Two More Ways to Lower Your Risk for Dementia

Now there are 14 actions to take to protect your brain, some easier than others

Kimberly Goad

Reviewed by

Jason Hassenstab, Ph.D.

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En español

Published September 30, 2024

Four circle images of healthy lifestyle choices to help support the brain

Photo Collage: AARP (Source: Getty Images(4))

A renowned group of researchers has just handed us two more ways to reduce our risk for dementia. If we can take those actions, and chip away at a dozen other risk factors, a substantial number of dementia cases could be delayed or prevented. Those risk factors are associated with up to half of all dementia cases.

When the group of doctors, epidemiologists and public health researchers collectively known as the Lancet Commission on Dementia Prevention, Intervention and Care first suggested in 2017 that you could cut your risk for dementia by altering some key lifestyle habits, it was unexpected. Could eating healthy, exercising more, going light on alcohol and amping up our social lives, plus a few other actions, really guard against cognitive decline?

Surprisingly, yes. And the health care heavy hitters on the Lancet Commission have a mountain of research to back up their claims.

“A lot of people … thought it was extremely radical,” says Gill Livingston, M.D., Lancet Commission lead, professor of psychiatry at University College London and a member of AARP’s Global Council on Brain Health. But the evidence has grown over the years, she says.

The Lancet Commission’s latest report, released in July, now lists 14 modifiable risk factors, things you can actually do something about (although some risk factors are arguably beyond an individual’s control). The two new risk factors are untreated vision loss and high LDL cholesterol.

“The data is pretty clear that managing a lot of these risk factors [in midlife] can have a fairly significant impact on dementia risk later in life,” says Ian Grant, M.D., assistant professor of neurology at Northwestern University School of Medicine, who was not on the committee.

“People with healthy lifestyles … were shown not only to have a lower risk of dementia than those with less healthy lifestyles but also to have dementia onset delayed … resulting in more healthy years and fewer years of illness,” the commission wrote. And for people with dementia, these lifestyle changes can “help maximize physical health and improve quality of life.”

Here’s the list of 14 modifiable risk factors, along with what you can do about them.

1. Untreated vision loss. Get your annual eye exams.

One of two new risk factors in the Lancet Commission’s 2024 report, untreated vision loss is arguably the most confounding. How can it lead to cognitive impairment?

“Any kind of what we call primary sensory loss — like vision — is bad for the brain because the brain doesn’t like a lack of input,” Grant explains. “That stimulus into the brain is important for maintaining certain connections.”

The Lancet Commission’s report found an increased risk for dementia associated with two common vision problems: cataracts, a clouding of the lens, and diabetic retinopathy, caused when excess sugar in the blood damages blood vessels in the back of the eye. When those problems are corrected, the risk drops dramatically. More than half of people with diabetes will develop diabetic retinopathy, the leading cause of blindness in working-age adults.

2. Hearing loss. Have your hearing checked and get hearing aids if needed.

The Lancet Commission considers hearing loss the single biggest modifiable risk for dementia. Why? “Hearing loss may impact dementia risk by reducing overall neural stimulation and by reducing social interaction,” says Jessica Caldwell, director of the Women’s Alzheimer’s Movement Prevention and Research Center at Cleveland Clinic. “It’s also possible that hearing loss and dementia have a common cause, such as [changes in the small blood vessels of the brain].”

Less than a third of people 71 and older with hearing loss use hearing aids, according to a July 2023 JAMA study. Yet use of hearing aids appears to be particularly effective at protecting cognitive well-being, according to a July report from AARP’s Global Council on Brain Health.

3. Obesity. Maintain a healthy weight.

Obesity ups your risk for dementia mostly because it’s linked to so many of the other risk factors, especially type 2 diabetes. How so? Like all cells, the nerve cells, or neurons, in the brain use glucose as their energy source. But they can’t take it up unless insulin is doing its job. Excess body weight (especially around the belly) makes it harder for insulin to essentially open the doors of the cells in your body, which then allows glucose to leave your bloodstream and move into cells where it’s then used as energy, leading to insulin resistance. That’s a stepping stone to type 2 diabetes.

Although the Lancet Commission doesn’t recommend a specific dementia-preventing diet — citing inconclusive research — it does say that eating a diet high in fruits and vegetables and low in ultra-processed foods is good for many health conditions and can reduce the dementia risk factors of obesity, diabetes, high LDL cholesterol and hypertension (high blood pressure).

4. Diabetes. Try to avoid it, especially in midlife.

The focus here is type 2 diabetes, the kind that strikes later in life and leads to chronically high blood sugar levels that can damage several organs if not controlled with diet and/or medications. “Long illness duration and poorly controlled diabetes increase the risk of dementia,” the Lancet Commission wrote. “Overall improved control of diabetes … might attenuate the risk of dementia and be a way of decreasing dementia risk.”

