Many women still believe mammograms should start at age 50—experts say age 40

 Key takeaways

• 44% of women incorrectly believe mammograms should start at age 50.
• The survey found widespread confusion about screening guidelines, which can delay detection.
• CDC’s U.S. Cancer Statistics show breast cancer rates are rising among women younger than 45.
• Experts urge women to talk with a health care provider about when to start mammograms based on age and risk.

COLUMBUS, Ohio – A new national survey reveals many women are unsure about when to start mammogram screening for breast cancer and believe they should start later than doctors recommend.

The survey, commissioned by The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC–James), found that 44% of women incorrectly believe annual mammograms should start at age 50. Leading medical organizations recommend women at average risk for breast cancer begin yearly mammograms at age 40.

“Our biggest concern is ongoing confusion about screening guidelines,” said Alyssa Cubbison, DO, a breast radiologist at the OSUCCC – James. “For most women, breast cancer screening should begin with annual mammograms at age 40. Clear, accurate information helps women make informed decisions with their clinician and may lead to earlier detection.”

What major guidelines recommend

The confusion continues after the U.S. Preventive Services Task Force (USPSTF) updated its mammography recommendations in April 2024. The task force recommends women at average risk get a screening mammogram every other year starting at age 40. But many medical experts—including the Society of Breast Imaging and the American College of Radiology—continue to recommend annual screening starting at age 40 for average risk women, a guideline followed by the OSUCCC – James.

The survey also found that many women believe screening should start even earlier. More than half of women (51%) said mammograms should be done every year, and 41% believe screening should begin by age 35.

“Initiating screening mammography before the age of 40 is appropriate in only certain patients deemed to be higher risk based on factors such as family history and genetic mutations,” said Cubbison.

In April 2026, the American College of Physicians updated its guidance to recommend mammography for average‑risk women ages 50 to 74 occur every two years, citing individualized decision‑making. The OSUCCC – James follows radiology‑focused guidelines recommending yearly mammograms beginning at age 40. Under the Affordable Care Act, annual screening mammography starting at age 40 is covered under Medicare and most commercial insurance providers. Insurance coverage may vary; patients should check with their insurance provider about specific coverage.

Why starting mammograms at 40 matters

Experts say the confusion is especially concerning as breast cancer diagnoses in younger women rise. According to the Centers for Disease Control and Prevention’s U.S. Cancer Statistics, more than 27,000 U.S. women younger than 45 were diagnosed with breast cancer in 2022. CDC data also show the number of new cases in this age group increased an average of 0.7% per year from 2001 to 2022. Because younger women are not routinely screened, cancers in this group are more likely to be found at a later stage, when treatment can be more complex.

Why some women delay mammograms

Beyond confusion about screening guidelines, about half (53%) of the women surveyed cited some reported belief or reason for delaying or avoiding mammograms, including:

• Cost (28%)
• Discomfort (26%)
• Believing they were too young (26 %)
• Not having symptoms (25%)
• Concerns about radiation exposure (21%)

Younger women: when to talk to a clinician

The survey also highlighted uncertainty among younger women. About one in four women ages 18 to 29 said they would wait until symptoms such as pain or a lump appear before seeing a doctor—an approach experts say can delay diagnosis and treatment.

Most women under 40 are not eligible for regular screening mammograms. But experts encourage younger women—especially those with a personal or family history of breast cancer—to talk with a clinician about their risk. Knowing whether you have dense breast tissue can also help. Dense breast tissue can raise risk and make cancers harder to detect on mammograms. The survey found that most women would take follow-up action if a mammogram showed dense breast tissue, including talking with a primary care doctor or gynecologist (60%) or requesting additional imaging such as ultrasound or MRI (54%).

“Sharing these findings is meant to correct misconceptions, clarify screening guidance and encourage women of all ages to talk with their health care providers about when to start mammograms and how to protect their breast health,” said Cubbison.

To learn more about breast cancer research and patient care at the OSUCCC – James, visit cancer.osu.edu/breastcancer. The OSUCCC – James also recently launched the Building Research Innovation and Care Delivery for Groups with Early-Onset Cancers (BRIDGE) initiative to support people diagnosed with cancer at a young age.

