How To Prevent Cognitive Decline

By: Holly L. Thacker, MD • Posted on March 27, 2025

WHAT IS COGNITIVE DECLINE?

Some gradual mental decline is considered normal as people age and it is called cognitive decline.

These declines due to aging should not affect someone’s daily life and activities and include a gradual loss of thinking abilities like learning, remembering, reasoning and paying attention.

There are four stages of cognitive decline:

No cognitive impairment – No decline or problems in remembering or thinking.
Subjective cognitive decline – Some decline in thinking abilities but no interference with daily activities.
Mild cognitive impairment – Important memory impairments occur without loss of independent functioning. Forgetfulness and struggling to perform self-care tasks (for example, taking medications, paying bills) but still able to do so without the direct help of another person.
Dementia – A loss of memory, language, and other thinking abilities that interfere with daily life.

Research has shown that women may have greater cognitive reserve but faster cognitive decline than men. The reason is unknown but thought to be related to female hormones. It appears that estrogen (especially if taken within 10 years of menopause) has some neural protective abilities and women with “brain fog” subjectively report improvement in word-finding ability with menopausal hormone therapy. Recent research has shown improved cognition and larger brain volumes in at-risk APOE4 women.

Certain genes can increase the risk of developing dementia, including Alzheimer's disease. Women with the gene APOE3/4 and APOE4 have a 3-4 fold and 12-15 fold increased risk of SDAT (Senile Dementia of the Alzheimer's Type) relative to women with the wild-type APOE3/E3 genotype, with cognitive decline appearing several years earlier. The APOE2 gene seems to protect against SDAT.

WHAT ARE THE SIGNS OF COGNITIVE DECLINE?

Each person experiences cognitive decline differently. However, the most common symptoms include:

Trouble finding the right words to express yourself
Lose or misplace items
Forget dates, appointments or events
Overwhelmed by tasks

WHEN TO TALK TO YOUR DOCTOR ABOUT MEMORY LOSS

If you experience any of the following, it’s important to talk with your healthcare clinician:

Forgetfulness or amnesia for recent events
Need to write reminders to do things or else will forget
Struggles but is able to perform daily chores and tasks
Sometimes needs a reminder or prompt to remember
Unable to perform complex daily tasks (for example, paying bills, taking medications, shopping, driving)
Loss of insight or awareness of memory loss
Poor judgment
Behavioral symptoms (for example, irritability worrying, anger, agitation, suspiciousness)

TREATMENT FOR COGNITIVE DECLINE

Treatment for cognitive decline will vary depending on the symptoms. It’s important to talk with your healthcare clinician to determine the best treatment. Some potential treatments include medications, lifestyle modifications and supplements.

Medications

CerefolinNAC

CerefolinNAC is a so-called “medical food” specially formulated to meet the distinctive nutritional requirements of patients with a type of memory loss called mild cognitive impairment. CerefolinNAC was originally only available by prescription, but now is available over-the-counter making it convenient for those adults who suffer from mild cognitive impairment.

What are the ingredients in CerefolinNAC?

Active Folate: L-Methylfolate is the active form of folate that supports memory and focus-related neurotransmitter production, while improving brain metabolism.
Vitamin B12: Methylcobalamin (vitamin B12) boosts energy production to support overall brain function.
N-Acetyl-l-cysteine (NAC): NAC contributes to brain health by reducing oxidative stress.

What are the benefits of CerefolinNAC?

CerefolinNAC is backed by an MRI study and up to 7 years of clinical data from the same patients, showing long-term use may help slow cognitive decline and maintain essential brain function. Starting CerefolinNAC early can help protect your brain cells, slow the loss of brain function and improve your overall quality of life.

As of March 2025, CerefolinNAC is available over the counter and is called “Cerefolin Brain Wellness.” Cerefolin Brain Wellness is free and clear of all dyes, preservatives, allergens, and is caffeine free.

Those with MTHFR mutations may benefit from methylated B complex vitamins especially if their homocysteine levels are elevated.

Supplements

Vitamin B12

A new study in older adults with low levels of vitamin B12, but still in normal range showed signs of neurological and cognitive deficiency.

More research is needed on vitamin B12 insufficiency as it may be a preventable cause of cognitive decline. Healthcare clinicians should consider vitamin B12 supplements in older adults with neurological symptoms even if their levels are within normal limits.

Omega 3 fats

Omega 3 fatty acids support brain cell health and help facilitate communication, boost brain blood flow and support cognition. Signs of omega-3 deficiency can include brain fog, poor memory, trouble concentrating as well as skin problems, dry eyes, brittle nails, joint pain, insomnia and even ear wax build up!

Magnesium

Some studies suggest that magnesium is linked to better cognitive function and may reduce dementia risk.

People who consume more than 550 mg of magnesium daily had higher brain volumes than people who only consume 350 mg of magnesium daily. These effects were greater in women than compared to men.

Dietary surveys of people in the United States consistently show that many people consume less than the recommended amounts of magnesium. The daily recommendation of magnesium for adult females is between 310-320 mg. Adult males need between 400-420 mg each day.

Foods such as avocado, nuts, pumpkin seeds and bananas are high in magnesium. If you are unable to get the recommended amount of magnesium through your diet, talk with your healthcare clinician about taking a magnesium supplement.

LIFESTYLE CHANGES

Diet - Eat a whole food plant-based diet, a Mediterranean diet or the MIND diet. Avoid unprocessed foods and focus on whole foods.
Exercise – The more physical activity, the lower the risk of cognitive decline.
Social interaction - Communication stimulates and engages different parts of the brain. Social isolation after age 65 is one of the modifiable risk factors of dementia.
Reduce screen time - Watching television for more than 3.5 hours per day is associated with a dose-response decline in verbal memory.
Learn new things – Trying new things stimulates different parts of the brain and strengthens brain function.
Work or Volunteer - Work-related tasks stimulate the brain through the use of different cognitive functions like thinking, reasoning, communicating, organizing, and problem solving.

Be Strong, Be Healthy, Be in Charge!
-Holly L. Thacker, MD

About Holly L. Thacker, MD, FACP

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Specialized Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Her special interests are menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. Dr. Thacker is the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause.

cognitive health, cognitive decline, vitamin B12, magnesium, omega-3 fats, mental decline, aging, memory, memory loss, dementia, Alzheimer's Disease, mild cognitive impairment

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