The Dementia Prevention Checklist: 15 Modifiable Risk Factors You Can Start Changing Today

15 Ways to Protect Your Brain: An Interconnected Guide to Reducing Dementia Risk

Did You Know You Can Reduce Your Risk of Dementia?

Many people assume that dementia is simply a part of aging or something that is entirely determined by genetics. While age and genetics do play a role, research continues to show that there are steps we can take throughout life to help reduce our risk.

In 2024, the Lancet Commission on Dementia Prevention, Intervention, and Care updated its landmark report and concluded that addressing 14 modifiable risk factors could potentially prevent or delay nearly 45% of dementia cases worldwide.

While we cannot eliminate our risk entirely, we can take meaningful steps to protect brain health.

I have included an additional factor, sleep, because of the growing body of evidence linking sleep quality and sleep disorders to brain health, cognitive decline, and many of the same pathways involved in dementia risk.

Why This Matters

The 2024 Lancet Commission estimates that addressing 14 modifiable risk factors throughout life could potentially prevent or delay nearly 45% of dementia cases worldwide. Two new risk factors, high LDL cholesterol and untreated vision loss, were added to the 2024 update.

Non-Modifiable Risk Factors

Some risk factors cannot be changed.

1. Age

Age remains the strongest known risk factor for dementia. Most people who develop dementia are over the age of 65, and risk increases as we get older.

2. Family History

Having a first-degree relative with Alzheimer's disease may increase your risk. However, many people with a family history never develop dementia, and many people with dementia have no family history.

3. Genetics

Certain genes, such as APOE4, can increase the likelihood of developing Alzheimer's disease. However, genetics are only one piece of the puzzle and do not determine your future.

Modifiable Risk Factors

The 15 Risk Factors I Discuss With Patients

The 2024 Lancet Commission identified 14 modifiable risk factors that may account for nearly 45% of dementia cases worldwide. While we cannot eliminate dementia risk entirely, addressing these factors may help delay or prevent many cases.

1. Hearing Loss

Untreated hearing loss is one of the largest modifiable risk factors for dementia. The Lancet Commission estimates that hearing loss may account for approximately 7% of dementia cases worldwide.

People with mild hearing loss may be nearly twice as likely to develop dementia compared with those with normal hearing.

If you struggle to hear conversations, frequently ask people to repeat themselves, or avoid social situations because of hearing difficulties, consider a hearing evaluation.

2. High LDL Cholesterol

High cholesterol contributes to vascular disease, which can affect blood flow to the brain. Managing cholesterol through nutrition, exercise, and medication when appropriate may help protect both heart and brain health.

3. Limited Education and Lifelong Learning

The Lancet Commission estimates that lower educational attainment early in life may account for approximately 5% of dementia cases worldwide.

Education helps build cognitive reserve, the brain's ability to compensate for age-related changes. Lifelong learning remains important at any age.

Read, learn new skills, take classes, engage in hobbies, and continue challenging your brain.

4. Social Isolation

Social isolation may account for approximately 5% of dementia cases worldwide.

Research suggests that individuals who are socially isolated may have about a 50% higher risk of developing dementia compared with those who remain socially engaged.

Maintaining meaningful relationships, volunteering, joining clubs, attending religious services, or participating in community activities may help support brain health.

5. Depression

Depression may account for approximately 3% of dementia cases worldwide.

Studies suggest that individuals with a history of depression may have up to twice the risk of developing dementia later in life.

Depression affects more than mood. It can influence physical activity, sleep, social engagement, and overall health.

6. Traumatic Brain Injury

Traumatic brain injury may account for approximately 3% of dementia cases worldwide.

Head injuries, especially those involving loss of consciousness or repeated trauma, can increase the risk of cognitive decline later in life.

Wear helmets, use seat belts, and take steps to prevent falls.

7. Physical Inactivity

Regular exercise is associated with a 20% to 30% lower risk of dementia and cognitive decline. Exercise improves blood flow to the brain, supports cardiovascular health, reduces inflammation, improves insulin sensitivity, and helps preserve muscle mass as we age.

Aim for:

• At least 150 minutes of moderate aerobic activity weekly

• Strength training at least twice weekly

• Balance and flexibility exercises

Even small amounts of movement are better than none.

8. Diabetes

Poorly controlled blood sugar contributes to vascular disease, inflammation, and metabolic dysfunction, all of which can affect brain health.

