Brain Health Is Shaped by Lifetime Factors, New American Heart Association Statement Says

A new scientific statement from the American Heart Association highlights that brain health is not solely determined by genetics or later-life events but is shaped by a lifetime of mental, physical, environmental, and lifestyle factors. Published today in the Association’s journal Stroke, the statement, “Brain Health Across the Life Span: A Framework for Future Studies,” underscores the importance of early detection, prevention, and intervention to protect brain health and support healthy aging.

According to the U.S. Census Bureau, the number of U.S. adults ages 65 and older is projected to increase from 58 million in 2022 to 82 million by 2050, a 42% rise. This demographic shift is expected to increase the prevalence of brain conditions affecting memory, thinking, and mental health. “As medical and scientific advancements have extended life expectancies, brain health has become increasingly important,” said Dr. Elisabeth Marsh, chair of the writing group and professor of neurology at Johns Hopkins University School of Medicine. “The number of people with age-related cognitive impairment is rising rapidly, creating significant personal, emotional, and health care system burdens.”

Stroke is now the fourth leading cause of death in the U.S., according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics. A 2023 scientific statement on cognitive impairment after stroke noted that more than half of stroke survivors develop cognitive impairment within the first year, and up to one in three may develop dementia within five years.

The statement expands beyond traditional vascular risk factors like blood pressure and cholesterol to include psychological, environmental, and social determinants. Mental health, including chronic stress, depression, and anxiety, can cause physiological changes such as inflammation and loss of brain cells, increasing the risk of memory loss and stroke. Adverse childhood experiences, such as abuse or neglect, may raise the risk of cognitive decline later in life. Chronic inflammation, triggered by infection during pregnancy or ongoing stress, can damage brain cells and blood vessels. The gut microbiome also plays a role; healthy gut bacteria help protect the brain, while imbalances are linked to Alzheimer’s and Parkinson’s diseases.

Obesity, poor sleep, and social drivers of health—including lower socioeconomic status, limited access to healthy foods, and unstable housing—further contribute to cognitive decline. Environmental exposures like air pollution, heavy metals, and microplastics can slowly damage the brain by triggering inflammation and harming blood vessels.

The statement encourages healthy lifestyle habits outlined in the American Heart Association’s Life’s Essential 8: regular physical activity, blood pressure control, healthy sleep, not smoking, and stress management. A Mediterranean-style diet rich in fiber and fermented foods supports gut and brain health, while avoiding heavy alcohol and substance use improves mental health.

“Brain health is a lifelong journey, influenced by our mental well-being, environment and lifestyle choices from childhood through late adulthood,” said Dr. Mitchell Elkind, chief science officer for brain health and stroke at the American Heart Association. “Every stage of life offers a new opportunity to nurture our brains and minds, supporting healthier aging and reducing the risk of cognitive decline, dementia, stroke, depression and other brain disorders.”