What strategies can a healthy adult with a family history of dementia use to support cognitive function and potentially reduce the risk of dementia?

Cognitive Support Strategies for Healthy Adults with Family History of Dementia

Prioritize resistance training over aerobic exercise alone, as it demonstrates superior cognitive benefits, combined with a Mediterranean diet and adequate sleep—these three interventions have the strongest evidence for reducing dementia risk and supporting cognitive function. 1, 2

Exercise: The Primary Intervention

Resistance Training Takes Priority

• Resistance training shows superior cognitive effects compared to aerobic exercise or other modalities in older adults, making it the cornerstone of any exercise program 2, 1
• Perform muscle-strengthening activities involving major muscle groups at least 3 times per week 2, 1
• Benefits begin immediately with no minimum threshold required—any amount helps 2, 1

Optimal Exercise Dosing

• Target 724 METs-min per week for clinically meaningful cognitive changes (approximately 150 minutes of moderate-intensity activity) 2, 1
• Doses beyond 1200 METs-min per week provide diminishing returns 2, 1
• Lower doses of resistance training achieve clinically meaningful benefits, so high-intensity programs are unnecessary 1, 3
• Combine aerobic exercise (150-300 min/week moderate intensity or 75-150 min/week vigorous intensity) with resistance training for comprehensive benefits 2

Additional Exercise Modalities

• Mind-body exercises (Tai Chi, Qigong) and dance show promising cognitive benefits, though evidence is still emerging 2
• Multicomponent exercise (combining aerobic and resistance training) provides robust benefits 2

Nutrition: Mediterranean Diet Pattern

Core Dietary Recommendations

• Adhere to a Mediterranean diet to decrease cognitive decline risk 2
• Emphasize high consumption of fruits, vegetables, legumes, and unrefined cereals 2
• Include moderate amounts of dairy products 2
• Consume regular fish intake while limiting meat 2

Specific Fat Recommendations

• Prioritize high intake of mono- and polyunsaturated fatty acids 2
• Minimize saturated fatty acid consumption 2
• Avoid restrictive diets (low salt, low sugar, low cholesterol) as they reduce dietary enjoyment without proven cognitive benefits 2

Sleep Optimization

Target Sleep Duration

• Aim for 7-8 hours of sleep per night—avoiding severe sleep deprivation (<5 hours) may improve cognition and decrease dementia risk 2

Sleep Disorder Management

• Assess for sleep apnea symptoms (snoring, daytime sleepiness, witnessed apneas) 2
• If sleep apnea is suspected, obtain polysomnography and consider CPAP treatment, which may improve cognition and decrease dementia risk 2
• Address insomnia symptoms, though specific treatment evidence for dementia prevention remains insufficient 2

Hearing Health

Assessment and Intervention

• Ask specifically about difficulty hearing in everyday life (not just "do you have hearing loss") 2
• If hearing difficulty is reported, confirm with formal audiometry 2
• Pursue audiologic rehabilitation including behavioral counseling and hearing aid use when indicated 2
• Hearing impairment is an established dementia risk factor based on observational evidence 2

Common Pitfalls to Avoid

• Do not focus exclusively on aerobic exercise while neglecting resistance training—this is the most common mistake, as resistance training provides superior cognitive benefits 1, 3
• Do not recommend only high-intensity exercise programs—lower doses of resistance training achieve meaningful results 1, 3
• Do not treat all exercise doses as equivalent—the dose-response relationship is non-linear and exercise-type dependent 1
• Avoid restrictive diets that reduce eating enjoyment without proven cognitive benefits 2
• Do not rely on cognitive training programs or nutritional supplements beyond correcting deficiencies—evidence for these interventions is insufficient or weak 4, 5

Implementation Strategy

Start with resistance training 3 times weekly, gradually building to the 724 METs-min/week target while simultaneously adopting Mediterranean dietary patterns and optimizing sleep to 7-8 hours nightly. Address hearing impairment if present. This combination targets the modifiable risk factors with the strongest evidence base for dementia prevention. 2, 1