Cognitive Resilience Strategies Spotlighted at ADCD Symposium
Key Clinical Summary
- Alzheimer disease (AD) affects ~7.2 million Americans, with annual US costs near $384 billion; multifactorial prevention targeting 14 modifiable risks could avert up to 45% of dementia cases.
- Lifestyle interventions (MIND/Mediterranean-style diet, regular exercise, cognitive/social engagement, risk-factor control) improved cognition in FINGER and US POINTER trials, and remain the foundation of brain health.
- Anti-amyloid antibodies (lecanemab, donanemab) slow decline in early Alzheimer disease; benefits relate to substantial amyloid reduction and may be greater with lower tau—raising prospects for earlier, combination strategies.
On Thursday, November 13, at the inaugural Alzheimer’s Disease and Cognitive Disorders (ADCD) Symposium, the session “Building Cognitive Resilience: A Clinician’s Guide to Supplements, Brain Tonics, and Preventive Approaches” emphasized that resilience and risk reduction can meaningfully shape cognitive aging. Led by meeting Co-Chair Mark Agronin, MD, Miami Jewish Health, and James Galvin, MD, MPH, University of Miami, the discussion connected epidemiology, lifestyle, and emerging immunotherapies to pragmatic dementia-prevention frameworks for clinical practice.
Session Highlights
Dr Agronin outlined the public-health burden—7.2 million Americans with Alzheimer disease (AD) and rising prevalence with aging—yet noted declining incidence in younger cohorts, likely tied to lifestyle shifts. Stress, loneliness, multimorbidity, and sensory loss compound late-life cognitive risk, while psychological resilience, purpose, and “post-formal” wisdom may buffer adversity.
He also summarized the Lancet-aligned model of 14 modifiable risk factors spanning life stages, including education, midlife hearing loss, lipids, depression, TBI, inactivity, diabetes, smoking, hypertension, obesity, alcohol, late-life social isolation, prior air pollution, and visual loss. It is estimated that comprehensive mitigation could prevent up to 45% of dementia cases. Clinically, patients should be prescribed moderate physical activity most days for 30 to 60 minutes; adherence to the MIND/Mediterranean diet with emphasis on fish, olive oil, fruits, and vegetables; sleep optimization; vascular risk control; and cognitive cross-training.
Dr Galvin then reviewed supplements that, despite wide use, make claims based on small, low-effect studies. For example, over-the-counter memory boosters (eg., ginkgo extracts) have not shown benefit in rigorous randomized controlled trials. Some targeted supplementation (eg., vitamin D, B12, folate in deficiency states or vegan diets) can be appropriate, but whole-food patterns outperform single-nutrient pills.
Regarding disease-modifying therapies, lecanemab and donanemab produced separation on global, cognitive, and functional outcomes in early Alzheimer disease, with efficacy linked to large amyloid reductions and modulated by tau burden. Prevention-stage trials for the therapies are underway, most notably AHEAD 3-45 (lecanemab in cognitively normal adults with elevated tau) and TRAILBLAZER-ALZ 3 (donanemab in adults with preclinical Alzheimer disease with enrollment stratified by phosphorylated tau).
Expert Perspectives
According to Dr Agronin, brain health is built through consistent habits: exercise elevates brain-derived neurotrophic factor (BDNF), enhancing synaptic connectivity, sleep, mood, and stress tolerance—benefits that patients feel quickly and endure when activities are enjoyable. He highlighted volunteering and social and spiritual engagement as potent, scalable resilience tools that reduce cardiovascular events and mortality while enriching purpose.
Dr Galvin cautioned that “a supplement by itself offers very little benefit.” He underscored that multimodal therapy—as in oncology or HIV—will likely be necessary in Alzheimer disease, with anti-amyloid plus anti-tau and adjunct repurposed agents both under study. Early immunotherapy may function as tertiary prevention now (prolonging early stages) and possibly secondary/primary prevention pending outcomes from AHEAD and TRAILBLAZER.
Implications for Practice
Prioritize lifestyle prescriptions (MIND diet, exercise, cognitive/social engagement, sleep, vascular risk control, hearing/vision optimization) for every patient, regardless of APOE status. Use supplements only to correct documented deficiencies. For eligible patients with early Alzheimer disease, discuss lecanemab and donanemab candidly—mechanisms, monitoring needs, and expected magnitude of benefit—while reinforcing that behavioral risk reduction remains foundational.
Evidence continues to favor structured, multi-domain prevention with selective use of immunotherapy in early Alzheimer disease. Pending results from AHEAD and TRAILBLAZER-ALZ 3 will clarify preclinical applications and future combination strategies, guiding updates to clinical pathways and prevention counseling.
For more information about the Alzheimer’s Disease and Cognitive Disorders Symposium, visit the meeting website.
Reference
Agronin M and Galvin J. Building cognitive resilience: A clinician's guide to supplements, brain tonics, and preventative approaches. Presented at: Alzheimer’s Disease and Cognitive Disorders Symposium; November 12-13, 2025; Virtual.
