down.

4. A poor diet: If you eat junk food regularly, you are working against your own brain. Studies have linked higher intake of trans fats, the kind found in processed food, to a smaller brain. Excess body weight points in the same direction. As a rough rule, the bigger the belly, the smaller the hippocampus.

5. Untreated depression: Depression that is being treated is manageable, and people do well. Depression that is left untreated for years is different. Over time, it wears the hippocampus down further and further, which is one more reason to take it seriously and get help.

6. Vitamin deficiency, especially B12: Low levels of certain vitamins are a significant risk factor for brain shrinkage, and B12 stands out. When B12 runs low, the likelihood of losing brain volume goes up.

Think of Your Brain as a Garden

Here is the hopeful part. Can you reverse these things and rebuild the hippocampus? Yes, you can.

I find it useful to picture the brain as a garden. Neglect it, and it goes to weeds. Tend it with a little daily care, and it grows green and healthy. So what does tending your garden actually look like? Six habits, and each one has real science behind it.

The Six Things That Grow Your Brain

1. Sleep seven to eight hours a night: During deep sleep, your brain clears out amyloid, a protein that builds up in Alzheimer’s disease. When you fall short on sleep, and especially on deep sleep, amyloid levels climb. When you sleep well, your brain rinses that amyloid away. Aim for seven to eight hours whenever you can.

2. Exercise three hours a week: You can split it however works for you, whether that is one hour three times a week or ninety minutes twice a week. Three hours is the minimum for a healthy brain. And exercise earns its place at the top of the list for one reason above all: when you exercise, you grow new neurons. Actual new brain cells form. Nothing else does that.

3. Cut out junk food: Keep processed food off your plate as much as you can, and build your meals around fruits and vegetables. The Mediterranean diet is the pattern I recommend and follow.

4. Meditate: Sit down, close your eyes, and repeat a mantra. If sitting with a mantra feels difficult, try a breathing exercise instead. Breathe in for a count of seven, hold for a count of seven, and breathe out for a count of seven. Ten minutes a day, five days a week, will do a great deal for you, and this has been shown scientifically.

5. Learn something new every day: Keep a sense of curiosity, and take on things you have never done before. Better still, practice memorizing. There are many apps built for this, and the more you practice recall, the sharper your memory becomes and the larger your hippocampus grows. Using your brain is good for your brain. Use it or lose it.

6. Be kind to yourself and to others: Let things go. Try not to take everything so seriously. As my daughter would say, it’s not that deep.

Every day you do a few things from one list and a few from the other. The balance you strike, repeated over years, becomes the brain you carry into your seventies, eighties, and nineties. You get to choose which list wins.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

📺 Watch the full video on Dr. Fotuhi’s YouTube Channel.

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I want to talk to you about sleep, and why it matters so much more than most people realize, both in the short term and over the course of your life.

Most of us think of sleep as simply rest, a time when the brain switches off. It’s the opposite. When you sleep, your brain goes into a rinsing and washing cycle. And once you understand how that cycle works, you start to treat your sleep very differently.

The Nightly Wash Cycle

Here is what actually happens inside your head at night.

With each beat of your heart, the arteries in your brain pulsate a little. That small pulsation pushes the fluid in your brain, the cerebrospinal fluid, or CSF, through the brain tissue. As it moves, it rinses away debris and waste. The now-dirty CSF is then collected and carried out of the brain.

This cleaning process is particularly active during deep sleep. It is, in a very real sense, your brain’s waste management system.

So what happens if you don’t get enough sleep? The rinsing doesn’t work properly. Debris and waste byproducts start to accumulate, and your neurons end up surrounded by dirt. Neurons sitting in their own waste are not happy neurons, and unhappy neurons do not function well.

Why I Think of New York City

Let me give you an analogy I come back to often.

Imagine New York City, and imagine that every night the garbage collection gets disrupted. For a day or two, you might not notice much. But after a couple of weeks, piles of garbage bags would start blocking the streets. Within a month or so, the whole city could grind to a halt.

The nightly collection and cleaning system is essential for a city to function. Your brain is no different. That nightly rinse is not a luxury. It is what keeps everything else working.

What Poor Sleep Does to You, Short Term and Long Term

In the short term, the effects of not sleeping enough are familiar to all of us. You feel tired and grumpy. You make mistakes at work. You become irritable. Your anxiety climbs, and your mood can sink toward depression.

The long-term consequences are far more serious, and they are the reason I take sleep so seriously with my patients.

Chronic poor sleep raises your risk of heart attacks and strokes. It can contribute to depression. And, most concerning of all, it raises your risk of Alzheimer’s disease.

I want to be precise about the timeline, because the details matter and I don’t want to frighten anyone unnecessarily. If you go through a difficult stretch and sleep fewer than six hours a night for a year or two, your brain can recover once you get your sleep back on track. Everything can be fine.

