The Future of Aging Is Brain Health: Reflections from a Conversation with the Milken Institute

By: Dr. Sue Paul, Sr. Dir. Well-being & Brain Health, Asbury Communities, Inc.

I recently had the opportunity to speak with Mike Brown, Director on the Future of Aging team at the Milken Institute, and it was one of those conversations that sharpens your thinking.

The Milken Institute operates as a non-profit, non-partisan think tank working across finance, philanthropy, and health. What stood out to me is how intentionally they are connecting those sectors around a common reality. Adults over 65 will soon make up about 20 percent of the U.S. population, and people are living longer than ever. That shift is not theoretical. It is already reshaping demand across healthcare, communities, and policy.

One insight that stayed with me is how inseparable brain health and longevity really are. We cannot talk about adding years to life without also talking about maintaining cognitive function during those years.

We spent time discussing the Alliance to Improve Dementia Care, which is now in its sixth year. Asbury Communities is part of this Alliance, and it was helpful to better understand the scope of the work. The Alliance has engaged roughly 150 organizations across health systems, advocacy groups, researchers, pharmaceutical and diagnostics companies, along with individuals living with dementia and their care partners. It is a coordinated effort to improve both the delivery and experience of dementia care.

Mike shared that in its early years, the Alliance helped champion the GUIDE Model with the Centers for Medicare and Medicaid Innovation, focusing on integrating care navigation into comprehensive dementia care. That foundation has now evolved into three clear priorities. Improving early detection and accurate diagnosis. Scaling interventions that are effective. And engaging payers, including Medicare Advantage and commercial plans, to prioritize Alzheimer’s disease, related dementias, and mild cognitive impairment.

The pace of change in the field is notable.

Mike framed current advancements in brain health across three domains: mood, movement, and memory. In the area of cognition, where much of my work sits, there are several important developments. There are now FDA-approved disease-modifying treatments for early Alzheimer’s disease. Blood-based biomarkers, including amyloid and phosphorylated tau, are making early detection far more accessible and less invasive. Digital cognitive assessments are also becoming more common, allowing subtle changes to be detected and tracked over time using smartphones and tablets.

At the same time, the evidence behind lifestyle interventions continues to be built. The U.S. POINTER study reinforces that physical activity, cognitive engagement, nutrition, and social connection can positively influence brain health. There is also increasing attention to care partners. Dementia affects entire families, and models like GUIDE are beginning to provide structured support and training for caregivers, not just the individual diagnosed.

We also discussed the policy landscape, which is starting to move in alignment with these advancements.

Several federal efforts are worth watching. The ASAP Act would allow Medicare to cover blood-based screening tied to emerging treatments. The BRIDGE Act would expand Medicare access for individuals diagnosed with Alzheimer’s disease before age 65. The CHANGE Act would provide more consistency in how validated cognitive assessments are used during Annual Wellness Visits. The National Alzheimer’s Plan has also been recommitted to, with a new advisory council helping to define priorities for the next decade.

At the state level, dementia action plans are becoming more common, with states partnering with Area Agencies on Aging to better anticipate and plan for future needs.

What I took away from this conversation is that the pieces are starting to come together. Science is advancing. The tools for detection and intervention are improving. Policy is beginning to respond. And organizations like the Milken Institute are helping to align stakeholders across sectors.

The challenge now is execution. The opportunity is already here.