Dementia is not inevitable and, in some cases, can be prevented. While there is currently no known cure for dementia once onset is detected, researchers now estimate that nearly half of worldwide dementia cases can be prevented or delayed.
Unfortunately, dementia remains a serious health concern for over 7 million Americans over 65 years old, and teaching patients how to prevent dementia is only one half of the brain health equation; early detection is key. Scientifically backed clinical assessment tools are readily available for clinicians, such as computerized assessments and care plans that can screen a patient for dementia symptoms early and detect, track, and measure cognitive decline.
In this article, we'll cover 12 modifiable dementia risk factors and what physicians can do to help their patients prevent cognitive decline and preserve their brain health as they age.
What Are 12 Modifiable Risk Factors for Dementia?
Physical Activity and Diet
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Lack of Exercise
Exercise has been linked to cognitive outcomes and better brain health. There is also a connection between exercise and a delay in the onset of dementia. In one study investigating aerobic exercise, it was shown to affect the progression of vascular dementia. After six months of brisk walking for three hours a week, the participants showed performance improvements on cognitive tests of executive function and memory.
For dementia patients, as well as those who want to support their brain and physiological health through exercise, physicians can support them with cognitive tests for dementia to track their progress. Cognitive tests can be used to monitor a patient’s cognitive performance over time. This allows for the accurate measurement of the long-term effects of exercise and other interventions on their brain function.
2. Poor Diet and Obesity
Evidence suggests that proper nutrition can also play an important role in dementia prevention. There are a number of dietary factors that can be causes for concerns related to physiological health, like poor nutrition, blood cholesterol levels, and unbalanced blood sugar. If left untreated or unaddressed, these conditions can give rise to several chronic diseases, including dementia.
Clinicians can help shift focus on a patient’s modifiable risk factors by promoting physical activity and a diet that supports a healthy weight. Generally, patients can reduce their risk of dementia with a healthy lifestyle that includes frequent activity and proper or personalized nutrition to support brain health, reduce cognitive decline, and stay sharp in old age.
3. Alcohol Consumption
High alcohol intake has many known links with dementia, including neurodegeneration, cognitive impairment, and an increased risk of a diagnosis. But how much alcohol is too much? Excessive consumption can lead to alcohol-related brain damage, and even moderate consumption may increase the risk of other diseases such as cancer, according to WHO guidelines.
Treatment for alcohol-related disorders can be difficult, but administering a short and simple questionnaire can be a great place to start the conversation. The Alcohol Use Disorders Identification Test (AUDIT) is designed to assess alcohol consumption, drinking behaviors, and alcohol-related health problems in just two minutes. A quick AUDIT can capture behavioral data, while pairing it with cognitive assessments can collect a baseline that helps patients to better understand how heavy drinking is affecting their cognition.
4. Diabetes
When it comes to type 2 diabetes and dementia, patients should aim for prevention in both cases. Often, the recommendations for managing diabetes overlap with those for preventing dementia—healthy diet, regular exercise, and tackling related risk factors all contribute to lowering risk. If diagnosed with diabetes, patients can further benefit from taking the prescribed medication and health strategies intended for managing diabetes, as they may also help prevent dementia.
Respiratory and Cardiovascular Health
5. Smoking
Smokers are generally at a higher risk of developing dementia in their senior years than non-smokers. A longitudinal study on how smoking cessation is related to the risk of dementia found that participants who never smoked or who had quit smoking for over four years had significantly lower dementia risk for the next eight years.
On the other hand, those who continued smoking in late life had a higher risk of developing dementia, Alzheimer's disease, and vascular dementia. Encouraging patients to stop smoking may result in risk reduction in this case, which can include creating a quit plan tailored to their health and lifestyle.
6. Air Pollution
While air pollution is already known to be associated with poor respiratory health, certain studies tested how exposure is linked with cognitive function. A systematic review of studies reporting on air pollution and dementia found that exposure to fine ambient particulate matter, nitrogen dioxide, nitrous oxides, and carbon monoxide from traffic was all associated with increased incident dementia risk.
Unfortunately, air pollution is a difficult risk factor to modify. Pollution varies by region and is largely outside the control of individual patients. But there are ways for patients to minimize the pollutants they come into contact with. Strategies like avoiding exercising near high traffic areas or during days with high air pollution, wearing a mask outside, and using an air filter while indoors can help alleviate exposure.
7. Hypertension
Also known as high blood pressure, hypertension not only increases the risk of heart disease but is also associated with an increased risk of developing dementia in late life. A cohort study on blood pressure and late-life brain structure found that participants with hypertension as young as 40 years old tended to have reduced brain volumes and increased white matter hyperintensity volumes later in life. To support patients, physicians can provide ways to keep track of and manage high blood pressure for patients to help protect their cognition and prevent dementia onset even in their later years.
Head and Hearing Protection
8. Traumatic Brain Injury
Traumatic brain injury (TBI) can either be classified as mild (like a concussion) or severe (skull fracture, brain damage, etc.). These types of head injuries have been shown to increase the risk of developing dementia. A systematic review of studies examining this relationship found that individuals were 1.96 times more likely to be diagnosed with dementia if they had reported a previous mild TBI. Furthermore, patients demonstrated impaired performance on several tests of neuropsychological performance, and structural brain changes were even detected in some instances.