Survey methodology

This survey was conducted by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from April 2-6, 2026, among a sample of 1,043 female respondents. The survey was conducted via web (n=1,014) and telephone (n=29) and administered in English. The margin of error for total respondents is +/-3.4 percentage points at the 95% confidence level. The Opinion Panel Omnibus data were weighted to represent the target population of U.S. female adults ages 18 or older.

Fiber, bathroom habits key to preventing and treating hemorrhoids

 The American Gastroenterological Association (AGA) has released a new clinical practice update providing expert guidance on the diagnosis and treatment of hemorrhoids, a common condition affecting approximately 50% of people by age 50. 

The update highlights that despite the prevalence of hemorrhoids, effective management often starts with simple, accessible lifestyle changes. 

Key takeaways for patients and providers: 

• Lifestyle changes come first: Increasing dietary fiber and reducing time and straining on the toilet are the most effective initial treatments.

• Common remedies lack strong evidence: Widely used treatments like sitz baths and over-the-counter topical products may provide relief, but data supporting their effectiveness are limited.  

• Use topical steroids cautiously: These products should not be used for more than two weeks due to the risk of skin thinning and irritation.  

• Proper diagnosis matters: A physical exam, often including anoscopy, is recommended to confirm hemorrhoids before starting treatment.  

• When to escalate care: Persistent or severe hemorrhoids may require office-based procedures (such as banding) or surgery.  

• Special populations: Hemorrhoids are common during pregnancy and are typically managed conservatively with diet and symptom relief. 

The update also emphasizes the importance of patient education, including discussing the potential risks of procedures (though rare) and ensuring patients know when to seek urgent care. 

Plant-based eating may reduce inflammation

 Consuming a plant-based diet may help lower levels of a key marker of inflammation in the body, according to analysis of clinical trials led by University of Warwick researchers. 

The study, published in Nutrition, Metabolism and Cardiovascular Diseases, is the first systematic review and meta-analysis of randomised controlled trials to assess whether plant-based dietary patterns influence levels of C-reactive protein (CRP), a widely used marker of systemic inflammation.  

Chronic low-grade inflammation (‘inflammageing’) is increasingly recognised as a driver of age-related diseases, contributing to conditions including cardiovascular disease, type 2 diabetes, and some cancers.  

Of nearly 3,000 studies initially identified as measuring plant-based diets and C-reactive protein (CRP), only seven met the strict criteria for inclusion as randomised controlled trials. Analysis of these trials, involving 541 participants, found that plant-based dietary patterns (including vegan, vegetarian, and wholefood plant-based diets) were associated with significantly lower CRP levels when compared to omnivorous diets.  

Lead author Luke Bell, a student at Warwick Medical School, said: “We found that consuming a plant-based diet instead of an omnivorous diet reduced CRP levels by 1.13 mg/L on average. CRP is one of the body’s main signals of inflammation, and lower levels generally indicate less background inflammation circulating in the body. 

“CRP levels are also commonly used to assess cardiovascular risk, with levels below 1 mg/L considered low risk and above 3 mg/L high risk. Therefore, a CRP reduction of the magnitude found in our study could move individuals into lower risk categories.”  

Plant-based diets are typically rich in fruits, vegetables, whole grains, legumes, nuts, and seeds, and tend to contain higher levels of fibre, antioxidants, and unsaturated fats than diets including more animal products. Researchers believe the anti-inflammatory effect may be partly explained by these nutrients, as well as lower intakes of saturated fat.  

Warwick co-author and project supervisor Joshua Gibbs added: “Plant-based diets are already known to improve key cardiovascular risk factors such as blood pressure, LDL cholesterol, and body weight. Our findings suggest an additional pathway through which these diets may reduce chronic disease risk.  

“When studies that included structured exercise programmes were excluded, the reduction remained, although slightly smaller. The largest reductions were seen in studies that combined plant-based diets with increased physical activity, suggesting lifestyle changes may have the greatest impact when adopted together, although more research is needed to confirm this.”  

Previous observational research has linked these diets to lower levels of inflammation and reduced risk of chronic disease, but unlike earlier reviews that relied largely on observational evidence, this analysis focused exclusively on randomised controlled trials - considered the gold standard for establishing cause and effect.  

