At least 57 million people worldwide have some form of dementia. By 2050, that number is expected to more than double. And even more people are living with mild cognitive impairment (MCI) — an early stage of cognitive decline that can be a precursor to dementia.

While these numbers are staggering, studies have found that individuals can significantly reduce their odds of developing dementia through lifestyle changes. According to a recent report by the Lancet Commission, addressing 14 key risk factors associated with dementia — such as social isolation, physical inactivity, hypertension and alcohol consumption — can delay or prevent nearly half of all dementia cases.

“These findings — that many risk factors for dementia can be addressed through behavior change — have been hugely motivating for efforts to improve brain health on both an individual and population level,” says Seth Gale, MD, a Mass General Brigham behavioral neurologist. Co-director of the Brain Health Program, Gale studies how lifestyle modifications and other nonpharmacologic interventions can reduce the risk of cognitive decline.

One challenge Gale and his team are tackling is how best to educate people about making and maintaining brain-healthy behavioral changes. In 2018, they launched the Brain Health Champion study to determine if meeting one-on-one with a brain health coach over a 6-month period could help participants with MCI adopt and maintain brain-healthy habits.

“There’s a lot we know that can help reduce dementia risk, but we’re just not doing it,” says Gale. “What motivated us was wondering what healthcare providers can do to bridge that gap.”

The results were clear. Participants who were assigned a brain health coach were far more likely to adhere to behaviors associated with dementia risk reduction, including exercising, eating a healthy diet and engaging in social and cognitive activities.

Building on this initial success, the team launched a second phase of the study in 2019, incorporating technologies such as video conferencing software, wearable fitness trackers and food photologs into the health coach model. Preliminary results indicate that augmenting the coaching experience with digital health tools is feasible and effectively promotes brain-healthy behavioral changes.

“Participants got super into it,” says Gale. “There was great feedback on the usability of the technologies, and satisfaction with the program was high.”

Many participants found the program significantly enhanced their quality of life. Elizabeth Reed joined the study to improve her brain health while also giving back to Brigham and Women’s Hospital and Spaulding Rehabilitation Hospital, where she received care after suffering a stroke in 2017.

“My participation fortified my belief that individual lifestyle choices are decisive in preserving brain health,” says Reed. “The weekly check-in with my coach became a touchstone experience for me and added an external and welcome accountability to the pre-existing accountability I have with myself.”

Even though the study formally concluded in 2024, Reed foresees it having a lasting impact on her health. “The goal-setting aspect of the study, in particular, has stayed with me. I regularly record, revisit and augment my health and wellness goals, acting as my own coach,” she says. “And I still use the Fitbit to document aspects of my exercise and lifestyle I hadn’t tracked previously, which has greatly improved my goal setting.”

Gale views the brain health coaching model as an inexpensive, scalable and effective way to promote brain health, foster sustainable behavior change and address the public health burden caused by Alzheimer’s and other types of dementia. A pilot program integrating brain health coaching into clinical care is currently underway.

“This is such an exciting time for Alzheimer’s early detection and treatment,” says Gale. “There’s a lot of increased interest in modifiable risk factors for dementia and in efforts to couple drug treatments with lifestyle interventions.”

Gale is enthusiastic about how enhanced cross-institutional collaboration across Mass General Brigham will build on this momentum and continue advancing brain health initiatives in the future.

“It’s definitely an opportunity to bring together ideas and efforts that were siloed before,” he says. “With all our institutions coming together, there will be a lot of newfound synergy between clinical and research efforts.”