The Four Stages of Cognitive Decline — And Why Early Testing Matters

Inspired by insights from The Ageless Brain, NPA Book Study Series

Cognitive decline doesn’t happen overnight. According to The Ageless Brain, the brain follows a surprisingly predictable path as it ages — and understanding this path is the key to preventing long-term damage. The earlier you monitor your brain health and address subtle shifts, the more powerfully you can intervene using neuroplasticity-based strategies.

Below is an easy-to-understand breakdown of the four stages of cognitive decline, plus why the MoCA Test is one of the most important screenings adults should complete at least once per year.

Stage 1: Presymptomatic — But Invisible Risks May Be Growing

Most people in this stage feel mentally sharp: good memory, strong focus, normal problem-solving.But Ageless Brain explains that microscopic changes — oxidative stress, inflammation, poor sleep, exposure to toxins and nutrient deficiencies — often begin years before symptoms appear.

What to watch for:

• Increased stress or emotional reactivity

• Occasional forgetfulness

• Poor sleep quality

• Heavy workload or burnout

Why it matters: Neuroplasticity is highest before symptoms appear, which means your brain can still easily rewire itself. Prevention is easier than reversal, so stay focused on taking actions that will help you thrive in the long-term.

Recommended Actions: In addition to minimizing sugar intake and staying physically active, make it a habit to lower cortisol every day through activities that truly relax you — such as meditation, yoga, deep breathing, enjoyable hobbies, or time in nature.  Dr. Bredeson also recommends taking the new highly sensitive blood test for phosphorylated tau 217 (p-tau217) every five years starting as early as age 35.  The test can detect early Alzheimer’s-related brain changes up to 15–20 years before memory loss or other symptoms appear. Getting this test every five years is a smart way to establish your personal baseline and catch any changes early, when protective lifestyle measures are most effective.

Stage 2: Subjective Cognitive Impairment (SCI)

This is the phase most people brush off as “aging” — but it’s actually the brain waving a yellow flag. People in SCI notice changes, but tests often appear normal.

Common signs:

• Losing words or names more often

• Needing more reminders

• Feeling mentally foggy

• Slower recall

• Difficulty multitasking

Research shows that SCI increases risk of later cognitive impairment, especially when combined with chronic stress, poor sleep, or high inflammation. For most people, SCI lasts about ten years— and is readily reversible.

Why it Matters: These are not normal signs of aging, but of brain decline, which can be reversed with a personalized care plan that identifies the specific factors causing your damage.

Recommended Actions: Take the full MoCA test to assess your level of cognitive decline and do so every 6 months to track your progress as you work with a certified ReCode Physician and Coach to determine which health factors are causing damage.   

Stage 3: Mild Cognitive Impairment (MCI)

MCI is the turning point — where symptoms are measurable, but you can still perform activities of daily living.

This stage is where intervention is CRITICAL. According to The Ageless Brain,  programs that enhance the brain’s neuroplasticity and overall function (movement, diet, supplements, brain exercises, emotional regulation work, and stress reduction) can still create significant improvement in this phase, stopping the decline and even recovering lost function.

Signs of MCI include:

• Noticeable memory loss

• Trouble planning or organizing

• Repeating questions

• Losing track of tasks

• Difficulty with numbers, conversations, or directions

Why it Matters: About 5 to 10% of patients with MCI will convert to dementia each year, however it is still possible to stop and reverse the decline.

Recommended Actions: Rigorous adherence to the ReCode Protocol is required.  Added stress or illness can cause significant relapses.  

Stage 4: Dementia

At this point, cognitive changes interfere with daily life. Memory, reasoning, and emotional regulation become widely affected.

While dementia is not fully reversible, people with strong neuroplasticity practices often experience:

• Slower progression

• Improved mood

• Better emotional stability

• Greater quality of life

• Enhanced independence

Why Early Testing Is Essential: The MoCA Test

The MoCA (Montreal Cognitive Assessment) is one of the best, simplest tools to detect early cognitive changes — especially in Stages 2–3.

The test measures:

✔ Memory

✔ Visuospatial skills

✔ Attention

✔ Language

✔ Executive function

✔ Orientation

It takes 10 minutes — and can literally change the trajectory of someone’s brain health.

We encourage:

• Adults 45+ to take the MoCA yearly

• Adults with family history of dementia to test every 6–12 months

• Adults under high stress (burnout, caregiving, chronic illness, trauma) to test routinely as a preventive measure

This gives early detection and the opportunity for a proactive neuroplasticity plan.

How Neuroplasticity Protects the Brain

As emphasized in The Ageless Brain, the brain can strengthen and regenerate even in older age through:

• Movement

• Novel learning

• Social engagement

• Stress reduction

• Diet and supplements

• Acetylcholine-supportive foods

• Breathwork & meditation

• Sleep optimization

• Purpose-driven activities

The goal at NPA is to translate these steps into simple, accessible, measurable tools for families and organizations.

The earlier you know your baseline, the more powerfully you can preserve your brain.

Cognitive decline is not inevitable.It is a spectrum — and early testing + neuroplasticity practices are the difference between decline and lifelong resilience.

About NPA (Neuroplasticity Alliance)

The Neuroplasticity Alliance is committed to educating communities, families, and organizations on the power of neuroplasticity to improve brain health, emotional well-being, learning, and longevity. Through outreach, training, and accessible science-based tools, NPA helps individuals understand how the brain changes — and how to intentionally shape those changes for a healthier, more resilient life.