What can be done to reduce the risk of dementia?

Dementia Risk Reduction Strategies

Adopt a Mediterranean diet combined with at least 150 minutes per week of moderate-intensity aerobic exercise, as this multimodal approach can reduce dementia risk by up to 60%. 1, 2

Dietary Modifications

Follow a Mediterranean-style eating pattern that emphasizes high consumption of fruits, vegetables, legumes, whole grains, fish, and olive oil, with moderate dairy intake and low meat consumption. 1

• Specifically increase mono- and polyunsaturated fatty acid intake while reducing saturated fat consumption. 1
• Consume fish regularly (at least one portion per week) for omega-3 fatty acids, particularly EPA and DHA, which show cognitive benefits especially when started before cognitive decline begins. 1
• Eat at least five portions of fruits and vegetables daily to ensure adequate antioxidant and nutrient intake. 1, 3
• Avoid restrictive diets that limit food selection, as these may reduce dietary enjoyment and intake without clear cognitive benefit. 1

Physical Activity Requirements

Engage in aerobic exercise and/or resistance training of at least moderate intensity for a minimum of 150 minutes weekly. 1

• Aerobic activities should reach 12-14 on the Borg scale (55-70% heart rate reserve) for optimal cognitive benefit. 4
• Include resistance training 2-3 days per week with 1-3 sets of 8-12 repetitions at 60-80% of one-repetition maximum. 4
• Consider adding mind-body exercises like Tai Chi or Qigong, which show promising cognitive benefits. 1
• Establish a consistent daily routine with exercise at predictable times to support long-term adherence. 4

Cardiovascular Risk Factor Management

Maintain systolic blood pressure at 130 mm Hg or less starting in midlife (around age 40), as antihypertensive treatment is the only known effective preventative medication for dementia. 1, 2

• Keep untreated total cholesterol below 200 mg/dL and fasting blood glucose below 100 mg/dL. 1, 2
• Maintain body mass index below 25 kg/m². 1, 2
• Manage diabetes aggressively, as it significantly increases dementia risk. 1, 2
• Avoid smoking or quit if currently smoking, as cessation reduces dementia risk even in later life. 1, 2

Sensory and Sleep Health

Address hearing loss promptly by getting audiometry testing and using hearing aids if indicated, as hearing impairment is a significant modifiable risk factor. 1, 2

• Protect ears from excessive noise exposure throughout life. 1, 2
• If you have symptoms suggesting sleep apnea (snoring, daytime sleepiness, witnessed breathing pauses), undergo polysomnography and consider CPAP treatment if diagnosed. 1
• Target 7-8 hours of sleep per night and avoid severe sleep deprivation (less than 5 hours). 1

Cognitive and Social Engagement

Pursue cognitively stimulating activities and maintain social connections, as both cognitive engagement and avoiding social isolation reduce dementia risk. 1, 2

• Engage in educational activities and lifelong learning, as higher educational attainment is protective. 1, 2
• Treat depression if present, as it represents a significant risk factor for cognitive decline. 1, 2

Lifestyle Factors

Limit alcohol consumption to light-to-moderate levels only (if you drink at all), and avoid head injuries through appropriate safety measures. 1, 2

• Reduce exposure to air pollution and secondhand tobacco smoke when possible. 1, 2
• Prevent head trauma by using seatbelts, helmets, and fall prevention strategies. 1, 2

Implementation Approach

The key to success is addressing multiple risk factors simultaneously rather than focusing on single interventions, as multimodal approaches are significantly more effective. 1, 2

• Begin these preventive strategies in midlife (40s-50s) when intervention appears most effective, but continue them throughout life as benefits persist even when started later. 1, 2
• Recent longitudinal trials demonstrate that adhering to 4 or all 5 healthy behaviors (weekly moderate/vigorous exercise, not smoking, light-to-moderate alcohol consumption, brain-healthy diet, and cognitive engagement) reduces Alzheimer's risk by up to 60%. 1, 2

Critical Pitfalls to Avoid

Do not rely on single nutrient supplements (like isolated B vitamins or antioxidants) as they have not proven effective for dementia prevention; the protective effects come from complete dietary patterns. 1, 3

• Do not wait until cognitive symptoms appear to implement these strategies, as early intervention is substantially more effective. 2
• Do not overlook hearing loss as "normal aging"—it is a treatable risk factor that requires intervention. 1, 2
• Do not assume cognitive decline is inevitable; current evidence suggests 20-60% of cases could potentially be prevented or delayed through these modifiable risk factors. 2