# What’s good for your arteries is good for your brain.

> The 2024 Lancet Commission estimates that 14 modifiable risk factors account for about 45% of dementia worldwide. Nothing guarantees you won’t get it, but you can shift the odds: control blood pressure, LDL and blood sugar, treat hearing loss, move every day, sleep, don’t smoke, drink little, and stay connected.

- URL: https://www.plansforyourbody.com/plans/lower-dementia-risk/
- Categories: Hormones, sleep & ageing
- Updated: 2026-10-06
- Not medical advice: Discuss everything here with a medical doctor before acting on it — supplements included. Your doctor has your bloodwork and history. We have neither.

## The goal

Most people treat dementia as fate: it’s in the family or it isn’t. The Lancet Commission, which reviews the evidence every few years, keeps finding otherwise. Nearly half of cases worldwide are linked to things that can be changed, and most of them are the same things that wreck your heart. This plan measures them, works on the ones you control, and is honest about the ones you don’t.

- **Measure:** Blood pressure · LDL or ApoB · HbA1c · hearing test · eye exam · sleep apnea screen
- **Change:** Daily movement and strength · real food · sleep · no smoking · little alcohol · people
- **Protect:** Hearing aids if needed · helmets · treat depression · yearly checks with your doctor

## Why it matters: The damage starts decades before the diagnosis.

- **The default:** Ignore it until memory slips, then hope for a pill. By the time symptoms show, the brain has often been changing for years, and the drugs available slow decline modestly at best.
- **The evidence:** The 2024 Lancet Commission put 45% of dementia down to 14 modifiable factors. Trials back the direction: in FINGER, Miia Kivipelto’s Finnish trial, and in US POINTER, multi-part lifestyle programs improved cognition in at-risk older adults, and in SPRINT MIND, tighter blood pressure control cut mild cognitive impairment.

## How it works: The brain is an organ with a blood supply.

The brain uses about a fifth of your energy and depends on small, fragile blood vessels. Anything that damages vessels, starves the brain of input, or keeps it inflamed adds to the load that Alzheimer’s and vascular disease put on it. Miia Kivipelto’s CAIDE study showed how early this starts: blood pressure, cholesterol and weight measured in midlife predicted dementia 20 years later. Louisa Nicola and Richard Isaacson frame it the same way: protect the supply, keep the brain busy, and reduce the load.

- **Blood pressure:** High pressure damages the small vessels deep in the brain, causing silent strokes and white-matter damage. The Commission recommends keeping systolic at 130 or lower from about age 40.
- **LDL cholesterol:** New to the 2024 list, and one of the two biggest factors. High LDL in midlife is linked to later dementia, likely through vessel damage and possibly amyloid.
- **Blood sugar and insulin:** Diabetes raises dementia risk. High insulin and glucose damage vessels, and the brain’s own insulin signalling is impaired in Alzheimer’s.
- **Hearing and vision:** Hearing loss is the other biggest factor. When the brain gets less input, it gets less stimulation and you withdraw socially. Untreated vision loss joined the list in 2024.
- **Movement:** Exercise raises blood flow to the brain, improves insulin sensitivity and blood pressure, and is linked to a larger hippocampus, the brain’s memory centre.
- **Sleep:** Deep sleep is when the brain clears waste. One night without sleep measurably raised beta-amyloid in a small NIH study. Sleep isn’t on the Commission’s list yet; the evidence is promising, not settled.
- **Genes:** APOE4 raises risk, more so with two copies. It loads the dice; it doesn’t decide the game. The modifiable factors still matter for carriers.

## The steps: Measure. Change the inputs. Recheck every year.


### Measure (Month 0): Find the risk factors you actually have.

- **Blood pressure** (home monitor, a week of readings): Office readings miss a lot. Average a week of morning and evening readings at home.
- **LDL and ApoB** (lipid panel): Ask for ApoB as well. If either is high, the cholesterol plan on this site applies to your brain too.
- **HbA1c and fasting insulin** (blood sugar): Diabetes and prediabetes both raise the risk. Fasting insulin catches the problem earlier.
- **Hearing test** (audiologist): If you turn the TV up or struggle in restaurants, get tested. Most people wait far too long.
- **Eye exam** (optometrist): Cataracts and other vision loss are treatable. Treat them.
- **Sleep apnea screen** (STOP-Bang): Loud snoring, witnessed pauses, daytime sleepiness. Untreated apnea starves the brain of oxygen at night. See the sleep plan.
- **Mood** (be honest): Depression in midlife is on the list. If you’ve felt flat or hopeless for weeks, tell your doctor.

