This Thanksgiving, Bring Brain Health to the Table

Ah, Thanksgiving, when families gather. When the air is crisp and aromas from the feast-in-preparation provoke salivation and prodigious debates about which pie is best. Ah, Thanksgiving, when the kids come home and notice. . . wait, what’s wrong with Mom? Why didn’t she remember that I got divorced? Or, hold on, is my uncle’s shirt on backward? What’s going on? Yes, Thanksgiving, can also be when the kids come home and notice subtle (or shocking) changes in loved ones. What to do?

Here's a suggestion—use Thanksgiving to start the brain health conversation. Daunting? Probably. But read on for tips about doing it well—and most especially why. Let's start with the why.

Science confirms that cognitive function naturally changes with age, but the changes vary widely. Some people retain sharp mental abilities into their nineties, while others experience significant decline decades earlier. Establishing a cognitive baseline through early and regular screening helps differentiate normal aging from potentially treatable impairments, enabling earlier and more informed interventions that can preserve independence and quality of life for years.

Age is among the strongest risk factors for cognitive decline, and more than 11,000 Americans turn 65 daily. Together, this means the U.S. faces a critical public health challenge. Yet, many of us shy away from discussing cognitive health at festive holiday gatherings. Or, ever. Regular colonoscopies and cardiovascular check-ups are commonly discussed, but conversations about cognitive assessment remain glaringly absent from preventive health dialogues.

The July 2024 Lancet Commission on Dementia report emphasizes that addressing 14 modifiable risk factors—like hypertension, diabetes, smoking, and social isolation—could potentially prevent or delay nearly 50% of dementia cases. Early cognitive screenings can identify risks and describe strategies to reduce them, significantly improving long-term brain health outcomes.

Despite the clear benefits, our healthcare system falls short. Medicare’s annual wellness visit mandates a brief cognitive screen, but comprehensive evaluations aren’t covered unless symptoms are evident—discouraging early detection. Worse, fewer than half of eligible patients receive even this basic screen, though nearly all primary care clinicians acknowledge its importance. The Alzheimer’s Association estimates that early diagnosis could save nearly $7.9 trillion in direct medical and unpaid caregiving costs. Preventive brain care is a missed opportunity.

This gap is even more concerning given recent advances in diagnosing and treating cognitive decline. The FDA has approved blood-based biomarker tests that can detect Alzheimer's disease pathology years before symptoms arise. Two newly-approved medications show promise in slowing disease progression. When combined with advanced cognitive assessment tools and brain imaging techniques, our opportunities to identify and address cognitive decline early are unprecedented. Yet many Americans go years without a formal cognitive evaluation, often waiting until symptoms disrupt daily life. By then, critical intervention windows are missed.

So why aren’t we having these conversations? Perhaps it’s the stigma surrounding cognitive decline or the misconception that “nothing can be done.” This belief is as pernicious as the myth that cognitive decline is inevitable. Just as we don’t wait for symptoms to get colonoscopies or mammograms, we shouldn’t delay cognitive assessments until memory lapses become debilitating.

To approach these conversations during Thanksgiving, the goal is less to point out a loved’s deficits than to embrace brain health, proactively, as an integral part of well-being. Try these tips for navigating the topic with empathy and ease:

1. Be curious: Use open-ended questions to encourage dialogue, such as, “How have you been feeling lately?” or “I am concerned about you. Let’s talk.” 
2. Frame it as shared concerns: Instead of singling out one person, consider “I’ve been reading about brain health. I think we should pay attention to something this important, as a family.”
3. Normalize it: Share personal anecdotes or mention routine health checks to reduce defensiveness. For example, “I’m getting my brain health evaluation next month. I’ll let you know how it goes!”
4. Empower, don’t alarm: Focus on the benefits of early detection rather than potential problems. “Catching small changes early can help us all stay independent and healthy longer.”

These conversations require sensitivity. Avoid making the person feel interrogated or judged. Frame brain health as a shared commitment and suggest next steps that feel manageable, like scheduling a cognitive screening or learning more about brain health, but doing it together.

This Thanksgiving, talking turkey about brain health is about more than addressing concerns. It’s about embracing a proactive approach to aging and health—together. With advances in diagnostics and interventions, we have more tools than ever to support cognitive wellness. Normalizing these conversations now could make all the difference in the years to come.

So, pass the cranberry sauce—and let’s talk brain health.

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Looking for more guidance on how to discuss brain health, changes in memory and thinking, and cognitive testing with a loved one? In this video, Dr. Amy Sanders offers helpful tips to encourage your loved one to consider a cognitive assessment.