Co-author Professor Francesco Cappuccio, Warwick Medical School concluded: “It is worth bearing in mind that of the nearly 3,000 studies identified for this study, only seven met the inclusion criteria for randomised controlled trials. Although the results suggest a plausible effect of plant-based food in reducing inflammation, given the paucity of large trials, we should encourage more robust evidence to support these early findings.” 

ENDS 

The paper – ‘The effect of plant-based dietary patterns on C-reactive protein: A systematic review and meta-analysis of randomised controlled trials’ is published in Nutrition, Metabolism and Cardiovascular Diseases. DOI: 10.1016/j.numecd.2026.104631 

Diets rich in plant protein, dairy, omega-3 fatty acids, whole foods = lower Alzheimer's risk

 

Alzheimer's disease affects more than 55 million people worldwide, and that number is projected to nearly triple by 2050. It has long been thought of as something that happens in the brain: a slow accumulation of toxic proteins, a gradual loss of neurons, a tragedy that unfolds in the mind. But a new collaborative transdisciplinary study by the University of Technology Sydney and Massachusetts General Hospital/Harvard Medical School is pointing somewhere else entirely: the gut.

In one of the largest multi-modal machine learning studies of its kind using artificial intelligence (AI) trained on data from nearly 10,000 people, a team of UTS researchers analysed more than 120 everyday factors, including diet, medical history, gut bacteria, and lifestyle, to identify which of them are most strongly associated with Alzheimer's risk. The outcome could lead to an AI framework that could be deployed as a low-cost, community-level screening tool.

Diet as a driver, not just a signal

Dietary patterns emerged as one of the strongest predictors of Alzheimer’s risk, highlighting the role of everyday habits in shaping brain health.

“Rather than individual nutrients, the study found that overall eating patterns were more informative,” said Khalilpour “Diets rich in plant protein, dairy, omega-3 fatty acids, and whole foods were consistently associated with lower Alzheimer's risk. Whereas diets dominated by processed food, refined sugars, and saturated fats pointed sharply in the other direction.

“Notably, overall dietary patterns outperformed individual nutrient measurements, meaning it is not a single vitamin or supplement that matters, but the cumulative, daily effect of how a person eats across years and decades.”

Higher dairy consumption emerged as a particularly striking individual signal, with higher dairy consumption associated with lower predicted risk, that may reflect the gut microbiome's response to fermented and dairy-rich foods, as well as calcium's known neuroprotective properties.

“The implication is significant: if diet contributes to neurodegeneration, it can also, potentially, help prevent it.”, said Ali Zomorrodi, Assistant Professor at Massachusetts General Hospital & Harvard Medical School, and a collaborator of this ongoing project.

The appendix finding that changes the picture

“The most unexpected result in the study was perhaps also among the most revealing,” said Associate Professor Kaveh Khalilpour, co-lead of the project and a specialist in complex socio-technical systems at the UTS Visualisation Institute “People who had their appendix removed – one of the most routine surgical procedures in the world – showed substantially elevated Alzheimer's risk, emerging as one of the strongest contributors in the entire analysis.

“We speculate that it functions as a reservoir of beneficial gut bacteria. When it is removed, the microbiome loses a key recovery mechanism, its ability to replenish healthy microbial communities after illness, infection, or antibiotic use,” he said.

 Over decades, that disruption may compound, leaving the gut progressively less able to protect the brain from the inflammatory signals linked to neurodegeneration.

“This finding is particularly compelling, as it indicates that long-term brain health may be shaped by earlier life experiences through their enduring effects on the gut microbiome,” said PhD researcher Tallat Jabeen.

“It reframes how we think about Alzheimer's risk, not as something that arrives with old age, but as something quietly accumulating across a lifetime.”

A supine exercise program is associated with improved body balance and agility

A 10-minute daily exercise program done lying down improved participants' balance, flexibility and agility within just two weeks, per new clinical trial

 "Flexed their knee joints" means that individuals bent their knees, decreasing the angle between their thigh and lower leg. 

This motion is the opposite of straightening (extending) the knee.

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Caption

Exercise program protocols. The exercise program comprised the following three types of exercises.