### Move (Months 1–12, then for life): The single most reliable lever.

- **Training** (strength 2–3×/week, cardio 150+ min/week): Lift, and walk briskly or cycle most days. Muscle is where most of a meal’s glucose ends up, so more muscle means more room for it. Cardio makes that muscle more sensitive to insulin. For the brain, the cardio half matters as much as the lifting. Both improve the blood pressure and insulin numbers above.
- **Steps** (aim for ~10,000, some brisk): In a UK Biobank study, more daily steps tracked with lower dementia risk up to about 9,800 a day, with benefits starting near 3,800. Brisk steps counted for more.
- **Get fit, not just active** (1–2 hard sessions a week): Intervals that get you breathing hard raise cardiorespiratory fitness, a marker Nicola puts at the centre of brain health.

### Feed and protect (Months 1–12): Food, sleep, alcohol, smoking, people.

- **Sugar and refined carbs** (cut hard): Sugar, sweet drinks, juice, white flour and most packaged snacks. The fastest lever on insulin, blood sugar and triglycerides. Less sugar and refined flour means lower insulin and glucose, the vessel damage behind the diabetes link.
- **Real food** (protein first): Build meals on protein, vegetables and natural fats: fish, meat, eggs, dairy, legumes, nuts. Protein and fibre keep you full and flatten glucose spikes.
- **Fats to cook with** (olive oil first): Extra-virgin olive oil, avocado and its oil, nuts, oily fish. Olive oil has the strongest trial evidence: in PREDIMED, a Mediterranean diet with extra olive oil cut heart attacks and strokes. A Mediterranean pattern was part of the diet arm in FINGER.
- **Sleep** (7+ hours): One short night measurably worsens insulin sensitivity, blood sugar and appetite the next day. The cheapest part of the protocol, and the most skipped. For the brain, deep sleep is also when waste gets cleared.
- **Alcohol** (less, and never heavy): The Commission lists heavy drinking as a risk factor. Less is better for the brain; none is simplest.
- **Smoking** (stop; it’s harm reduction): It damages blood vessels everywhere, the ones feeding your brain included. Quitting cuts the heart and vessel risk smoking adds, quickly at first: in Framingham data, heavy smokers who quit had about 39% lower cardiovascular risk within five years than those who kept going. But their risk stayed above a never-smoker’s for a decade or more. It’s harm reduction, not a full repair, and worth doing at any age. Ask your doctor about help to quit; you don’t have to do it on willpower alone. Lung and cancer risk are your doctor’s territory.
- **Hearing aids** (if you need them, wear them): In the ACHIEVE trial, hearing aids slowed cognitive decline in the older adults at higher risk. They work only if they’re in your ears.
- **Head injury** (helmets): Traumatic brain injury is on the list. Wear a helmet for cycling, skiing and anything with speed.
- **People and challenge** (weekly): Social isolation is a late-life risk factor. Learn things that are hard for you, and do them with other people.

**Before you change medication:** If you take medication for blood pressure, cholesterol or diabetes, keep taking it. As your numbers improve, your doctor decides whether to adjust it.

### Supplements and heat (optional, with your doctor’s OK): Promising, not proven.

- **EPA/DHA omega-3** (2–4 g/day of EPA+DHA, with food): Count EPA+DHA on the label, not “fish oil”. High doses slightly raise the risk of atrial fibrillation and add to the effect of blood thinners. DHA is a major building block of the brain. Rhonda Patrick argues for testing your omega-3 index rather than guessing, and raising it if it’s low. Trial evidence for preventing cognitive decline is mixed: take it for the heart and triglycerides, and treat any brain benefit as a bonus.
- **B vitamins (folic acid, B6, B12)** (Folic acid 0.8 mg, B6 20 mg, B12 0.5 mg a day, only if homocysteine is high): In older adults with mild memory problems, two years of these three vitamins slowed brain shrinkage, but only in those whose homocysteine was above about 11 µmol/L. In 22,000 people not selected this way, B vitamins didn’t slow cognitive ageing. Get homocysteine and B12 tested first: folic acid can mask a B12 deficiency. Only if homocysteine is high: in that group, B vitamins slowed brain shrinkage. Ask your doctor to test homocysteine and B12 first.
- **Sauna** (if you have access, and your doctor agrees): In a Finnish study of men followed for 20 years, those who used a sauna 4–7 times a week had about two-thirds lower dementia risk than once-a-week users. Observational, men only. Skip it if you have unstable heart disease, low blood pressure or drink alcohol beforehand.

### Recheck (Every year): Repeat the numbers. Watch for change.

- **Same tests** (yearly): Blood pressure, lipids, HbA1c. Hearing and eyes every few years, or sooner if things change.
- **If memory is slipping** (see your doctor early): Forgetting where you put the keys is normal. Getting lost on a familiar route, repeating questions, or others noticing changes are not. Ask your doctor for a cognitive assessment; many causes, such as low B12, thyroid problems, depression, apnea and medication side effects, are treatable.
- **If you’re diagnosed early** (your doctor): Ask your doctor or a memory specialist whether newer anti-amyloid treatments apply to you, and what their risks are. They slow decline modestly in early Alzheimer’s and need careful monitoring.
- **If the numbers won’t move** (your doctor): Take the before-and-after numbers to your doctor. Whether you need medication is their call. Needing it isn’t failure.

## The rules: Short list. No exceptions.

**Choose:**
- Move every day, and get out of breath at least twice a week
- Protein, vegetables, olive oil, fish
- 7+ hours of sleep, with apnea ruled out
- Hard things to learn, with other people

**Avoid:**
- Smoking, in any form
- Heavy drinking
- Untreated hearing loss
- Ignoring a blood pressure over 130

**Non-negotiables:**
- Know your blood pressure, LDL and HbA1c, and act on them.
- Get your hearing tested if anyone has to repeat themselves to you.
- Talk to a medical doctor before starting supplements or sauna.
- Report memory changes early. Many causes are treatable.

## Checkpoints: What to track, and what good looks like.

Your doctor sets your targets based on your overall risk. These are the reference points the evidence points to.

| What | Target | How and when |
|---|---|---|
| Systolic blood pressure | ≤130 mm Hg from midlife | Home monitor, a week of readings every few months. The Lancet Commission’s target from about age 40. |
| LDL-C / ApoB | Your doctor’s target; commonly LDL <2.6 mmol/L (100 mg/dL) or ApoB <0.9 g/L | Lipid panel yearly. Lower if you have other risk factors. |
| HbA1c | <6.0% (Canada) · <5.7% (US) | Yearly, more often if high. |
| Daily steps | ~10,000, with some brisk | Phone or watch, weekly average. |
| Sleep | 7–9 hours, apnea ruled out | Sleep diary for a week, twice a year. |
| Hearing | Tested; aids worn if prescribed | Audiologist. Every few years after 50, sooner if you notice change. |
| Waist-to-height | <0.5 | Waist at the belly button divided by height, same units. |

There is no blood test that tells you your dementia risk is falling. You track the inputs because they are what the evidence says you can move.

## Where experts disagree: Where the experts don’t agree.

Everyone agrees that high blood pressure, smoking and inactivity are bad for the brain. The fights are about what Alzheimer’s actually is, and how much lifestyle can do.

### How much can lifestyle really prevent?

- **Optimists: Livingston (Lancet Commission), Kivipelto (FINGER), Isaacson:** Nearly half of dementia is linked to modifiable factors, and trials like FINGER and US POINTER show multi-part programs improve cognition. Kivipelto’s rationale: single-factor trials mostly disappointed, so FINGER worked on several at once. Act on all of them, from midlife.
- **Cautious trialists: preDIVA investigators:** The 45% is a modelled estimate that assumes each link is causal. In preDIVA, six years of nurse-led vascular care in older adults didn’t reduce dementia overall, and the trials so far measure cognitive scores, not diagnoses.

**Our read:** The 45% is a ceiling, not a promise. But the same changes cut heart attacks and strokes, so there is no downside to starting early.

