Keep Your Aging Brain Sharp—Here are the Best Ways

December 2025

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By Sarah Bonnema

Cognitive decline starts in your 30s. But you can slow it down.

If you’re over 30, neurologist Dr. Norman Bettle of Novant Health Neurology—Beaufort Plaza, has some unsettling news: You might be starting to cognitively decline. Studies show that by your 30s and 40s, you may be worse at learning new things than you used to be. And by your 50s and 60s, memory, retrieval, multitasking, and paying attention can become harder. The good news: You’ve also gained judgment and experience with age, so your overall performance is probably still better than during your younger years. And taking some proactive steps can help keep your brain sharp.

What is cognitive decline?
“Even though “cognitive decline,” (what many call “slipping”) sounds scary, it’s a normal part of aging that won’t end with a diagnosis for most of us,” said Dr. Bettle. The term refers to the loss of thinking abilities, which usually happens very slowly over decades. With typical cognitive decline, you’ll be able to function just fine by making adjustments like using a calendar, creating to-do lists, setting cellphone reminders and timers or writing notes as you learn a new process at work. You can make a sign reminding you to grab your phone and wallet when you leave the house, or use a pill container to visually check if you’ve taken your daily medications.

Creating routines that “automate” tasks, such as always putting your keys in the same place and charging your cellphone in the same place, can help free up your brain’s resources to focus and remember more complex things.

With adjustments like these, Dr. Bettle said, those experiencing normal cognitive decline from aging should be able to live independently into our 80s and 90s unless other physical health needs get in the way. But if these types of strategies aren’t helping, your decline has happened quickly, or family members are concerned you’re more forgetful than usual, see the box at the end of the article.

How to Slow Down Cognitive Decline:
Although you can’t prevent cognitive decline, you can slow it. We can make choices now to help our brains keep remembering, learning, and thinking clearly for as long as possible. Here are tips Dr. Bettle recommends for brain health—and those you can skip:

> Make lifestyle choices to delay or prevent vascular diseases that harm blood flow and circulation. This is a fancy way of saying manage your cholesterol and blood pressure, prevent Type 2 diabetes, if possible, and take care of yourself if you do develop diabetes. Get to and stay at a healthy weight. Don’t smoke.

> How does this help? Damage from vascular disease can lead to a type of dementia called vascular dementia, and vascular disease is also a risk factor for developing Alzheimer’s Disease.

> Diet matters: A Mediterranean diet has been shown to delay cognitive decline, but if that’s confusing, keep it simple: Roughly, avoid large amounts of animal fats, stick more to olive oils, and eat a balanced diet with fruits, vegetables, grains and lean proteins. Emerging research shows that certain “super foods”, such as blueberries, might improve brain health. But science doesn’t yet show eating a huge amount of any specific food prevents cognitive decline.

> Drink alcohol in moderation: “Neurologists generally agree that anything beyond two alcoholic drinks a day may be harmful,” Dr. Bettle said. And that’s two standard drinks (12oz beer; 5oz wine; and 1.5oz liquor), not two Long Island iced teas.

> Stay physically active—and you might like this definition: To delay cognitive decline, Dr. Bettle said, “Exercise within the physical limits you can, a few times a week. That may just be walking to where you break a sweat.” Research isn’t unanimous on the exact amount of exercise needed to delay cognitive decline, so don’t sweat that detail but still sweat. The main point is to do something physical, on purpose, a few times a week, to the point that you’re exerting yourself.

> If you’ve found yourself asking, Can you repeat that? recently, get help: Hearing impairment can speed up cognitive decline. If you’re having difficulty hearing, especially in social settings, get an evaluation and hearing aids, if warranted.

> There’s nothing magic about puzzles: Patients often ask Dr. Bettle if they should do crosswords or Sudoku to prevent cognitive decline. He said puzzles aren’t necessary, but cognitive engagement is. The point is to get thinking; passively watching TV isn’t cognitively engaging but discussing the show you just saw is.

> Good news for introverts: You may have heard staying social is important for brain health, but you don’t have to go out every night. It’s important not to get socially isolated, which reduces cognitive engagement significantly. If socializing is difficult for you, Dr. Bettle recommends attending group classes that address both physical and social health such as yoga or tai chi.

> Use vitamins and supplements only under medical supervision. Many have risks, especially if taken at excessive dosages, and some may not have benefits for your cognitive health. Talk to your primary care doctor.

Still concerned about cognitive decline?

Talk to your primary care doctor first to rule out physical causes like hypothyroidism, vitamin B-12 deficiency, hearing loss or depression. You may be referred to a neurologist or psychiatrist for additional assessment.

According to Dr. Bettle, the following two questions will provide you with critical information regarding cognitive decline:

1. With prompting, can I remember the right information? “The most important distinction for normal versus abnormal aging is whether or not a person can be prompted to remember,” Dr. Bettle said. For instance, you might remember meeting a new neighbor yesterday, but not his name. But when given a few choices of names, can you identify the correct name? “If the memory is somewhere in there, even if you can’t find the drawer right away, that is less concerning,” he added. “Abnormal aging, especially Alzheimer’s disease, leads to diminished ability to store new memories. If the name of the neighbor never made it into storage at all, as opposed to just not being able to retrieve the name in the moment, that is a warning sign for abnormal aging and abnormal cognitive decline.”

2. Am I aware of my slips? People who are truly developing dementia are usually not self-aware about the extent of their slips. In some people with dementia, some self-awareness may be present early on, but progressively the gap of self-awareness and true impairment widens. But many people are not aware and will fight allegations that they are showing signs of cognitive impairment. In contrast, people with “normal” cognitive decline are aware they’re forgetting things and will implement strategies to help themselves.

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Board-certified in neurology and in clinical neurophysiology, Norman Bettle, MD, joins Novant Health ready to serve the Lowcountry with trusted neurological care. Through his extensive expertise in diagnosing and managing a wide range of neurological conditions, Dr. Bettle will be a valuable resource for patients across the Lowcountry. His addition enhances access to high-quality, specialized care close to home—ensuring our community receives the neurological support it needs. To make an appointment with Dr. Bettle at Novant Health Neurology, call 843-836-3667.