Healthy brain, healthy metabolism: why we need to act earlier

We usually think about memory only when a loved one starts to forget. By then, many opportunities have passed. Many factors that shape brain health in old age, such as blood pressure, glucose, weight and cholesterol, can be identified and managed from midlife, or even earlier.

Living longer is not the same as living well

Life expectancy in Vietnam has risen considerably, but the gap between years lived and years lived in good health remains wide. For me, the goal of longevity medicine is not to add years to life, but to preserve health, independence and quality of life in those years. Brain health and metabolic health are two closely linked pillars of that goal.

Nearly half could be prevented or delayed

The 2024 report of the Lancet Commission on dementia identified 14 modifiable risk factors across the life course. The Commission estimated that eliminating all of them could prevent or delay around 45% of dementia cases. The figure is theoretical, but the message is clear: dementia is not destiny.

What strikes me as a cardiologist and endocrinologist is that many of these factors are conditions we treat every day.

• Cardiometabolic: hypertension, diabetes, obesity, high LDL cholesterol (newly added in 2024), physical inactivity, smoking and excessive alcohol.
• Sensory and mental health: hearing loss, untreated vision loss, depression.
• Social and environmental: less education, social isolation, traumatic brain injury, air pollution.

Sleep is not on the list because the evidence is not yet strong enough, but it is a research direction worth watching. Sleep apnoea is already closely linked to hypertension and cardiovascular disease, so sleep screening is valuable even before we consider the brain.

Biomarkers: separating evidence from expectation

Longevity medicine is seeing a boom in “biological age” tests, epigenetic clocks and premium screening packages. Some are promising for research, but few have enough evidence yet to change treatment decisions for an individual. I believe the foundation remains familiar, affordable, evidence-based measures: blood pressure, glucose and HbA1c, lipids, waist circumference, hearing, vision, cognitive assessment, sleep and mood. Doing these basics well, regularly and over the long term is worth more than an expensive test done once.

Continuous care, not a single check-up

Risk builds over decades, so care must be continuous too. From building daycare and mobile rehabilitation models at Hospital 199, I believe in a connected pathway: comprehensive assessment in hospital, personalised risk management, home care and daycare when needed, and data-driven follow-up between visits.

This is also the direction of the Vinmec Da Nang Longevity Centre, whose model we are developing: bringing cardiology, endocrinology, neurology, sleep medicine, nutrition and rehabilitation together around the person rather than around each specialty. The model is still in development; we will share concrete results when we have them.

Conclusion

Protecting the brain starts with controlling blood pressure, glucose and lifestyle, the earlier the better.

I will discuss this further on the panel “Healthy Brain, Healthy Metabolism – From Risk to Resilience: What Can We Do Earlier?” at the Da Nang Longevity Summit & Exhibition 2026, on 13 November 2026 at the International Convention Palace (ICP), Furama Resort Da Nang.