 (A) This is an exercise of the abdominal muscles. Participants flexed their knee joints, placed their hands on their abdomens, and lightly compressed using their fingertips. They contracted the abdominal muscles in that area against the pressure for 5 s and subsequently relaxed. The inlet shows the abdominal region in the frontal plane (A’). The abdomen is divided into nine areas surrounding the lower end of the ribs, pubis, and both iliac crests. Participants performed the exercise in each area three times (Exercise 1). 

(B) This is an exercise that improves trunk and lower extremity linkages. Participants flexed their knee joints, with their hands placed on their abdomen. They tilted their pelvis backward while keeping their abdomen contracted and subsequently contracted their hip extensors as in a bridge exercise. The arrow indicates the direction of pelvic movement. They contracted for 5 s with their hips slightly off the floor and subsequently relaxed, repeating ten times (Exercise 2). (

C) This is an exercise that improves lower extremity muscle coordination. Participants started in a supine position with both lower extremities extended, then they flexed one knee to 90°, and placed the sole on the floor. Next, they maintained the flexed toe and dorsiflexed ankle joint positions. Subsequently, their hip and knee joints were extended while slightly scraping their heels on the floor while maintaining the angle of the ankle joint as much as possible. The arrow indicates the direction of leg movement. Finally, their lower extremities, with their knees fully extended, were exerted for 5 s by pushing their heels out caudally and subsequently relaxed. Both lower extremities were exercised three times alternately (Exercise 3). 

(D) From left to right, with both lower extremities in extension, rock-paper-scissors training was performed with the toes: rock (clenching the toes), scissors (raising the thumb), scissors (behind the thumb), and paper (keeping toes apart). This exercise was repeated five times. The figure shows the right toes (Exercise 3).

Credit

Atomi et al., 2026, PLOS One, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

Study shows your favorite playlist can help you train harder and longer

New research from the University of Jyväskylä (JYU) shows that letting exercisers choose their own music can boost endurance by nearly 20 % - without making the workout feel any tougher. The findings have practical benefits for both athletes and everyday exercisers.

Participants who pedalled to their own self-selected tracks (around 120-140 beats per minute) lasted an average of nearly 6 minutes longer before reaching exhaustion compared to riding in silence. That’s the key finding from a new study now available online in the journal Psychology of Sport & Exercise. Lead researcher Andrew Danso from JYU’s Centre of Excellence in Music, Mind, Body and Brain explains the real-world impact:

“Self-selected music doesn’t change your fitness level or make your heart work dramatically harder in the moment - it simply helps you tolerate sustained effort for longer. It may be an incredibly simple, zero-cost tool that lets people push further in training without feeling extra strain at the end. Our findings suggest that the right playlist may make tough sessions feel more doable and more enjoyable.”

In the study, 29 recreationally active adults completed two identical high-intensity cycling tests (at about 80 % of their peak power). One test had no music; the other let participants pick their own songs. With music they cycled for 35.6 minutes on average versus 29.8 minutes without (a clear 20 % improvement).

Favourite music boosts quality training time

Importantly, even though they exercised longer and burned more total energy, their heart-rate, and lactate levels at the finish line were the same in both conditions. In other words, the music helped them “stay in the pain zone” longer without making the pain feel worse.

The findings have clear practical applications for athletes, coaches and everyday exercisers.

“Many people struggle to stick with hard training because it feels exhausting too quickly,” says Danso.

“Our research shows that letting people choose their own motivating music may help them accumulate more quality training time, which could translate to better fitness gains, improved adherence to exercise programmes, and possibly more people staying active.”

From a broader societal perspective, the study highlights how music could play a role in tackling inactivity-related health challenges. Longer, more tolerable exercise sessions may help reduce risks linked to low fitness.