It is the long, uninterrupted years of poor sleep that cause real structural damage. A person who has lived with insomnia for twenty years may end up with a hippocampus, the memory center of the brain, that is roughly half the size it would otherwise have been.

Long-term insomnia is a major risk factor for Alzheimer’s disease. We know that for a fact.

How Do You Know If You’re Sleeping Well?

The simplest measure is how you feel when you wake up in the morning.

Beyond that, we now have plenty of tools. The rings and smartwatches many people wear can give you useful data about your nights. There are also questionnaires that can help you gauge how poor your sleep really is, such as the Pittsburgh Insomnia Rating Scale.

And if you have significant sleep problems, please see a specialist. In most cases, they will order a sleep study to understand what is actually going on.

The First Step Is Believing It Can Be Fixed

Let’s say you have insomnia. Some nights you get four hours, some nights five, and you’re frustrated. What should you do?

The first thing, and I mean this genuinely, is to adopt a positive attitude toward improving your sleep.

In my experience, too many patients tell me, “Well, everybody has sleep problems. I’m just like everybody else.” That is not true. Sleep problems are almost always treatable. But you have to make a real effort to treat your insomnia, and to make sure it is fully treated, not just partly managed. Sometimes that means addressing an underlying medical issue, like chronic pain, that is disrupting your sleep in the first place.

What Actually Works

There are some standard, well-established habits that genuinely help.

Don’t drink coffee or caffeinated products in the afternoon. Limit how much alcohol you drink at night. Wind down with a book or a warm shower. Avoid a large meal right before bed. You might try a small snack instead, like yogurt, a banana, or cherries. And some people find supplements like magnesium or melatonin helpful.

If those measures aren’t enough, the next step I recommend is cognitive behavioral therapy for insomnia. When you work with a therapist, they can go through your thought process and figure out what is keeping you up at night. Very often it is anxiety, and that anxiety has to be resolved before real sleep can return. I find this approach extremely helpful with my own patients. In fact, cognitive behavioral therapy is the most effective treatment for insomnia that I know of.

I leave sleeping medications as a last resort. Honestly, I don’t like them, and I very rarely prescribe them.

Your Brain Will Thank You

So here is what I want you to take away.

Sleep is essential for your brain health, both in the short term and across your whole life. If you have sleep problems, please take them seriously, because there are many things you can do to improve your sleep.

Do them. Your brain will thank you for it.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

 Watch the full video on Dr. Fotuhi’s YouTube Channel.

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What if the brain fog you’re feeling in your 40s or 50s isn’t just normal aging, but your brain reacting to the hormonal changes of menopause?

I want to tell you about a patient of mine, and about two brand-new studies that are changing how we think about hormones, menopause, and Alzheimer’s disease. The answer is more encouraging than you might think. Stay with me to the end, because I’ll also tell you exactly what I would do if I were you.

A few years ago, a lawyer in her late 40s came to see me.

She told me she felt slower handling her cases. She was less articulate than she used to be. She kept forgetting things: appointments and why she’d walked into a room. Her mother had died of Alzheimer’s, and she was terrified she was next. She wanted me to fix it, immediately.

She was serious. She was panicked. And honestly, I understood why.

I’ll tell you what we actually found, and what happened to her, later in this article. But first, let me explain what’s happening in women like her.

Why Menopause Can Change How Your Brain Feels

When a woman goes through menopause, her estrogen levels drop dramatically.

We usually think of estrogen as a reproductive hormone. But it does far more than that. There are estrogen receptors throughout the brain. Estrogen helps brain cells communicate with one another. It supports the connections between neurons. It affects the neurotransmitters involved in mood, sleep, and memory. It even influences the parts of the brain in charge of temperature regulation, appetite, and weight management.

So when estrogen falls during menopause, it makes sense that some women notice changes in how their brain functions. It makes sense that they might experience brain fog, trouble finding the right word, mood swings, or a feeling of being less sharp than they used to be.

Many women also experience hot flashes, weight gain, sleep apnea, and metabolic issues around this time, all of which can affect memory and thinking indirectly.

For years, scientists have wondered whether losing estrogen might help explain why women are so much more likely than men to develop Alzheimer’s disease. We still don’t have a definitive answer. But two brand-new studies are giving us some real clues. If you’ve heard conflicting things about hormone replacement therapy over the past twenty years, these two studies are a big part of why that conversation is finally starting to change.

Two New Studies Worth Knowing About

The first was published on August 12 in the journal Neurology, by researchers at Stanford.

Instead of simply asking women whether they had memory problems, the researchers looked inside their brains. They studied more than 21,000 women, including thousands whose brains were examined after they passed away. Women who had used estrogen-only hormone therapy had 35% lower odds of showing Alzheimer’s-related damage in their brains, and 39% lower odds of ever being diagnosed with any form of dementia.

The second study was published on August 26 in the journal Alzheimer’s & Dementia. Researchers from the University of Exeter and the University of East Anglia followed more than 183,000 postmenopausal women in the UK for over 13 years.

Women who had used HRT had a 16% lower risk of Alzheimer’s disease. And among women who had gone through a surgical menopause, those who used HRT had about a 26% lower risk of developing any form of dementia. This study found the biggest benefit in women who started HRT between the ages of 46 and 56.

Both studies point to something researchers call the window of opportunity. The idea is that estrogen may help the brain most when it is started around the time of menopause, rather than decades later. In other words, timing may matter more than we used to think.

I do want to be careful here. Both of these are observational studies. They show an association between hormone therapy and lower dementia risk, not proof that HRT prevents dementia. The researchers behind both studies have said the same thing, and they’ve called for randomized clinical trials to test the question properly. I agree with them. But after twenty years of fear and confusion around this topic, findings this large and this consistent are genuinely reassuring.

What Actually Happened to My Patient

Now, back to the terrified lawyer: she had Alzheimer’s.

Her workup told a very different story than the one she feared. She was sleeping poorly. She was working full time, raising three teenage sons, and taking on extra projects after hours to try to earn a promotion. On top of all that, she had gained weight, and she was not exercising.

When we went through it together, she understood that her symptoms were not caused by Alzheimer’s disease. They were the product of exhaustion, stress, poor sleep, and a body under strain. And that meant they were fixable.

She completed our 12-week Brain Fitness Program, and my brain coaches helped her improve her exercise routine, her diet, her sleep, her stress levels, and her brain training. In parallel, her own doctor started her on hormone replacement therapy.

Twelve weeks later, her memory had gone from the 40th percentile for her age to the 80th percentile. She was thrilled. And she stopped worrying about Alzheimer’s disease.

Her story is the whole point, really. Her fog was real. But it was not what she was most afraid of, and it responded to the right combination of changes.

So Should You Take HRT to Protect Your Brain?

This is the question I get most often, so let me answer it honestly.

Not for that reason alone, and not yet. We do not yet have the gold-standard proof from a randomized clinical trial to recommend HRT specifically for cognitive symptoms.

But if you are also struggling with hot flashes, vaginal dryness, or other menopausal symptoms, then HRT for a couple of years can be a very reasonable option, one worth discussing seriously with your doctor. And these new studies are reassuring, not alarming.

Please keep one thing in mind. Your brain does not exist in isolation. Sleep, exercise, nutrition, stress, brain training, and your hormones are all connected. Hormones may be one piece of the puzzle, but they are not the whole picture, exactly as I saw with my patient.

What I Want You to Do

If you are at this stage of life and wondering whether HRT is right for you, talk to your doctor about your own personal history and risk factors. That conversation is the single most important next step you can take. Every woman’s situation is different, and this is a decision to make with a physician who knows your history, not one to make from a newsletter or a video.

And regardless of what your hormones are doing, you should always work on the five pillars of brain health:

• Walk daily, and exercise about three hours a week.
• Sleep 7 to 8 hours a night.
• Eat a Mediterranean diet.
• Reduce your stress, and consider meditation or yoga.
• Challenge your brain with a fun hobby at least once a week.

The fog you’re feeling is not a life sentence. Very often, like it was for my patient, it’s a signal, and a signal is something you can act on.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

📺 Watch the full video on Dr. Fotuhi’s YouTube Channel.

How to Fix your brain fog in 40s & 50s | Dr. Fotuhi

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How many days do you think it takes to start losing a skill you’ve had for decades?

For me, the answer was three.

A few weeks ago, I got into a self-driving car for the first time and let it take me around my town. It was smooth. It was relaxing. And honestly, it was a little bit magical. I sat there with my hands barely on the wheel, watching the car make its own decisions.

Three days later, I got behind the wheel of my own car again. This time with no assistance. Just me. And something felt off. It was slightly difficult to manage the heavy traffic on a busy highway. My sense of the road felt a little rusty.

It had only been three days, and I could already feel the difference.

That small moment stuck with me. Because as a neurologist who has spent forty years studying the brain, I knew exactly what was happening. My brain had not lost the skill of driving. But the parts of my brain responsible for it had quietly relaxed, because for three days they simply did not have to work that hard.

Negative Neuroplasticity: The Part Nobody Talks About

This is what I call negative neuroplasticity.

Your brain is not fixed. It is not a piece of hardware that stays the same your whole life. Your brain is living tissue, and it changes its shape, its structure, and its strength based on how you use it every single day.

Think of your brain like a muscle. If you work your biceps and triceps, they grow. If you stop using them, they shrink. Your brain grows and shrinks in the same way, in response to your lifestyle and your environment. The parts you use and challenge often get stronger. That is positive neuroplasticity. The parts you stop using quietly fade and shrink. That is negative neuroplasticity.

And we have seen this before, long before AI arrived.

When calculators became common, our collective ability to do math in our heads got weaker. When GPS became common, our sense of direction got weaker too. So here is the honest question all of us need to ask: if AI can now write our emails, solve our problems, remember our facts, and even drive our cars, what happens to the parts of our brains that used to do all of that work?

What the Research Is Starting to Show

There is new research beginning to answer that question, and the results are worth paying attention to.

In one study, researchers had people write essays in one of three ways: completely on their own, using a search engine, or using ChatGPT. The whole time, machines measured their brain activity. The group that used ChatGPT showed the weakest brain engagement of the three. And afterward, many of them could barely remember what they had just written, because in a very real sense, they had not actually written it themselves.

We are seeing the same pattern in medicine.

In one study, experienced doctors used an AI tool to help them spot polyps during colonoscopies. After they grew used to working alongside the AI, their detection rate without it actually dropped, compared to how they performed before they ever used the tool. These were skilled physicians, quietly losing a bit of their edge, simply because the tool had been doing that part of the thinking for them.

To me, this all makes perfect sense. The activity in the parts of our brain that we stop using and challenging gradually fades away.

This Is Not About Fearing AI

I want to be very clear about something, because this is not a message about fearing AI or rejecting it.

I use AI every single day. I think of it almost like one of my staff members. I let it handle the tedious, minor parts of my work, the things that do not require my judgment or my creativity. But I still do the hard thinking myself. The writing. The decisions. The real work. Because I know that “use it or lose it” applies to my brain just as much as it applies to my muscles.

Here is the strange thing. We already understand this instinct perfectly well when it comes to our bodies. We just have not caught up yet when it comes to our brains.

Think about how life used to require constant movement. People walked to work. They rolled their windows up with their own hands. They pushed in a clutch and changed gears with their own feet, over and over, every time they drove. All of that built-in movement quietly kept our bodies strong, without anyone ever thinking of it as exercise.

Today, machines do almost all of that work for us. We press a button, and the window rolls up. We slide into an automatic car and never touch a gear again. And what did we do as a society, once daily life stopped giving us that movement for free? We built gyms. We started going to Zumba classes, yoga classes, and Pilates. We began taking long walks on purpose, specifically to give our muscles the workout that daily life no longer provided automatically.

This is exactly the position we are now in with our brains.

AI is quietly becoming the automatic window button and the automatic transmission for our minds. It removes the friction, and it feels wonderful in the moment. But if we are not careful, we are quietly losing the mental exercise that daily life used to give us for free, when we had to remember phone numbers, do math, navigate our own cities, and write our own thoughts from a blank page.

Six Ways I Build a Gym for My Own Brain

So, just as we built gyms for our bodies once our environment stopped providing free exercise, we now need to build a gym for our brains. These are small, deliberate exercises we choose on purpose, precisely because daily life no longer forces us to do them.

Here are six exercises I personally do. Not because I read them in a textbook, but because I know they are important for keeping my own brain sharp.

1. I minimize using GPS on purpose: When I am driving somewhere I have been before, I make myself recall the way, even if it takes an extra moment of thinking. That small effort keeps my hippocampus and other memory areas active and engaged.

2. I memorize names: I work to remember the names of all my students and every person I meet, every single day. Holding a name in my mind and pulling it back later sounds almost too simple to matter. But that daily repetition is exactly what keeps my memory strong, the same way a short walk keeps my heart healthy.

3. I protect at least one block of deep, unassisted thinking: No AI, no shortcuts. Just my own mind, working hard on a project from beginning to end.

4. I keep authorship of anything that truly matters. I let AI carry the tedious, minor parts of my work, but the real writing, the real decisions, and the real thinking stay mine.

5. I take up hobbies that challenge my mind: Learning new dance steps is at the top of my list, and this one is for pure joy as much as it is for my brain. I am willing to bet you already have a small wish list in the back of your mind, something you have always wanted to learn from scratch or finally get better at. The science is clear that a new, challenging skill grows your brain in a matter of weeks. So pick the one hobby that sounds the most fun, and enjoy practicing it until you get really good at it.

6. I use AI to challenge me, not replace me: After I write an essay or prepare a presentation, I ask AI to critique my work and push back on it. I also use AI as a tutor when I need to understand something complex. In other words, I use AI to stimulate my brain, not to replace it.

The Brain You Have Is the Result of Your Daily Choices

So here is what I want to leave you with.

AI is not going to make you stupid. But how you use it will absolutely shape whether your brain stays sharp or slowly grows weaker.

Your brain, like your body, becomes what you ask of it every single day. The brain you have, sharp or dull, strong or weak, is the result of your daily choices. Just as the shape of your body is in your hands, so is the shape of your brain.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

📺 Watch on Dr. Fotuhi’s YouTube Channel.

How Ai is slowly destroying your brain health – Dr. Fotuhi

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Let me start with a simple question.

If you were managing a $10 million investment portfolio, would you put all of it into a single stock?

Of course not. You would diversify. You would spread your money across different types of assets. You would manage your risk, monitor your performance, and make adjustments over time. That is simply what anyone serious about money does.

Now I want you to think about your brain the same way.

Your Brain Is an Asset

Your brain is an asset too. In fact, it may be the single most important asset you have. It allows you to think, make decisions, solve problems, lead your organization, manage your finances, and maintain your relationships.

And yet most of us do not manage our brain the way we manage a financial portfolio. Instead, we wait. We wait until there is a problem. We wait until our memory starts to slip, or until we are exhausted, stressed, and burned out. And only then do we ask, “What can I do about it now? Do I have early signs of Alzheimer’s disease?”

I believe we should approach brain health very differently. We should look at the brain the way we look at a financial portfolio. I call it your brain portfolio.

Just as a financial portfolio has different asset classes, your brain portfolio has five major assets: exercise, sleep, diet, stress management, and brain training.

And the key idea, the one I want you to hold onto, is diversification. You do not want to pour all of your brain health investment into a single area. Exercise is extremely important, but exercise alone is not enough. A good night’s sleep is important, but sleep alone is not enough. Eating well is important, but diet alone is not enough. You need to invest across all five. Each one contributes something different, and together they build a far stronger brain.

Let me walk you through each asset.

Asset One: Exercise

Think of exercise as one of the highest-performing assets you have.

When you exercise, you are not simply strengthening your muscles and your heart. You are increasing blood flow to the brain, supporting the growth and maintenance of brain connections, and helping to regulate blood pressure, glucose, and inflammation, all of which matter for optimal brain health.

Exercise also helps grow new neurons in the hippocampus, the memory center of your brain. And it strengthens the frontal lobes, the regions critical for emotional regulation and decision-making.

So exercise is not just a fitness investment. It is an important investment in your brain capital.

Asset Two: Sleep

Sleep is your brain’s maintenance department.

While you sleep, your brain is not shutting down. During deep sleep, your brain clears out the metabolic waste that accumulates throughout the day. This remarkable cleaning and rinsing process is your brain’s waste management system. At the same time, the parts of your brain responsible for consolidating memories, regulating emotions, and making decisions are refreshed and restored.

If you consistently under-invest in sleep, eventually you pay the price. The waste that does not get rinsed out accumulates night after night, week after week, year after year. Over time, that buildup contributes to significant brain shrinkage.

Regularly sleeping fewer than six hours a night carries serious long-term consequences, including an accelerated risk of developing Alzheimer’s disease.

Asset Three: Diet

I think of diet as the raw material your brain uses every single day.

Your brain requires energy, essential fats, vitamins, minerals, and other nutrients to function properly. A good diet provides the building blocks for your brain cells and blood vessels.

So when you choose what to eat, you are not simply deciding what goes into your stomach. You are deciding what resources you are providing to one of the most valuable organs in your body. You are supplying the raw material your brain needs to function at its peak.

Asset Four: Stress Management

Your fourth asset is stress management, and I think of it as risk management for the brain.

Some stress is normal and even healthy. But chronic, unmanaged stress can become a major risk factor for both mental and physical health.

You do not need to eliminate every stressful situation, which is neither possible nor the goal. What you need is to reduce stress where you can and learn to manage the rest effectively. That means learning how to recover from stress: creating periods of calm, maintaining meaningful relationships, and making sure your brain has enough time to recharge.

Asset Five: Brain Training

The fifth asset is brain training, and here the rule is simple: your brain is a use-it-or-lose-it organ.

When you learn something new, you challenge your attention and stimulate the parts of your brain responsible for problem-solving. When you play music or take on intellectually demanding activities, you give your brain the chance to build new neural networks.

The regions you stimulate with new hobbies and new learning, such as picking up a new language, literally grow larger. It works just like your muscles, which grow in proportion to how much you challenge them with exercise.

Your brain remains an active, adaptable asset throughout your entire life, not just in childhood. You can expand and grow your brain at any age.

The Real Power Is in the Portfolio

Here is the part that matters most. These five assets do not operate independently. They interact.

Exercise can improve your sleep. Better sleep improves your attention and emotional regulation. A healthy diet supplies the energy and nutrients your brain needs to function well. Stress management improves both your sleep and your decision-making. And brain training gives your brain the stimulation it needs to stay adaptable.

The real power comes from the portfolio as a whole.

This is exactly how we think about financial diversification. We do not ask, “Which single stock will make me rich?” We ask, “How can I build a diversified portfolio that performs well and manages risk over time?”

