If you've ever worried about your memory or watched a loved one struggle with cognitive decline, you're not alone. It's true that aging is a major risk factor for dementia — but it's far from the whole story.
In fact, the latest research shows that as much as 45% of dementia risk may be reduced through lifestyle changes. That means that while we can't control our age or genes, we can influence many modifiable risk factors.
"Many of the dementia risk factors are things we can monitor and modify," says Dr. Juan B. Toledo Atucha, a neurologist at Houston Methodist. "The effects of these habits accumulate over a lifetime, so the earlier we start, the more of a difference we can make."
What is dementia?
Many people think of dementia as a single disease. Instead, it's a group of symptoms related to cognitive decline, including memory loss, language impairment, behavior changes and difficulty with thinking or decision-making.
"More than half the people who die from a dementia condition have at least three different conditions related to their cognitive impairment, says Dr. Toledo. "It's not one single problem. It's multiple conditions causing these symptoms."
Alzheimer's disease is the most common condition, followed by vascular dementia and Lewy body dementia. Most cognitive disorders are progressive, with symptoms getting worse over time. However, as we learn more about how these diseases progress, researchers are finding new ways to identify, and potentially slow, them earlier than ever before.
"We're now able to use specific biomarkers that can pinpoint changes in the brain 10 to 20 years before symptoms develop," Dr. Toledo says. "This is good news, because these brain changes are very slow processes. The longer the changes take to appear, the bigger our window to intervene to prevent or delay the onset of symptoms."
What are risk factors for dementia that we can't change?
Getting older is the greatest known risk factor for dementia, with symptoms typically appearing in people older than age 65. With Alzheimer's disease, for example, the risk of developing the condition roughly doubles every five years after age 65. By 85, nearly one in three people are affected.
Your family history may also play a role in your risk for cognitive decline. Less than 1% of dementia cases are linked to a single gene that causes a specific disease. Instead, your risk increases if you carry multiple genes associated with dementia. Recent research has also uncovered links between specific genetic changes and geographic ancestry.
"In people of European descent, a gene variant called APOE-ε4 is the strongest inherited risk factor," explains Dr. Toledo. "However, for people of African or Caribbean descent, the impact of the APOE gene is decreased."
Why are modifiable risk factors so important?
Decades of research have shown that lifestyle choices are key to lowering our risk of dementia. This is because eating right and staying active are vital for our heart, lungs, and blood vessels. When these systems are running smoothly, the brain receives the blood and oxygen it needs to survive and thrive.
"We know that hypertension, high blood sugar, and obesity are all linked to cognitive decline," says Dr. Toledo. "The latest guidance from an international commission on dementia risk factors added high LDL cholesterol to the list of medical concerns."
Neurologists now believe healthy habits help the brain can build up a "cognitive reserve" of resiliency. The idea is that a healthy and active brain is better able to cope with changes caused by neurodegenerative disease.
"The lifestyle habits we establish at a young age have a cumulative effect throughout our lifetime," Dr. Toledo explains. "The sooner we start addressing the risk factors we can control, the more time we give the brain to build up the resilience it needs to fend off cognitive decline."
Tips to lower dementia risk
The American Alzheimer's Association recommends key steps we can take to lower our risk of dementia. Many of these are lifestyle habits that are vital for our overall health:
- Eat right and maintain a healthy weight
- Control blood pressure
- Manage type 2 diabetes
- Quit smoking
- Stay physically active
Your primary care provider and specialists can help you understand the important numbers and address your medical needs. Talk with your provider about weight management, wellness training, and tobacco cessation programs guided by professional counselors to help you achieve and sustain long-term results.
(Related: 4 Habits That Help Boost Brain Health)
What else can we do to build up our brain resilience?
In addition to our physical health, we also need to pay attention to our cognitive health as well. You might be surprised to learn how sensory input, social interaction, sleep and other factors all affect our brain health.
1. Challenge your cognitive skills
Extensive research over the past few decades has shown the importance of continuing to stimulate our memory and other cognitive skills as we get older. Lifelong learning and curiosity are key to maintaining a sharp mind.