Managing blood sugar through nutrition, exercise, weight management, and medication when needed may help reduce risk.

9. Smoking

Smoking damages blood vessels, increases oxidative stress, and promotes chronic inflammation.

The good news is that quitting smoking provides benefits at any age.

10. High Blood Pressure

Untreated high blood pressure can damage the small blood vessels that supply the brain. Midlife blood pressure control appears particularly important for long-term cognitive health.

11. Obesity

Research suggests that obesity during midlife is associated with approximately a 30% to 40% higher risk of developing dementia later in life.

Maintaining a healthy weight supports metabolic, cardiovascular, and brain health.

12. Excessive Alcohol Consumption

Heavy alcohol consumption can damage brain cells, contribute to nutritional deficiencies, and increase the risk of cognitive decline. A large 2025 analysis found that higher alcohol consumption was associated with an increased risk of dementia and estimated that reducing alcohol use disorder could potentially prevent up to 16% of dementia cases.

13. Air Pollution

Researchers believe that chronic exposure to air pollution may contribute to inflammation and vascular injury that affect the brain over time.

14. Vision Loss

Vision impairment can increase social isolation, reduce cognitive stimulation, and decrease physical activity. Regular eye examinations and treatment of correctable vision problems may help maintain both independence and cognitive health.

15. Sleep: My Additional Risk Factor

Sleep is not currently one of the 14 formal Lancet dementia risk factors, but I believe it deserves special attention.

In my practice, I routinely screen patients for sleep disorders because sleep affects nearly every system involved in healthy aging, including memory, mood, metabolism, cardiovascular health, inflammation, and brain function.

Research has shown that untreated obstructive sleep apnea is associated with a significantly increased risk of cognitive impairment and dementia. Some studies suggest that individuals with sleep apnea may be 20% to 60% more likely to experience cognitive decline over time.

Sleep is also closely connected to many of the established Lancet risk factors. Poor sleep can worsen obesity, diabetes, hypertension, depression, physical inactivity, and cardiovascular disease.

During deep sleep, the brain becomes more efficient at clearing metabolic waste products, including beta-amyloid and tau proteins that are associated with Alzheimer's disease.

For these reasons, I consider healthy sleep and screening for sleep apnea to be an important part of a comprehensive brain health strategy.

If you snore loudly, wake feeling unrefreshed, feel excessively sleepy during the day, or have been told that you stop breathing during sleep, talk with your healthcare provider.

To learn more, read my article:

Sleep Apnea: The Silent Risk Hiding in Plain Sight

The Bottom Line

No single intervention can completely prevent dementia. However, the evidence continues to show that many cases may be delayed or prevented through a combination of healthy lifestyle habits and appropriate medical care.

The same habits that support healthy aging, regular exercise, good nutrition, controlling blood pressure and cholesterol, maintaining social connections, treating hearing and vision loss, avoiding tobacco, limiting alcohol, and prioritizing sleep, also support long-term brain health.

Medical Disclaimer

The information provided in this article is intended for educational and informational purposes only and should not be considered medical advice. The content is based on current scientific research and the clinical experience of the author but is not intended to diagnose, treat, cure, or prevent any disease.

Every individual has unique health circumstances, risk factors, and medical conditions. Decisions regarding medical care, medications, testing, nutrition, exercise, or lifestyle changes should be made in consultation with your physician or other qualified healthcare professional.

Never disregard professional medical advice or delay seeking medical care because of information you have read on this website.

References to scientific studies are provided for educational purposes and do not guarantee that any specific intervention will reduce disease risk for a particular individual.

If you have concerns about memory loss, cognitive decline, sleep disorders, cardiovascular health, diabetes, hearing loss, vision changes, or other medical conditions discussed in this article, please consult your healthcare provider for personalized evaluation and recommendations.

Sources

• Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404(10452):572-628. Published online July 31, 2024.

• Topiwala A, Gelernter J, Elsworth B, Tzoulaki I, Carter AR, Larsson SC, Burgess S. Alcohol use and risk of dementia in diverse populations: evidence from cohort, case-control and Mendelian randomisation approaches. BMJ Evidence Based Medicine. Published online September 23, 2025. doi:10.1136/bmjebm-2025-113913

• Livingston, Gill, et al. "Dementia prevention, intervention, and care: 2020 report of the Lancet Commission." The Lancet 396.10248 (2020): 413-446.