The publication is open access and available now at Psychology of Sport and Exercise: https://www.sciencedirect.com/science/article/pii/S1469029226000579 

Brain health shaped by lifetime mental, physical, environmental and lifestyle factors

Statement Highlights:

• An individual’s brain health is influenced by their psychological health, environment, sleep quality, social conditions and chronic health conditions over a lifetime. Life events and experiences even in early life also affect long-term brain development and brain health.
• Healthy lifestyle habits, such as eating a healthy diet; getting adequate physical activity and sleep; avoiding smoking, heavy alcohol or illicit substance use; and reducing stress, can improve brain health throughout life.
• The new scientific statement identifies opportunities to protect brain health and reduce the risk of stroke, cognitive decline and dementia by promoting healthy lifestyle behaviors, improving environmental conditions, expanding health care access and increasing social support for mental health and well-being.

Embargoed until 4:00 a.m. CT / 5:00 a.m. ET Tuesday, April 28, 2026

DALLAS, April 28, 2026 — Brain health isn’t determined only by genetics or what happens later in life. A growing body of research shows that a range of factors—from mental health and sleep to environment, lifestyle and social conditions—play a powerful role in shaping how the brain functions and ages. A new American Heart Association scientific statement highlights how experiences starting early in life and continuing through life may influence brain health and affect the risk of stroke, cognitive decline or dementia in later years, according to a new American Heart Association scientific statement, published today in the Association’s peer-reviewed scientific journal Stroke.

The new scientific statement, “Brain Health Across the Life Span: A Framework for Future Studies,” highlights opportunities for 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% increase, and the 65-and-older age group’s share of the total population is projected to rise from 17% to 23%. The aging of the U.S. population is expected to increase the prevalence of brain conditions that affect memory, thinking, communication skills and mental health.

“As medical and scientific advancements have extended life expectancies, brain health has become increasingly important,” said the Chair of the scientific statement’s writing group Elisabeth Marsh, M.D., FAHA, a professor of neurology and associate director of the neurology residency program at The Johns Hopkins University School of Medicine and director of the Stroke Center at Johns Hopkins Bayview Medical Center in Baltimore. “The number of people with age-related cognitive impairment is rising rapidly, creating significant personal, emotional, and health care system burdens.”

According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, stroke is now the #4 leading cause of death in the U.S. A 2023 American Heart Association/American Stroke Association scientific statement on cognitive impairment after stroke highlighted that more than half of people who survive a stroke develop cognitive impairment within the first year after their stroke, and as many as 1 in 3 may develop dementia within 5 years.

Previous research about brain health has considered factors that damage blood vessels and reduce blood flow to the brain, which can increase the risk of developing stroke, cognitive decline and/or dementia. Recent research has also focused on the role of psychological, environmental, lifestyle and social factors, that affect brain health over a lifetime.

“We’ve long focused on managing risk factors like blood pressure and cholesterol, which remain critical for heart and brain health, however, this statement spotlights research on external factors like sleep quality, the gut microbiome and social conditions that are also linked to brain health,” said Marsh.

“One of the most important messages in this scientific statement is that brain health is shaped across the entire life span. What happens early in life can matter decades later, which also means there are opportunities at every life stage to support healthier brain aging,” she added.

What factors affect brain health?

Recent research shows that numerous mental, physical, environmental and social factors influence brain health across the life span.

• Mental Health: A 2021 American Heart Association scientific statement on the mind-heart-body connection stated that negative psychological factors and mental health disorders can negatively impact cardiovascular health. Over time, chronic stress, depression and anxiety may change the brain in ways that increase the risk of memory loss, dementia and stroke. These physiological and structural changes may include inflammation, stress-related damage, and loss of brain cells and connections. Long-term psychological stress that keeps stress hormones elevated contributes to atherosclerosis (buildup of plaque in arteries) and impaired glucose metabolism, both of which can have damaging effects on brain health over time.

• Adverse Childhood Experiences: Children who experience abuse, neglect, exposure to domestic violence, or parental separation or divorce, incarceration or illicit substance use or dependence, may be at increased risk for learning and attention difficulties in childhood, as well as mental health conditions and cognitive decline and dementia as they age.  

• Chronic Inflammation: Long-term inflammation can damage brain cells and blood vessels over time. When inflammation begins early in life, it may interfere with healthy brain development. It can be triggered by infection during pregnancy or ongoing stress. Over time, this may increase the risk of learning, thinking and mental health challenges. In adulthood, persistent inflammation is linked to memory loss and neurodegenerative conditions, such as Alzheimer’s and Parkinson’s disease.

