3 things I'd never do as a neurologist — and the lesser-known signs of dementia to look out for

New York Post

08-05-2025

A good rule of thumb for protecting your brain health? If a neurologist wouldn't do it, you probably shouldn't either.
Nearly 7 million Americans and more than 55 million people around the world are living with dementia, an umbrella term used to describe several progressive disorders that affect memory and cognition.
While aging — and some age-related diseases — can't be prevented, our lifestyle choices can accelerate or decelerate the process.
Dr. Salvatore Napoli, the medical director at Neurology and Infusion Centers of New England, told The Post his three big no-nos on his list — plus some subtler signs of dementia to keep your eyes open for.
4 While other organs, such as the lungs, can recover after a person quits smoking, there are no subsequent increases in brain volume
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1. Smoking
People who smoke are more likely to have deterioration in gray and white matter, which provides a possible explanation as to why 14% of global Alzheimer's disease cases could be attributable to cigarette smoking.
When someone smokes, the person's blood vessel linings are 'bombarded' by free radicals, which are electrons that cause cell damage.
That impacts not only the heart and lungs but also the brain.
While other organs, such as the lungs, can recover after a person quits smoking, there are no subsequent increases in brain volume.
It has long been known that aging is linked to a gradual reduction in brain volume, and a 2024 study shows that smoking speeds up that process
The study found those who smoked one pack daily were found to have decreased brain volume compared to those who never smoked or had smoked fewer than 100 total cigarettes. With each additional year of smoking, the shrinkage was greater.
4 When we perform aerobic exercise, our heart pumps more blood to our brain, carrying vital oxygen and nutrients to keep our brains healthy.
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2. Lead a sedentary lifestyle
Staying active is among our best defenses against dementia according to Napoli.
A recent study published in the Journal of Alzheimer's Disease found that regular exercise — even as little as a few thousand steps — is associated with larger brain volume, suggesting it takes less exercise than previously thought to maintain cognitive function.
When we perform aerobic exercise, our heart pumps more blood to our brain, carrying vital oxygen and nutrients to keep our brains healthy.
Regular aerobic exercise has also been shown to significantly lower the risk of developing high blood pressure, diabetes, high cholesterol, and sleep apnea — these conditions can affect the brain. Some good exercises for the brain include:
Walking
Running
Cycling
Swimming
People who walk about 9,800 steps — around five miles — a day are 51% less likely to develop dementia than those who don't walk often, a 2022 Harvard study found.
And there's no better time than now to start putting in your steps and working up a sweat.
'Put yourself in a good position when you're younger so that things don't catch up with you when you're older. In other words, the good choices you make in your 30s, 40s and 50s will pay dividends in your 60s and 70s,' Napoli said.
4 The Alzheimer's Society lists stress as a major trigger for dementia, thanks to the constant release of cortisol, which can wreak havoc on memory over time.
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3. Spend life disappointed or anxious
'I would never spend my life thinking about, 'What am I going to get…'' said Napoli. 'Control the things you can control. It's important to live your life to the fullest.'
His advice echoes that of other experts who say prioritizing mental health is critical to staving off dementia as depressive symptoms can both worsen cognitive decline and impair quality of life.
Further, the Alzheimer's Society lists stress as a major trigger for dementia, thanks to the constant release of cortisol, which can wreak havoc on memory over time.
What you should do to protect your brain
In addition to his never list, Napoli shared three simple things people can do to slow or prevent the development of dementia.
They include keeping up with doctors appointments, being mindful of modifiable risk factors like high blood pressure, and leading a healthy, active lifestyle that includes a diet rich in whole foods.
'Everyone is different and there is a uniqueness to how each individual may experience cognitive decline. That's why the basics become so important: good sleep, regular exercise, reduction of stressors, good family support and socialization,' Napoli said.
4 Napoli notes that being aware of subtle warning signs can lead to early intervention and a more positive prognosis.
Dr. Salvatore Napoli
Look out for these signs
While many are aware of major warning signs of dementia such as memory loss, confusion, and trouble concentrating, he warned that people should be on the lookout for more subtle signs of cognitive decline.
'It's also a good idea to be mindful of behavior changes, such as becoming short tempered or impatient,' he said.
When observing a loved one, you may also notice that they forget to pay bills, forget people's names, or start to struggle with skills that once came easily.
Napoli noted that being aware and on top of these warning signs can lead to early intervention and a more positive prognosis.
'The earlier you can catch something the less damage accumulates, and you'll improve your chances of slowing the condition down. The earlier you intervene there is less of a chance of amyloid and tau accumulation in the brain,' he said.
In terms of treatment, Napoli said there's never been more hope for dementia patients.
'We have the opportunity to slow down the disease with new therapies, like Leqembi and Kisunla, and alter natural history of the condition.'
Napoli notes that diagnositc technologies like PET scans can lead to earlier diagnoses, better care and access to new treatments.
'This provides a gateway for future therapies where we can slow the disease even more and buy more time to get patients stable enough where we can add on therapies that might show the progression of Alzheimer's even more. This is the advent of bigger things to come,' he added.