• Gudala K, Bansal D, Schifano F, Bhansali A. Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies. J Diabetes Invest 2013;4:640–650

• Cholerton B, Baker LD, Montine TJ, Craft S. Type 2 Diabetes, Cognition, and Dementia in Older Adults: Toward a Precision Health Approach. Diabetes Spectr. 2016 Nov;29(4):210-219. doi: 10.2337/ds16-0041. PMID: 27899872; PMCID: PMC5111529

• Lennon MJ, Lam BCP, Lipnicki DM, et al. Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis. JAMA Netw Open. 2023;6(9):e2333353. doi:10.1001/jamanetworkopen.2023.33353

• Li Y, Li Y, Li X, Zhang S, Zhao J, Zhu X, Tian G. Head Injury as a Risk Factor for Dementia and Alzheimer's Disease: A Systematic Review and Meta-Analysis of 32 Observational Studies. PLoS One. 2017 Jan 9;12(1):e0169650. doi: 10.1371/journal.pone.0169650. PMID: 28068405; PMCID: PMC5221805.

• Guay-Gagnon, M., Vat, S., Forget, M. F., Tremblay-Gravel, M., Ducharme, S., Nguyen, Q. D., & Desmarais, P. (2022). Sleep apnea and the risk of dementia: A systematic review and meta-analysis. Journal of sleep research, 31(5), e13589. https://doi.org/10.1111/jsr.13589

• Jiang F. Mishra S. R. Shrestha N. Ozaki A. Virani S. S. Bright T. (2023) Association between hearing aid use all-cause cause-specific dementia: an analysis of the UK Biobank cohort. Lancet Public Health 8, e329. 10.1016/S2468-2667(23)00048-8 .

• Loneliness and Social Isolation Linked to Serious Health Conditions (cdc.gov)

• Lee SL, Pearce E, Ajnakina O, Johnson S, Lewis G, Mann F, Pitman A, Solmi F, Sommerlad A, Steptoe A, Tymoszuk U, Lewis G. The association between loneliness and depressive symptoms among adults aged 50 years and older: a 12-year population-based cohort study. Lancet Psychiatry. 2021 Jan;8(1):48-57. doi: 10.1016/S2215-0366(20)30383-7. Epub 2020 Nov 9. PMID: 33181096; PMCID: PMC8009277.

• Bubu OM, Andrade AG, Umasabor-Bubu OQ, Hogan MM, Turner AD, de Leon MJ, Ogedegbe G, Ayappa I, Jean-Louis GG, Jackson ML, Varga AW, Osorio RS. Obstructive sleep apnea, cognition and Alzheimer’s disease: a systematic revi of multidisciplinary research. Sleep Med Rev. 2020;50:101250

• Ercolano, E., Bencivenga, L., Palaia, M.E. et al. Intricate relationship between obstructive sleep apnea and dementia in older adults. GeroScience 46, 99–111 (2024). https://doi.orgew integrating three decades/10.1007/s11357-023-00958-4

• Guay-Gagnon, M., Vat, S., Forget, M. F., Tremblay-Gravel, M., Ducharme, S., Nguyen, Q. D., & Desmarais, P. (2022). Sleep apnea and the risk of dementia: A systematic review and meta-analysis. Journal of sleep research, 31(5), e13589. https://doi.org/10.1111/jsr.13589

• Yoon M, Yang P, Jin M, et al. Association of Physical Activity Level With Risk of Dementia in a Nationwide Cohort in Korea. JAMA Netw Open. 2021;4(12):e2138526. doi:10.1001/jamanetworkopen.2021.38526

• https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/reduce-your-risk-of-dementia/physical-activity#:~:text=Physical%20exercise%20to%20reduce%20dementia,developing%20dementia%20by%20about%2028%25. (accessed 1/18/2024)

• Wang S, Liu HY, Cheng YC, Su CH. Exercise Dosage in Reducing the Risk of Dementia Development: Mode, Duration, and Intensity-A Narrative Review. Int J Environ Res Public Health. 2021 Dec 17;18(24):13331. doi: 10.3390/ijerph182413331. PMID: 34948942; PMCID: PMC8703896.

• Lennon MJ, Lam BCP, Lipnicki DM, et al. Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis. JAMA Netw Open. 2023;6(9):e2333353. doi:10.1001/jamanetworkopen.2023.33353