9. Hearing Loss
While more research is required to determine the exact mechanism by which hearing loss impairs cognition, studies show a clear link between the two. For example, a cross-sectional study on subclinical hearing loss and cognitive performance found a decrease in cognitive ability with as little as a 10 dB reduction in hearing for adults over 50.
When it comes to noise-induced hearing loss, doctors can help by teaching patients the importance of reducing or eliminating loud noise. Simple actions like turning the volume down on the TV and headphones, taking breaks in silence, using quieter products (such as power tools and vacuum cleaners), and using earplugs or earmuffs when noise is unavoidable can help patients preserve their hearing and minimize risk.
Mental Health
10. Poor Access to Education
The connection between education and late-life cognition is largely positive, with dementia research showing that high school-level education or higher can serve as a protective factor by decreasing the risk of cognitive decline.
Older patients who regularly engage in mentally stimulating activities may also have an increased chance of preserving their cognition in late life. These lifestyle factors stand to benefit patients' cognitive reserve—the ability of the brain to build new networks or change strategy despite age-related changes or to compensate for damage—making their cognition more resilient to decline. It’s important to start thinking about neurological care early so that clinicians can discuss relevant long-term modifiable risk factors with patients.
11. Depression
While depression is a potentially modifiable risk factor, like diabetes, starting treatment before it reaches chronic stages may decrease the risk of dementia. One large study found that depression was associated with a 51% higher risk of dementia, while participants who were treated for less severe symptoms of depression were associated with at least a 28% lower risk of dementia.
One tool that can assist in the screening and diagnosis of depression is the Patient Health Questionnaire (PHQ-9). By capturing a patient's depression symptoms in a quick, simple test, physicians can use those data to reach a more accurate diagnosis—especially when coupled with cognitive assessments and clinical interviews. Every aspect of a patient’s experience is connected and should be considered for risk factors as part of whole-person care.
12. Social Isolation
While isolation makes older patients more vulnerable to incident dementia, the good news is that encouraging them to be more socially active can prevent or delay dementia onset. A study on social relationships and dementia identified five points of social contact that affected dementia onset. Participants in late life who were married, received support from family members, maintained close friendships, participated in community groups, and engaged in paid work were less likely to have dementia at an earlier age.
It’s important to have tools for assessing dementia that are easy to use and readily available so clinicians can detect symptoms early, giving patients time to modify certain risk factors before disease progression.
Other Risk Factors for Dementia
While the 12 risk factors we've discussed are all modifiable to some degree, there are other risk factors for dementia that are considered non-modifiable. They include:
Age
Mild decreases in certain cognitive abilities are a natural process of aging, but impairment that disrupts daily life and affects familiar tasks may relate to health conditions such as mild cognitive impairment (MCI) or dementia. To counteract the cognitive vulnerabilities that come with age, it's important for patients to engage in healthy lifestyle habits and reduce modifiable risk factors in their early and mid-life to build a more robust cognitive reserve for the future.
Genetics
Genes will always play a part in determining a person’s risk for health conditions later in life. Certain dementias, like Alzheimer's disease, are known to be more closely associated with genetic causes. However, even patients who have a family history of dementia can still reduce their chances of developing the disease by focusing on the other risk factors they can modify.
Access to Healthcare Services
Poor access to healthcare is another risk factor for developing dementia. Systemic and socio-economic inequalities can also prevent marginalized peoples from seeking and receiving medical aid. When healthcare is hard to access, it becomes more difficult for people from minority communities to find the right support for conditions like dementia.
While making the healthcare system more accessible is a necessary but large task, smaller societal changes can also start bringing positive benefits to communities.
Limits to Early Detection
Traditional cognitive screening tools, like the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE), can play a major role in the diagnosis of dementia, but they have limitations and may not be sensitive enough to detect early signs of cognitive decline or milder forms of dementia. Plus, they’re static and can be memorized by patients, leading to a limited capacity for retesting and longitudinal assessment.
An accessible and accurate alternative method to test, track, and monitor cognition over time is through online cognitive assessments. Through quick, scheduled checkups and assessments that can be performed completely online, patients can get a better sense of the state of their cognitive health without the stress of traveling to multiple clinic appointments.
With domain-specific data included in Creyos digital cognitive assessments, clinicians can make more informed conclusions regarding the state of a patient's brain health and catch early signs of cognitive decline. The Creyos Dementia Assessment also provides a robust, scientifically validated way to screen for dementia both remotely and in person.
Final Thoughts
Dementia is a prevalent health problem throughout the world, and although it may not yet be curable, in some cases it can be preventable. By supporting patients as they address their modifiable risk factors and improve brain health overall, clinicians can help patients build cognitive resilience later in life. When it comes to risk factors that can't be changed, early detection is key. Through routine tests carried out online and as part of a cognitive care plan, healthcare providers can increase the chances of detecting dementia at its earlier—and more preventable—stages.
Reviewed by Sydni Paleczny, Staff Scientist
Sydni earned her MSc in Neurosciences at Western University under Dr. Adrian Owen. Her research explores neuropsychological outcomes after cardiac surgery, with interests in cognitive neuroscience, critical care, and brain health. At Creyos, she supports scientific validity, health technology, and ongoing research.