5. LDL “bad” cholesterol. Talk to your doctor about statins if levels are high.

High levels of “bad” cholesterol is the second new factor that is worth changing if you want to cut dementia risk. Excess cholesterol in the brain increases stroke risk and boosts the two proteins that clump and tangle in Alzheimer’s disease, amyloid and tau. The commission points to studies showing that individual counseling about diet and exercise has a small effect on reducing LDL cholesterol. But statins, which are often prescribed to bring down high cholesterol levels, may lower risk of all types of dementia, including Alzheimer’s disease. Statins’ effects may be because the drugs are anti-inflammatory and they reduce cholesterol levels.

6. Hypertension. Prevent or reduce high blood pressure.

Hypertension in midlife increases risk for Alzheimer’s disease and vascular dementia. Black Americans tend to have higher blood pressure than other U.S. population groups, which may be contributing to their higher risk for dementia. Eating a healthy diet, exercising and maintaining a healthy weight are all ways to prevent hypertension. Use of antihypertensive drugs has also been shown to be helpful for reducing dementia risk, the report notes.

7. Physical inactivity. Get moving, often.

Is there any health condition that regular exercise doesn’t help ward off or alleviate? A review of research published in 2022 in the British Journal of Sports Medicine found that people who exercised regularly had roughly a 20 percent lower risk of developing dementia compared with those who didn’t. The Lancet Commission’s report suggests that exercise at any age is helpful for maintaining cognition, possibly through improved blood flow to the brain. People who engage in moderate-to-vigorous exercise on more days lose less brain volume as they age than those who do less or no exercise. The physical activity stimulates the release of a protein called brain-derived neurotrophic factor, or BDNF, which is key to the survival of existing brain neurons and the generation of new ones.

“Exercise is thought to protect the central nervous system by increasing vascular and cerebrovascular health, reducing inflammation and directly increasing neurochemistry that supports plasticity such as BDNF,” Caldwell says. “Larger brain volumes in people who exercise support this idea and indicate resilience in the face of aging.”

8. Smoking. It’s not too late to quit.

If you smoke, you don’t need to be told that you shouldn’t. It raises your risk for heart disease, stroke, lung cancer and, as it turns out, dementia. That’s especially true if you’re a smoker in midlife and later life, according to the Lancet Commission’s report. “Studies have suggested that long-term exposure to secondhand smoke can also increase dementia risk,” Caldwell says.

The good news? It’s never too late to quit. One review of studies reported an increased dementia risk among longtime smokers, but less risk in former smokers.

9. Lack of education. Stimulate your brain.

Early-life education offers the big win. Still, there are things you can do today. Sure, crossword puzzles, Wordle, Connections, Spelling Bee, Sudoku — name your obsession — play a role in stimulating the brain. But it’s more important to take on new challenges, such as learning a language or picking up a new instrument. “There’s not any evidence that any one particular thing is going to be good for reducing dementia risk,” Grant says. What matters is “that a person does something.... Trying a number of new things is good for the brain.”

10. Social isolation. Stay connected with others.

Nearly one in four adults 65 and older is considered socially isolated, according to the Centers for Disease Control and Prevention. Not to be confused with loneliness, which is the feeling of being alone regardless of the amount of social contact, social isolation is a lack of social connections.

Two large research reviews cited by the Lancet Commission found a strong link between social isolation (defined in the report as some combination of living alone, seeing family or friends less than once a month and participating in no weekly group activities) and a higher risk for dementia.

Does virtual connection count? Social contact in any form has a potentially beneficial effect on dementia risk by building cognitive reserve and promoting healthy behaviors. But Grant suggests that connecting through social media “is not a substitute for getting out of the house and being with people.”

11. Excessive alcohol consumption. Cut back on the booze.

Less is more and none is better than some. That’s the bottom-line message of the latest research looking at the risks of drinking alcohol. Overall, the commission concluded, light drinkers, as well as heavy drinkers who cut back, have a lower risk of dementia risk than people in the habit of drinking to excess. Part of that has to do with the fact that drinking raises your risk for obesity, depression and hypertension, all risk factors for dementia.

12. Depression. Treat it effectively.

Depression increases the risk of dementia at all adult ages, although in late life, some of the association is due to dementia that hasn’t yet been diagnosed. Either way, effective treatments for depression exist and are worth trying.

13. Head injury. Protect yourself from falls.

True, traumatic brain injury can be caused by contact sports picked up in childhood or college. But among older adults, the main way a head injury occurs is through a fall. So you may not be able to go back and choose archery over football, but you can strengthen your core and work on your balance to avoid falls; you can also wear a helmet on bike rides.

14. Air pollution. Reduce exposure.

This is a tough one, since we don’t all have the option to move away from areas of higher air pollution. Plus the rise in wildfires in recent years adds to the mix of dangerous air. The small particles carried into the air we breathe from car exhausts, industrial emissions and fires are a risk factor for dementia and cognitive impairment, the report says. But there are some steps you can take, including staying inside with windows closed or using a portable air filter when air quality is low and wearing an N95 mask when air quality is poor if you must go outside.

An infographic of the 14 risk factors for dementia

Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet 2024; published online July 31.

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Kimberly Goad is a New York–based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Men’s Health and Reader’s Digest.

Jason Hassenstab, Ph.D., is a professor of neurology and psychological and brain sciences and the director of the Cognitive Technology Research Laboratory at Washington University in St. Louis.