### Is Alzheimer’s an amyloid disease?

- **Amyloid first: lecanemab trialists (van Dyck et al.):** Clearing amyloid with an antibody slowed decline by 27% over 18 months in early Alzheimer’s, which supports amyloid as a driver.
- **Many roads: Herrup:** Plenty of older people have amyloid plaques and normal cognition. Alzheimer’s likely has many contributors, inflammation and vascular damage among them, and fixating on amyloid has slowed the field.

**Our read:** Both can be partly right. For prevention it barely matters: the modifiable risk factors work through vessels, metabolism and inflammation either way.

### Is sauna use brain protection?

- **Promising: Laukkanen (Kuopio cohort), Patrick:** Large Finnish cohorts show a strong dose-response link between frequent sauna use and lower dementia and cardiovascular risk, and heat stress has plausible effects on vessels and inflammation.
- **Sceptics:** It’s observational, in middle-aged Finnish men. People healthy and wealthy enough to sauna daily differ in many ways from those who don’t.

**Our read:** Enjoy it if you have access and your doctor agrees. Don’t trade it for exercise; the exercise evidence is far stronger.

### Is personalised prevention better than general advice?

- **Precision prevention: Isaacson:** Tailoring recommendations to each person’s genes, labs and cognitive testing improved cognition over 18 months in his prevention clinic, more so in people who followed more of the advice.
- **Population approach: Kivipelto (FINGER), US POINTER:** Standard multi-part programs improved cognition across sex, ethnicity and APOE4 status. Kivipelto’s World-Wide FINGERS network is now testing the same model in dozens of countries. You don’t need a specialist clinic to start.

**Our read:** Start with the general plan; it’s where most of the gain is. Personalised testing is worth discussing with your doctor if you have a strong family history.


## Limits: What no plan fixes.

- **Age and genes:** Age is the biggest risk factor, and APOE4 and rare inherited forms raise risk substantially. You can lower the odds, not erase them. People who did everything right still get dementia.
- **Disease already underway:** Once symptoms start, lifestyle can support function but won’t reverse the disease. Diagnosis, treatment and planning are your doctor’s and a memory clinic’s job.
- **No guarantee:** Nothing on this page has been shown to prevent Alzheimer’s disease. It lowers the risk on average, across many people, and it’s good for your heart anyway.

*The plan improves your odds. It doesn’t promise an outcome.*

## Resources

- [Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission](https://doi.org/10.1016/S0140-6736(24)01296-0) — Livingston et al., The Lancet. The evidence behind the 14 risk factors, and what to do about each.
- The Neuro Experience — Louisa Nicola. A neurophysiologist on exercise, sleep and cognitive ageing, with researchers as guests.
- [A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring (FINGER)](https://pubmed.ncbi.nlm.nih.gov/25771249/) — Ngandu, Kivipelto et al., The Lancet (2015). The trial that showed a multi-part lifestyle program can protect thinking in at-risk older adults. The model most later trials copied.
- [10 ways to reduce your risk of dementia](https://alzheimer.ca/reduceyourrisk) — Alzheimer Society of Canada. The Canadian plain-language version.

## Questions

### Can you prevent Alzheimer’s disease?

Nothing has been shown to prevent it. You can lower your risk of dementia: the Lancet Commission links about 45% of cases worldwide to factors that can be changed.

### What is the biggest modifiable risk factor for dementia?

In the 2024 Lancet Commission, hearing loss and high LDL cholesterol in midlife each account for the largest share, followed by factors such as inactivity, smoking, high blood pressure and diabetes.

### Do hearing aids reduce dementia risk?

In the ACHIEVE trial, hearing aids didn’t slow decline in the whole group, but did in older adults at higher risk. Treating hearing loss is a recommendation of the Lancet Commission.

### What is the best exercise for brain health?

The one you’ll do. The evidence favours regular aerobic exercise that raises fitness, plus strength training. More daily steps, and brisker ones, track with lower risk.

### I carry APOE4. Is it pointless?

No. APOE4 raises risk but doesn’t guarantee dementia, and in US POINTER carriers improved too. Discuss testing and what it means with your doctor or a genetic counsellor.