• Gut Microbiome: The gut and brain are closely connected and communicate through nerves, immune signals and hormones. Healthy gut bacteria produce substances that help protect the brain and regulate inflammation. When this balance is disrupted, inflammation can increase and place stress on the brain. Gut health may be especially important at certain stages of life, including early development, adolescence and older age, when changes in gut bacteria may have lasting effects on brain health. In later life, altered gut microbes have been linked to conditions such as Alzheimer’s and Parkinson’s disease.

• Obesity: Excess body weight can be harmful to overall health and is an important risk factor for brain health across the life span. Obesity can increase inflammation, disrupt hormones and damage blood vessels, which, over time, can harm brain structure and cognitive function at all stages of life.

• Sleep: Healthy sleep is essential to keeping the brain balanced and functioning well at every age. Some research has described sleep as an investment in brain health that builds over time. In children, sleep supports brain growth and long-term memory formation. In teens and adults, consistent, high-quality sleep supports memory, attention, decision-making, work performance, and long-term physical and mental health, making it an integral component in healthy development and aging. Inadequate sleep and sleep disorders like sleep apnea may increase inflammation and increase the risk of memory loss and cognitive decline.

• Social drivers of health: Current research confirms that lower socioeconomic status, including fewer years of education and lower income, is linked with a higher risk of health conditions like Type 2 diabetes and high blood pressure, both of which can contribute to memory loss, cognitive decline and dementia. Limited access to healthy foods, health care and stable housing can also increase the risk of cognitive decline over time.

• Environmental Exposures: Current research suggests that exposure to air pollution, heavy metals, microplastics and other environmental pollutants such as particulate matter from wildfires can slowly damage the brain by triggering inflammation, stressing brain cells and harming the blood vessels that supply it. Over time, this makes it harder to repair damage and may increase the risk of memory loss, dementia and stroke.

What are ways to improve brain health?

“Together, the evidence underscores that brain health is shaped throughout a person’s lifetime and that healthy lifestyle behaviors can make a difference. Addressing modifiable factors such as mental health, environmental exposures, sleep and social conditions may support brain development and healthy aging,“ Marsh said.

Research suggests that healthy lifestyle habits such as those outlined in the American Heart Association’s Life’s Essential 8 may support brain health. Getting regular physical activity, controlling blood pressure and cholesterol, practicing healthy sleep habits, avoiding smoking and managing stress have shown consistent benefits. Healthy eating patterns such as those detailed in the Association’s 2026 Dietary Guidance are also a key factor in shaping gut and brain health. Following a Mediterranean-style diet and eating fiber-rich, plant-based foods and fermented foods, like yogurt and kefir, support beneficial gut bacteria, while diets high in processed foods and added sugars can disrupt the gut microbiome. Avoiding heavy alcohol or substance use, increasing social support , and reducing financial stress  may also improve mental health.

What should health care professionals and other leaders do to support brain health?

The statement urges health care professionals and policymakers to protect and promote optimal brain health from before birth through adulthood across all communities. Prioritizing mental health screening and support and expanding access to timely, effective health care that supports Life’s Essential 8 can help to improve brain health across the life span. More research is needed to understand the approaches that may work best in different communities.

To address the growing burden of age-related cognitive impairment, the American Heart Association and the Paul G. Allen Frontiers Group have created the AHA-Allen Initiative in Brain Health and Cognitive Impairment. The two organizations, along with additional contributors, have committed more than $43 million toward research to advance the understanding of brain health and improve lives. More information about the awards given to fund brain health research is available here. In addition, the Association’s Strategically Focused Research Network on Inflammation in Cardiac and Neurovascular Disease awarded $15 million to researchers to study inflammation’s impact on heart and brain health.

“Brain health is a lifelong journey, influenced by our mental well-being, environment and lifestyle choices from childhood through late adulthood,” according to Mitchell Elkind, M.D., M.S., FAHA, the American Heart Association’s Chief Science Officer for Brain Health and Stroke and a past volunteer president of the Association (2020-2021). “This scientific statement comes at a timely moment, just as the American Heart Association is increasing its focus, research and programming in brain health. The exciting science in this area reminds us that 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.”