By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
How can you lower your dementia risk?
Your dementia risk is not set in stone. New international guidelines place brain health within the health of the heart, metabolism, the senses and social life. The core message is clear: there is no way to guarantee that you will avoid dementia. Even so, you can act today to reduce the risk or delay the onset of the disease.
The brain does not age in isolation
For years, people saw dementia as the result of age and genetics alone. However, the second edition of the World Health Organization guidelines, published on July 15, 2026, offers an optimistic picture. Throughout life, the body, mental and social activity, hearing and vision, and the environment all shape brain health. So does how well we treat metabolic and vascular risk factors.
That doesn’t mean we can prevent every case. Age, heredity and degenerative processes still play an important role. So the accurate term is not “preventing Alzheimer’s,” but rather reducing risk, delaying disease and preserving independence for years.
According to the World Health Organization, 57 million people worldwide were living with dementia in 2021. Nearly ten million new cases appear every year. The organization stresses that dementia is not an inevitable part of aging, even though it becomes more common after age 65.
Dementia risk and 14 factors you can change
The 2024 report of the Lancet Commission identified 14 risk factors that we can change, at least in part. According to the commission’s model, addressing them over a lifetime could prevent or delay about 45% of dementia cases at the population level. The latest report added two factors: high LDL cholesterol in midlife and untreated vision loss.
Here are the factors: less education, hearing loss, vision loss, high LDL, high blood pressure, diabetes, obesity, physical inactivity, smoking, heavy drinking, depression, social isolation, head injury and air pollution. I wrote at length about the link between weight and the brain in my article on Alzheimer’s and obesity.
It is also important to understand what the 45% figure does not mean. This figure does not promise any one person a 45% cut in their personal dementia risk. It is a population estimate, and the factors overlap. Still, the direction is clear: what protects the heart, blood vessels and senses may also protect the brain.
Exercise: brain medicine that doesn’t come in a box
The World Health Organization strongly recommends physical activity for adults with normal cognition. Aerobic exercise improves blood flow and metabolic balance. At the same time, strength training preserves muscle mass, balance and independence. I compare the two types of training in my article on aerobic vs. strength training.
You don’t need to become a competitive athlete. Brisk walking, cycling, swimming, dancing and climbing stairs suit most people. The goal is regular activity and less prolonged sitting. For older adults or people with chronic illness, it is worth tailoring activity to their medical condition.
What’s more, the U.S. POINTER study, published in JAMA in 2025, included 2,111 participants aged 60 to 79 at high risk of cognitive decline. The program combined exercise, the MIND diet, cognitive challenge, social connection and cardiovascular monitoring. After two years, the structured program led to significant cognitive improvement compared with a self-guided program. The researchers noted that they need longer follow-up to know whether the improvement will translate into less dementia.
Brain training: more than just another crossword
The new guidelines recommend encouraging mental stimulation and social activity. The recommendation applies to people with normal cognition and also to those with mild cognitive impairment.
Good brain training involves learning, novelty and effort. Examples include learning a language, playing an instrument, dancing with sequences, challenging reading, strategy games and learning a new technology. However, there is currently no proof that a single app or crosswords alone prevent dementia. That is why the current approach builds cognitive challenge into an active, social lifestyle. Curiosity and brain health are linked as well.
Social connections lower dementia risk
Loneliness is not just an emotional experience. It limits mental stimulation, increases depression and stress, and reduces physical activity. That is why the guidelines see social activity as a genuine health intervention.
A class, volunteering, a shared meal, a choir or a walking group all combine language, memory, attention, movement and emotion. Just like a prescription for exercise, you can put two regular weekly get-togethers in your calendar or rekindle a friendship that has lapsed.
A brain-healthy diet is not a supplement
The guidelines recommend a healthy, balanced eating pattern rather than one specific diet. The Mediterranean diet is a good example: vegetables, fruit, legumes, whole grains, nuts, olive oil and fish. On the other hand, it is wise to cut back on ultra-processed food, added sugar and processed meat. The benefit comes mainly from protecting blood vessels and metabolism.
In addition, the World Health Organization states that people should not take B or E vitamins, omega-3 or multivitamins to prevent cognitive decline if they have no diagnosed deficiency. Of course, a true deficiency in vitamin B12, folic acid or vitamin D requires diagnosis and treatment. But a supplement is no substitute for a good diet.
Cholesterol, blood pressure and diabetes: the brain pays the price, too
High blood pressure, diabetes, high cholesterol and obesity damage blood vessels. They raise the risk of stroke and cumulative brain damage, sometimes years before any sign of memory trouble. So the guidelines recommend treating them actively, according to the dedicated guidelines for each condition. We should control blood lipids as early as midlife.
That said, the guidelines make it clear that doctors should not start statins only to prevent dementia. Extra-intensive control of blood sugar or blood pressure has also not shown a clear added benefit for the brain. Treating cholesterol is not an “anti-Alzheimer’s treatment,” but it does ease the burden on the blood vessels.
Hearing, vision and dementia risk
The senses are the brain’s gateway to the world. Hearing loss makes it harder to understand speech and leads to withdrawal. Vision loss limits reading, movement and social activity. Both raise dementia risk when they go untreated.
The guidelines state that clinicians may offer hearing aids to older adults with hearing loss. The ACHIEVE study included 977 adults aged 70 to 84 with hearing loss. Across all participants, the researchers found no significant cognitive benefit. However, in the group that was at high risk to begin with, the intervention slowed cognitive decline over three years. So a hearing aid is not just a matter of convenience. In addition, a new blood test can now also detect early changes in the brain.
The air we breathe reaches the brain, too
For the first time, the new edition also addresses exposure to air pollution. Studies have linked air pollution to blood vessel damage, inflammation and a higher risk of stroke and dementia. Each of us can track air quality readings and avoid exercising near busy roads. But the big change requires policy: clean transportation, green spaces and urban planning that encourages walking.
The new approach: build a whole framework, not one habit
The guidelines support a multidomain, personalized intervention that addresses at least three risk factors. The approach rests in part on the Finnish FINGER study and the American POINTER study. It also makes sense: most people are exposed to several risk factors at once. A personal plan identifies where the greatest potential for improvement lies.
What can you do this week to lower your dementia risk?
The first step is not a new supplement. First, get to know your personal risk profile: blood pressure, blood sugar, cholesterol, weight and waist circumference. Second, have your hearing and vision checked, and find out whether you have sleep problems or depression. Restful nights and memory are closely connected.
Next, choose a few measurable steps: three weekly sessions of aerobic activity, two strength workouts, one Mediterranean-style meal a day, learning something new and a regular social get-together. If you have underlying health conditions, build the plan with your doctor.
Bottom line
The new guidelines don’t promise immunity from dementia, but they change the conversation. Instead of waiting for forgetfulness, we can build cognitive reserve, protect our blood vessels, preserve our senses and stay connected with others. This is how we lower dementia risk, and sometimes even delay its onset by precious years of independence and function.
The information in this article is general and does not replace personal medical advice.
References
Risk reduction of cognitive decline and dementia: WHO guidelines, second edition
Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission
