How to Become a Brain SuperAger
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Our understanding of what happens to the brain has changed completely in the past five to ten years. We are living through a major paradigm shift in how we view aging — and what we believe happens to the brain as we grow older.
The popular belief is that once you hit midlife, your memory fades, your thinking slows, and there is nothing you can do about it. Recent scientific discoveries, including my own research publications, tell a very different story.
I am a neurologist and a professor at Johns Hopkins with four decades of clinical and research experience in memory and Alzheimer’s disease. I want to introduce you to one of the most exciting concepts in modern medicine: becoming a Brain SuperAger.
What is a Brain SuperAger?
A Brain SuperAger is someone in their 80s or 90s who performs like a person 20 or 30 years younger.
My own grandmother was one. Even at 90, she loved volunteering in her community, joining her prayer groups, and reading books. She was vibrant and full of life until her very last days.
SuperAgers like my grandmother are not born special. Every day, they make choices that keep their brains healthy — and you can make those same choices, too. A person who exercises regularly, eats well, sleeps well, manages stress, and smiles often can remain strong and functional well into old age. Give your brain the right conditions, and it will thrive and grow. It will keep you sharp and vibrant for life. Neglect it, and it will shrink — bringing memory loss, confusion, and dementia.
The 10 ways we quietly shrink our brains
These are the most important ways we neglect the brain and cause it to shrink. Each one does its damage silently, in midlife, long before any symptoms appear.
- Chronic stress. Elevated cortisol damages the hippocampus, the thumb-sized region critical for learning and memory. The more years of chronic stress, the more the hippocampus shrinks.
- Poor diet. Highly processed foods and foods high in sugar impair brain function at a cellular level.
- Sedentary lifestyle. Physical inactivity reduces blood flow to the brain and lets brain cells shrink and fade.
- Poor sleep. During sleep, the brain literally cleans itself. Without it, toxic proteins such as amyloid accumulate and form plaques.
- Social isolation. Loneliness is one of the most powerful predictors of cognitive decline.
- Untreated depression or anxiety. These are not only mood disorders — over time, they physically shrink the brain.
- Uncontrolled high blood pressure. Vascular damage quietly erodes brain tissue for years before any symptoms appear.
- Obesity and metabolic syndrome. Insulin resistance in the brain is a key driver of memory loss and cognitive decline.
- Hearing and vision loss. When the brain stops receiving adequate sensory input, it begins to shrink.
- Low cognitive engagement. A brain that is not challenged is a brain that is not growing.
The good news is that every one of these factors can be addressed — often without medication — through better lifestyle choices. People who care for their brain every day, the same way they care for their skin, really do become SuperAgers.
What decades of research reveal
Researchers at Northwestern, Rush, Harvard, Johns Hopkins, and many other leading institutions have spent decades studying SuperAgers — people in their 80s who stay sharp and independent. What they found is remarkable.
These individuals carry no special genes. They have no special features. They have not discovered a secret supplement or a magic intervention. What they share is a pattern of healthy, consistent lifestyle habits maintained over decades. They exercise and stay active. They keep strong social connections. They sleep well. They eat diets rich in vegetables, healthy fats, and lean proteins. They keep learning — an instrument, a language, a curiosity about the world. Their brain MRIs show less atrophy and larger hippocampal volume than their peers. This is not anecdote. It is what science consistently shows across decades of research at the world’s leading universities.
Change how you think about aging
The most important step toward becoming a SuperAger is to change how you think about aging and the brain.
There is a deeply harmful narrative in our culture that cognitive decline is inevitable — that it simply happens, and nothing can be done. I have spent 40 years watching patients internalize that story and then unconsciously live it out. Do not accept that narrative.
If you are in your 50s, 60s, or 70s and feel you are not as sharp as you were a decade ago, that feeling is a signal, not a verdict. It is your brain telling you that something on the list of 10 factors needs attention. Go through them one by one and ask yourself honestly: Am I sleeping enough? Am I moving enough? Am I under chronic stress? Am I socially connected? Am I eating in a way that serves my brain?
Then begin to address whatever you find — on your own, with the guidance of my book The Invincible Brain, or with a health professional. Address those issues, and you will see a difference in your thinking within weeks. Your brain is far more adaptable than you believe. Neuroplasticity does not stop at 60 or 70; the capacity to grow, heal, and sharpen is present throughout your lifespan.
The 5 Pillars of Brain Health
Most of what I have described comes down to five pillars — the foundations of becoming a SuperAger.
- Regular exercise. Just 30 minutes of walking, five days a week, increases the size of your hippocampus and boosts BDNF, the brain’s growth hormone.
- Brain-healthy nutrition. A Mediterranean-style diet rich in olive oil, fish, leafy greens, nuts, and berries has been shown in multiple large studies to lower the risk of Alzheimer’s and slow cognitive decline.
- Optimal sleep. Seven to eight hours of quality sleep each night lets the brain flush out toxic proteins. Sleep is not passive — it is active brain maintenance.
- Stress reduction. Chronic stress is one of the fastest ways to age the brain. Mindfulness, social connection, time in nature, and regular exercise all protect and nourish it.
- Cognitive engagement. Challenging the brain with novel, complex activities — a new skill, a hard problem, structured brain training — builds cognitive reserve and expands resilience.
These pillars work together. Strengthen one, and you tend to strengthen the others, and the cumulative effect over time is profound.
Becoming a SuperAger is not about perfection. It is about awareness, intention, and consistency. Your brain responds to how you treat it, and the choices you make today are quietly shaping the brain you will live with tomorrow. You do not have to accept cognitive decline as your destiny. You can aim, instead, to become a Brain SuperAger.
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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Test Your Own Brain Health in Ten Questions
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
What is a good brain health score?
40 or higher out of 50 means you are in good shape. Below 40 means there are specific areas worth working on.
How often should I score myself?
Once a week. Use the same judgment each time so your week-to-week trend is meaningful.
How long does it take to improve my score?
Most people can raise it within 12 weeks by working on their weakest areas.
Does it matter if I score an answer a 3 instead of a 4?
Not really. Since you are scoring yourself consistently over time, the trend matters far more than any single rating.
What omega-3 dose do you recommend?
An omega-3 supplement with DHA and EPA, at around 1000 mg a day. It is the one supplement I recommend to everyone.
I do not enjoy sitting meditation, Is there an alternative?
Yes, try a breathing exercise instead: in for a count of seven, hold for seven, out for seven, for about ten minutes.
My lowest score is sleep, Where do I start?
Sleep has its own set of fixes, so read my separate article on improving sleep and begin there.
Can I really change my brain at my age?
Yes, the brain responds to how you live at every age, which is the whole reason this score is worth tracking.
What is the lowest possible score, and what does it mean?
The lowest is 10, which means all ten areas need attention. It is not a verdict on your future, just a clear signal of where to begin.
Do I need any special equipment or tests to score myself?
No, You answer the ten questions honestly and add them up. The assessment on my website does the scoring for you and adds a written report.
Which of the ten should I fix first?
Start with your single lowest score, since that is where you will see the biggest gain for the least effort.
Can I improve more than one area at once?
Yes, and they tend to help each other. Better sleep makes exercise easier, and exercise improves sleep, so progress in one area often lifts the others.
Is a score of 40 a reason to stop trying?
No, 40 means you are in good shape, not that you are finished. Keep your habits going and raise individual scores when you can.
How is this different from the free assessment on your website?
The ten-question score is a quick self-check you can repeat at home. The Invincible Brain Assessment takes about 10 minutes, scores you across all five pillars, and sends back a personalized 10-page report.
Is this a diagnosis?
No, It is a self-assessment to track your habits and progress, not a medical diagnosis. If you have real concerns about your memory, see a physician.
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
How HIV Affects the Brain, Even When the Virus Is Controlled
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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Why I Stopped Accepting "It's Just Alzheimer's"
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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