We should ask the same question about our brains: How can I build a diversified brain portfolio that helps me maintain my memory, focus, creativity, resilience, and independence as I grow older?

Monitor, Rebalance, and Start Now

There is one more principle from finance worth borrowing. You need to monitor your portfolio.

You do not invest once and forget about it. You review your performance, identify your weaknesses, rebalance, and make adjustments when your circumstances change. The same should be true for your brain health.

Maybe your exercise is strong, but your sleep is weak. Maybe your diet is excellent, but you are carrying too much chronic stress. Maybe you are physically active but intellectually under-stimulated.

The goal is not perfection. The goal is balance.

And you may be wondering when the best time is to start paying attention to your brain portfolio. The answer is now. When it comes to your brain, prevention is a far better strategy than waiting for a major problem to appear.

A Note for Executives and Leaders

For executives, business leaders, and CEOs, I think this concept is especially important.

You spend your professional life managing financial assets, human capital, operational risk, and long-term growth. But none of those assets matter very much if your own brain is not functioning at its peak. Your brain is the executive system behind every single decision you make.

So I encourage you to think about your brain the same way you think about your financial portfolio. Diversify. Invest consistently. Manage your risk. Monitor your performance. And rebalance when necessary.

Your brain is not simply another organ in your body. It is the most important asset you have, and it is built to grow and expand throughout your life.

Look into the five pillars of your brain health and build a brain portfolio that will last you a lifetime. The earlier you start, the more likely you are to enjoy strong cognitive returns for many years to come.

That is how you become not just a successful executive, but a brain super ager.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

📺 Watch the full video on Dr. Fotuhi’s YouTube channel

https://youtu.be/AegcfrO5BPI 

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“I love you from the bottom of my heart.”

We have all said it, or heard it. It is one of the oldest ways we express love, and most of us never stop to question it. We imagine that love lives deep in our heart.

But here is the surprising truth: your heart is made up of muscle, and it is not capable of experiencing emotions. Love does not begin in your heart. Love begins in your brain.

Let me explain what actually happens.

The Message Starts in Your Brain and Ends in Your Chest

The feeling of love emerges from the interactions of several brain areas the regions that handle emotion, motivation, reward, and social bonding. When you fall in love with someone, these areas glow with activity. They, in turn, stimulate the part of your brain that regulates hormones in your blood, such as adrenaline.

The adrenaline then makes your heart beat faster. That is why, when you see someone you love, your heart pounds.

The message begins in your brain and ends up in your heart. You cannot feel the glowing of activity in your brain, but you can feel the pounding of your heart in your chest. And so, understandably, we have spent centuries believing it is the heart that sparks with love.

Every Emotion You Feel Is Built by Your Brain

I am a neurologist, and I have spent much of my career studying the brain, mostly at Johns Hopkins and Harvard Medical School. One thing that never stops amazing me is this: every emotion we experience fear, joy, excitement, pride, sadness is created by the brain.

Different emotions involve different groups of brain regions working together as a network. Love is no exception. In fact, love gives us a beautiful window into how the human brain works when it comes to bonding and forming lasting relationships.

Feelings of love also engage the dopamine reward and motivation system. It is the activity of dopamine pathways in the brain that leads to the pleasure, joy, excitement, and motivation that make you want to keep seeing the person you love, over and over again.

What Scientists Saw Inside the Brain of Someone in Love

The research that uncovered this is fascinating.

Helen Fisher and her colleagues studied people who were intensely in love. While these volunteers lay inside a brain MRI scanner, the researchers showed them photographs of the person they loved. Something remarkable happened. The dopamine-rich areas deep inside the brain, including a region called the ventral tegmental area, or VTA, became intensely more active.

That surge of dopamine is what gives you the intense sense of pleasure about the person you love, and it is what motivates you to want to be near them at all times.

Animal studies help us understand the biology of love and lasting relationships even further. Prairie voles are small, monogamous rodents that form long-lasting pair bonds. Researchers have found that the dopamine system in their brains surges when these animals have to climb over a fence to seek out and reach their partner.

In other words, it appears that even the act of seeking the one you love can give you some of the same joy you feel when you are with them. The dopamine pathways in the brain, along with a hormone called oxytocin, help people who love each other bond and stay together.

Love Is Bigger Than Romance

As we research the biology of love, we have discovered something profound: our brains have evolved to connect with other human beings. Love and connection are part of what makes us human.

And this is where I want to expand the meaning of love. When we hear the word “love,” we often think about romance. But the human brain does not reserve something as important as love for romance alone. There is also the love between parents and children.

A few years ago, I saw something in the news that I will never forget. After the tsunami in Japan, photographs surfaced of mothers who had been found still holding their children, having used the last moments of their lives shielding them from the water. These women, in the most extreme situation imaginable, sacrificed their own lives for their children. Their love for their child outlived their instinct to save themselves.