### When should I worry about memory lapses?

When they disrupt daily life: getting lost somewhere familiar, repeating the same questions, struggling with tasks you used to do easily, or when others notice. See your doctor; many causes are treatable.


## Sources

- Louisa Nicola — Neurophysiologist, founder of Neuro Athletics. Host of The Neuro Experience podcast.
- Richard Isaacson, MD — Preventive neurologist. Founded the first Alzheimer’s Prevention Clinic in the US at Weill Cornell Medicine.
- Gill Livingston, MD — Psychiatrist, University College London. Leads the Lancet Commission on dementia.
- Rhonda Patrick, PhD — Biomedical scientist (PhD, biomedical science). Research and reviews on micronutrients, omega-3s, sauna and ageing; FoundMyFitness.
- Miia Kivipelto, MD, PhD — Professor of clinical geriatrics, Karolinska Institutet. Led the FINGER trial and the CAIDE study; founded the World-Wide FINGERS network.
- Frank Lin, MD, PhD — Otolaryngologist and epidemiologist, Johns Hopkins. Led the ACHIEVE hearing trial.
- Karl Herrup, PhD — Neurobiologist. Author of How Not to Study a Disease: The Story of Alzheimer’s.

1. [Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission](https://doi.org/10.1016/S0140-6736(24)01296-0). The Lancet, 2024.
2. [A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER)](https://pubmed.ncbi.nlm.nih.gov/25771249/). The Lancet, 2015.
3. [Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study (CAIDE)](https://doi.org/10.1016/S1474-4422(06)70537-3). The Lancet Neurology, 2006.
4. [Association of smoking cessation with subsequent risk of cardiovascular disease](https://doi.org/10.1001/jama.2019.10298). JAMA, 2019.
5. [U.S. POINTER study results](https://alz.org/us-pointer/study-results). Alzheimer’s Association, 2025.
6. [Effect of intensive vs standard blood pressure control on probable dementia (SPRINT MIND)](https://doi.org/10.1001/jama.2018.21442). JAMA, 2019.
7. [Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss (ACHIEVE)](https://pubmed.ncbi.nlm.nih.gov/37478886/). The Lancet, 2023.
8. [Association of daily step count and intensity with incident dementia in 78,430 adults living in the UK](https://pmc.ncbi.nlm.nih.gov/articles/PMC9449869/). JAMA Neurology, 2022.
9. [Sauna use as a lifestyle practice to extend healthspan](https://pubmed.ncbi.nlm.nih.gov/34363927/). Experimental Gerontology, 2021.
10. [Sauna bathing is inversely associated with dementia and Alzheimer’s disease in middle-aged Finnish men](https://doi.org/10.1093/ageing/afw212). Age and Ageing, 2017.
11. [Sleep deprivation increases Alzheimer’s protein (summary of Shokri-Kojori et al., PNAS 2018)](https://www.nih.gov/news-events/nih-research-matters/sleep-deprivation-increases-alzheimers-protein). National Institutes of Health, 2018.
12. [Homocysteine-lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trial (VITACOG)](https://pubmed.ncbi.nlm.nih.gov/20838622/). PLoS One, 2010.
13. [Preventing Alzheimer’s disease-related gray matter atrophy by B-vitamin treatment](https://doi.org/10.1073/pnas.1301816110). PNAS, 2013.
14. [Effects of homocysteine lowering with B vitamins on cognitive aging: meta-analysis of 11 trials with cognitive data on 22,000 individuals](https://doi.org/10.3945/ajcn.113.076349). American Journal of Clinical Nutrition, 2014.
15. [PreDIVA trial falls short](https://alzforum.org/node/667471). Alzforum, 2016.
16. [Lecanemab in early Alzheimer’s disease](https://profiles.wustl.edu/en/publications/lecanemab-in-early-alzheimers-disease/). New England Journal of Medicine, 2023.
17. [Individualized clinical management of patients at risk for Alzheimer’s dementia](https://neurology.weill.cornell.edu/publications/individualized-clinical-management-patients-risk-alzheimers-dementia). Alzheimer’s & Dementia, 2019.
18. [10 ways to reduce your risk of dementia](https://alzheimer.ca/reduceyourrisk). Alzheimer Society of Canada.