Brain & Cognitive Health
Brain health is where the evidence is strong about a few things and genuinely uncertain about many others. Sleep, hearing, blood pressure and activity have real support behind them. A good deal else marketed for the brain does not, and being clear about which is which is more useful than being encouraging.
What this means for healthspan
Brain and cognitive health covers memory, attention, thinking speed and everyday mental function. It is influenced by age and genes, and also by factors we can act on, such as blood pressure, hearing, sleep, mood, activity and social connection.
Research suggests that many of these factors matter across decades, starting in midlife. Not every factor can be changed and no approach can guarantee protection, but looking at them together can help you and your clinician focus on what is most likely to matter for you.
What we assess, and why
We may use a cognitive screening tool when appropriate, a neurological history and examination, and a review of sleep, mood, hearing, vascular risk factors and relevant blood tests. Advanced imaging may be considered when clinically indicated.
Recognizing changes and addressing contributing factors can help guide further assessment and support cognitive health. Cognitive screening is not offered as a routine test for everyone. It is most useful if you or someone close to you has noticed a change.
What we may assess
Cognitive screening when appropriate, neurological history and examination, sleep, mood, hearing, vascular risk factors and relevant laboratory investigations. Advanced imaging may be considered when clinically indicated.
What is used is chosen for you, according to your individual risk, clinical appropriateness, the evidence and what you decide with your physician.
Why it matters
Recognizing changes and addressing contributing factors can help guide further assessment and support cognitive health.
Examples of assessments and investigations
These are examples of what may be considered. Which of them are used for you depends on your history, your risk and what you decide with your physician.
Cognitive history and conversation
A careful discussion of what has changed, how quickly, and how it affects daily life. Input from a family member or friend, with your permission, is often helpful.
Cognitive screening questionnaire
A short set of tasks that checks memory, attention and thinking. It is considered if you or others notice changes, not as a routine test for people without concerns.
Neurological examination
A physical check of strength, balance, reflexes, vision and coordination, which can point to causes other than ageing.
Sleep review
Questions about sleep length, quality and snoring or pauses in breathing. Sleep problems, including sleep apnea, can affect memory and concentration and may be assessed further.
Mood and stress review
Low mood, anxiety and stress can affect thinking and can look like memory problems. Validated questionnaires may be used.
Hearing and vision check
Simple screening, with referral for a full hearing test or eye assessment where needed. Hearing loss is a recognized risk factor for later dementia.
Blood pressure and vascular risk review
Blood pressure, blood sugar, cholesterol and smoking are reviewed because they affect blood flow to the brain.
Blood tests for contributing causes
Tests such as blood count, thyroid, vitamin B12, kidney function, calcium and blood sugar, chosen by your symptoms. They can find treatable contributors to memory or thinking problems.
Brain imaging
CT or MRI may be considered if symptoms, examination findings or test results suggest a cause that imaging could identify. It is not used to screen people without symptoms.
What the evidence supports, and where it is uncertain
What the evidence supports
- The 2024 Lancet Commission on dementia identified 14 modifiable risk factors, including hearing loss, high blood pressure, high LDL cholesterol, diabetes, physical inactivity, smoking, depression, excessive alcohol, social isolation and untreated vision loss. It estimated that addressing them could prevent or delay a substantial share of dementia cases.
- The Alzheimer Society of Canada recommends physical activity, hearing care, social connection, managing blood pressure and diabetes, not smoking, limiting alcohol, treating depression, protecting the head and getting good sleep.
- Medical conditions such as thyroid problems, low vitamin B12, depression and medicine side effects can affect thinking and are treatable when found.
- Assessing someone who has noticed a change, rather than testing people without concerns, is the approach supported by Canadian guidance.
Limits and uncertainties
- The Lancet Commission's estimate assumes that the risk factors cause dementia and can be removed. It describes potential population benefit, not a guaranteed result for any one person.
- The Canadian Task Force on Preventive Health Care recommended against instrument-based cognitive screening in adults 65 and older without symptoms, citing a lack of evidence of benefit and a risk of false positives. This was reaffirmed in 2024.
- In a large trial of intensive blood pressure treatment, the lower blood pressure target reduced mild cognitive impairment but the reduction in dementia was not statistically significant.
- A large trial of hearing intervention did not show a benefit across all participants. A possible benefit was seen in a smaller higher-risk group and needs confirmation.
- Many brain health products and tests are marketed without good evidence. Memory scores can vary with sleep, mood, stress and illness, so one low result does not mean dementia.
From findings to a plan, and what follows
How findings can inform a plan
Findings are used to look for contributors that can be treated, such as untreated high blood pressure, hearing loss, poor sleep, low mood or medicine effects, and to set priorities with you. A plan may include activity, sleep and hearing care, social connection, nutrition and review of vascular risk. If there are signs of a possible memory condition, we explain the next steps and refer for specialist assessment. We will not suggest unproven products or promise any particular outcome.
Follow-up, monitoring and coordination
Follow-up may include repeating a cognitive check after a period of time to see whether there has been a change, rechecking contributing factors once treated, and coordinating with your family doctor, audiologist or specialists. If you are concerned about memory changes, we can involve a family member or support person with your agreement and connect you with community supports such as those offered by the Alzheimer Society.
What happens here
The approach is the same in every area: establish where you are, change something on a cadence, then measure again to find out whether it worked. In brain & cognitive health that work is organized into the programs below.
Brain Health
Assessment and protection of memory, thinking and cognitive health.
What this involvesSleep & Recovery
Assessment and improvement of sleep and recovery.
What this involves
Memory Concerns Check (for Families)
Eight short questions answered by a family member about someone they're caring for. Designed to surface early cognitive change. It runs in your browser and takes about 4 minutes. Your answers are not sent to us; if you're signed in, your result is saved to your account.
Reliable places to read more
These are independent organizations. Monarch Health does not control their content and has no arrangement with them.
Alzheimer Society of Canada
10 ways to reduce your risk of dementia(opens in a new tab)
Heart & Stroke
High blood pressure(opens in a new tab)
Hypertension Canada
Public resources on blood pressure(opens in a new tab)
HealthLink BC
24/7 health advice and health information(opens in a new tab)
Where to go next
The other areas we work on