"Brain games" such as crossword puzzles, jigsaw puzzles and Sudoku are a great way to build cognitive resilience. You can also try:
- Exploring a new hobby or creative project that requires concentration
- Taking an online course or learning a new language
- Reading or playing music regularly
Numerous apps are designed for seniors with daily challenges that track specific cognitive functions.
"Some of the recent studies have focused on educational attainment," says Dr. Toledo. "Not just how long did you study, but also how much did you get from studying, and what did it lead to? It might be that variables like quality of education or the level of engagement can have a measurable impact in cognitive function later in life."
(Related: Are Word Games & Puzzles Good for Your Brain?)
2. Stay social
The lockdowns during the COVID-19 pandemic showed how important social networks are for our mental health. Studies consistently show that people who remain socially engaged have lower rates of cognitive decline and depression.
"Isolation is strongly linked with depression, and midlife depression is associated with a greater risk of dementia," Dr. Toledo says. "When we lose those interactions with other people, we miss out on those opportunities to challenge the brain with conversation and emotional response."
Connections with friends and family not only enhance cognitive reserve but also reduce stress and provide a crucial support system. Even casual interactions, such as chatting with neighbors or joining a class, can help strengthen neural pathways. Look for opportunities to volunteer, join a club, or participate in community groups.
(Related: How to Care for Someone With Dementia: 5 Tips for Caregivers)
3. Keep your eyes and ears sharp
Seniors who have difficulty with vision or hearing loss are much more likely to become isolated from family and community. Research has shown that 7% of dementia cases can be linked to hearing loss beginning in midlife. The newest research on dementia risk factors now includes untreated vision loss as a key concern in later life.
"Wearing hearing aids or glasses, or undergoing minimally invasive procedures like cataract surgery, can be very cost-effective and have long-term positive impacts that we're still learning about," says Dr. Toledo. "It's a part of aging, but we don't have to accept the limitations."
(Related: Eye Health: 3 Tips for Protecting Your Vision)
4. Focus on a good night's sleep
Did you know that our brains consolidate our memories while we sleep? That's why sleep disruptions affect concentration and learning.
"It's both the number of hours that you sleep and the quality of your sleep," explains Dr. Toledo. "If you have chronic insomnia, your brain doesn't have enough time to store the memories. If you have sleep apnea, the regular sleep/wake cycles are interrupted, and oxygenation levels decrease throughout the night."
5. Protect your head
Brain injury is becoming an increasingly important health concern. We're more aware of the impact of traumatic brain injuries that might occur in an auto accident, and the cumulative effects of a high-contact sport like contact sports. Seniors are also at high risk for falling, and head injuries can go unnoticed.
"We also need to look at seemingly minor brain bleeds or indirect injuries from air pollution that don't produce any noticeable symptoms," says Dr. Toledo. "The damage can accumulate over time before we're able to detect any cognitive decline. Wear your seat belt, wear your helmet, wear your safety gear at work, and keep an eye out for things that might cause a fall."
When should you see a doctor about dementia symptoms?
Because cognitive changes leading to dementia are progressive, early detection matters. It's important to be aware of your cognitive well-being and not ignore changes as "just aging." If you or a loved one notice alarming or concerning signs, talk with a doctor. Signs to watch for include:
- Difficulty completing familiar tasks
- Difficulties recalling recent conversations
- Misplacing items in unusual places and being unable to retrace steps
- Changes in judgment, such as financial missteps or giving away money
- Confusion with time or place
- New and sudden onset of depression later in life
"Don't wait until symptoms are severe," says Dr. Toledo. "If something feels off, talk with your doctor. Early evaluation can help identify reversible causes and give you a head start on treatment or prevention."
Prioritize your brain health
Whether you're caring for a parent, thinking about your own future or simply looking to stay sharp as you age, there are steps you can take today to protect your brain health.
"It's never too early to start healthy habits, and it's never too late to make changes," says Dr. Toledo. "It's really heartening to learn how many things we can control to slow down the onset of cognitive decline."