I remember looking at those images and thinking, “I would do that too.” As I am sure almost every parent would. That is the power of love in the brain.

These relationships may look different from one another. But they all involve the same dopamine and oxytocin network in the brain that helps us connect, care, trust, and protect one another.

Why Heartbreak Physically Hurts

There is another side to this.

When an important relationship is lost, the pain can be very real. Research on social rejection and loss has shown that social pain can engage some of the same brain regions involved in physical pain.

So if you have ever experienced heartbreak and thought, “Why does this hurt so much?” there is a neurological reason for it. Some of the same brain areas that light up with physical pain also light up with the emotional pain of losing someone you love.

Your brain takes social connection seriously. From an evolutionary point of view, belonging to a group was essential for survival.

The Lesson From the Longest Study of Human Life

This brings me to something I believe is even more important than romantic love: human connection is a genuine part of brain health.

One of the longest-running studies of human life is the Harvard Study of Adult Development, which has followed people for more than eight decades. One of its most important lessons is remarkably simple: the quality of our relationships matters enormously for our health and happiness. People who have stronger, more supportive relationships tend to be healthier and live longer.

And this is not just one study. Large studies and meta-analyses involving hundreds of thousands of people have found associations between loneliness and a higher risk of dementia, and between social isolation and a higher risk of premature death.

I want to be careful here. That does not mean loneliness automatically causes dementia, or that one loving relationship guarantees a longer life. But the message from decades of research is remarkably consistent: we are social creatures. Our brains and bodies do better when we have meaningful connections.

Don’t Let Technology Replace What Makes Us Human

So as AI becomes more present in our lives, I think we have a responsibility: do not let technology replace the relationships that make us human.

Protect the connections you already have. Call your parents. Check on your friends. Make time for the people who matter. And be willing to let new people into your life.

Every time you reach out to someone, listen deeply, share a laugh, offer comfort, or allow someone to help you, you are participating in the life of another human being. You are also giving your own brain an experience it was designed to have. Connection. Belonging. Love.

A Challenge for You This Week

So now, I have a challenge for you.

Think of three people who matter to you. Not three people you follow. Not three people you text with an emoji. Three people who truly matter.

And sometime this week, reach out to them. Call them. Meet them. Tell them what they mean to you. Tell them you love them from the bottom of your heart, even though you now know your love for them actually resides in your brain, not your heart.

And know this: the connection you share with them will contribute to your own brain vitality and longevity for years to come.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

📺 Watch https://youtu.be/OwfFXOhhBKY on Dr. Fotuhi’s YouTube Channel.

Keep up with Dr. Fotuhi on LinkedIn & Instagram.

References

1. Aron, A., Fisher, H., Mashek, D. J., Strong, G., Li, H., & Brown, L. L. (2005). Reward, motivation, and emotion systems associated with early-stage intense romantic love. Journal of Neurophysiology, 94(1), 327–337.

2. Eisenberger, N. I., Lieberman, M. D., & Williams, K. D. (2003). Does rejection hurt? An fMRI study of social exclusion. Science, 302(5643), 290–292.

3. Fisher, H., Aron, A., & Brown, L. L. (2005). Romantic love: An fMRI study of a neural mechanism for mate choice. Journal of Comparative Neurology, 493(1), 58–62.

4. Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237.

5. Liu, Y., & Wang, Z. X. (2003). Nucleus accumbens oxytocin and dopamine interact to regulate pair bond formation in female prairie voles. Neuroscience, 121(3), 537–544.

6. Livingston, G., Huntley, J., Sommerlad, A., et al. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413–446.

7. Pierce, A. F., Protter, D. S. W., Watanabe, Y. L., Chapel, G. D., Cameron, R. T., & Donaldson, Z. R. (2024). Nucleus accumbens dopamine release reflects the selective nature of pair bonds. Current Biology, 34(3), 519–530.

8. Waldinger, R., & Schulz, M. (2023). The Good Life: Lessons from the World’s Longest Scientific Study of Happiness. Simon & Schuster.

If you are an executive who works long hours and lives under a heavy load of stress, I want you to read this closely. I have some good news and some bad news about your brain. But first, let me tell you about a patient of mine.

He was a 49-year-old hedge fund manager. Over two years, he had become the most successful person at his firm and had been promoted twice. On the surface, everything was going right.

Underneath, though, he had started to notice changes. He was getting grumpy with his family more easily. He would forget the names of his own clients. During afternoon meetings, he would feel foggy and struggle to keep up with everyone else in the room. And because his father had struggled with dementia late in life, he had begun to fear this was the start of Alzheimer’s disease.

My first job was to figure out what was actually driving those changes.

The Belief That Holds Most Executives Back

Most high performers assume their mental sharpness will either hold up with age or slowly slip away, and that there is very little they can do about it. They picture the brain as a fixed structure, like a computer you cannot upgrade.

That is absolutely wrong.

Your brain is much more like a portfolio. It appreciates with the right investment. It depreciates with neglect. And either way, it is compounding, for better or worse, every single day.

A short temper, memory lapses, and afternoon fog are not signs of permanent damage. They are signals that your brain portfolio needs more attention. As my patient came to learn, these warning signs can be reversed.

The Bad News: How Your Routine May Be Shrinking Your Brain

Let me start with the bad news, because it matters.

Sustained stress keeps a hormone called cortisol elevated in your blood. Over time, elevated cortisol is linked to shrinkage in parts of your frontal lobes and your hippocampus, the very regions responsible for decision-making, executive function, leadership, learning, memory, and emotional regulation.

Think of chronic stress as an unhedged risk exposure. It sits quietly on your balance sheet, and if you never address it, it erodes the asset every single day it goes unmanaged.

Stress is not the only factor. A sedentary lifestyle, an irregular sleep pattern, a poor diet, and a lack of downtime and relaxation all shrink your cortex and hippocampus over time. And the more your brain atrophies, the worse you function, which, for a leader whose work depends on judgment, is the entire game.

The Good News: Atrophy Can Be Reversed

Now the good news, and it is substantial.

Based on compelling scientific evidence, atrophy in the frontal lobe and hippocampus can be reversed through what I call the five pillars of brain health.

Think of the five pillars as five separate investments in your brain. Each one alone is enough to make a real difference in your cognitive performance. But when you combine them, the returns do not just add up. They compound. Imagine what your brain will look like when all five are working for you at once.

1. Exercise: Aerobic activity, such as walking for an hour, raises levels of a molecule called BDNF, which actively supports growth in the brain. This is real capital appreciation on your brain asset, not vague wellness advice. It is one of the most direct and measurable levers available to you.

2. Sleep: Your brain has an innate cleanup operation called the glymphatic system, and it runs hardest during deep sleep, clearing out the metabolic waste that builds up during a normal day of thinking and working. Sleep fewer than six hours a night, and that clearance does not finish completely. Over time, the deficit compounds night after night, the same way unpaid interest compounds on a balance. Sleep is not rest for your brain. It is an active maintenance system that protects your principal.

3. Diet: What you eat becomes the literal building material for your brain cells. The Mediterranean diet, rich in olive oil, leafy greens, fish, nuts, and berries, supplies the omega-3 fatty acids and antioxidants that calm the inflammation eroding neurons over time. Think of it as the raw material you feed into the factory. Even the best machinery produces poor output if the inputs are poor.

4. Stress regulation. This is trainable, not a personality trait, and it functions as your hedge. Something as simple as breathing slowly for two minutes has real benefits for your brain, both in the short term and the long term.

5. Novelty and cognitive challenge. Brains that keep learning something genuinely new build what is called cognitive reserve, a protective buffer that makes the whole portfolio more resilient to future stress or decline.

Where to Start: Rebalance Your Weakest Position

Now comes the most important question. What can you do right now, in the shortest amount of time, to see the best results?

Pick the one lever that is the weakest position in your portfolio, and work on it for two weeks.

If it is sleep, look for the underlying causes and make fixing it a priority. You really do not want insomnia quietly shrinking your brain and compounding over time in a way that could raise your risk for Alzheimer’s disease.

If it is stress, build a system to reduce it by ten percent over the next two weeks. Make a list of what matters most in your life, and eliminate one or two responsibilities that matter least. You are a smart person; figure out what needs to change so you can have some calm, relaxing time in your day. Try breathing slowly for two minutes, without interruption, at least once a day. Do it when you feel overwhelmed, or right before you fall asleep.

What Happened to the Hedge Fund Manager

Let me return to my patient for a moment.

Once I walked him through what was actually driving his brain changes, he had a genuine aha moment. He decided to cut back on his hours. He realized that his family and his own life mattered more to him than getting promoted at an accelerated pace. That one shift changed everything.

After six weeks of working on all five pillars of brain health, he was calmer, happier, and sharper. In fact, he stopped worrying about Alzheimer’s disease altogether.

Your Brain Is the Asset Everything Else Depends On

Here is what I want you to take from this.

Your brain is the one asset that every other asset in your life depends on. Everything else you optimize sits downstream of it. Start managing your brain like the highest ROI investment you have, and you will notice the difference within weeks, not years.

I believe what separates a good leader from a great leader is how they care for their company and their people while also caring for themselves and their own brains. Sacrificing your wellbeing to drive company revenue takes a toll on brain vitality and accelerates decline in the prefrontal cortex and hippocampus, the very regions essential for making decisions under pressure, and for memory and learning.

Build the five pillars into your daily routine as much as you can, and you will notice a clear improvement in your brain function within weeks.

Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.

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