Global dementia experts highlight the key health and lifestyle factors - from blood pressure to hearing, vision, and even air quality - that shape risk
Thank you, Mick. That's a great article. I've re-stacked it so hopefully more people will have the opportunity to see it.
There's a real opportunity to reduce our risk of dementia. Given what a terrible disease it is, I hope that as many Substackers as possible will learn about the simple changes that can cut dementia risk. It's not inevitable, and it's not just luck. Half our risk of dementia is within our control.
Ben, this is an absolutely magnificent and vital piece of work. You've taken the entire, complex landscape of dementia risk and distilled it into a clear, empowering, and actionable blueprint. This is public service journalism of the highest order.
As a biochemist, what's so striking is how every single one of these 15 factors is, at its core, a lever for controlling systemic inflammation and metabolic health. Whether it's the insulin dysregulation from diabetes, the inflammatory signaling from social isolation, or the oxidative stress from air pollution, they all point back to the same fundamental biochemical pathways.
Your "Mind Matters" section is particularly brilliant. It's a powerful reminder that our psychological state has a direct, measurable, and profound physiological consequence.
The link between depression, untreated hearing loss, and cognitive decline is a perfect example of how the brain is not an isolated organ, but an integrated system that relies on rich, high-quality inputs to maintain its structural integrity.
A truly masterful and important article. Thank you for creating such a clear roadmap for proactive brain care.
Thank you so much for this generous feedback - it means a great deal, especially coming from a biochemist. You’ve put your finger on something I wrestled with while writing: the through-line of systemic inflammation and metabolic health that underpins so many of these risk factors.
I sometimes worry that if I hammer too hard on “inflammation” as a unifying theme, I’ll lose readers in the abstraction. But you’re right, whether it’s insulin resistance, loneliness-driven stress hormones, or oxidative stress from air pollution, they’re all pulling on the same biochemical threads.
And I completely agree with you on Mind Matters. We still tend to treat mood and cognition as somehow separate from “real” physiology, when in fact the brain is utterly dependent on high-quality inputs from both the body and our relationships.
I’m grateful for your perspective - it helps me think about how to keep drawing those connections without overwhelming readers with jargon. Please keep jumping into the comments; your scientific framing adds much to the conversation.
I just signed up to learn the German language on Babbel. My great grandfather came from Germany and I always enjoy seeing their long funny sounding words.
Good for you, John. I always hear that German is one of the easier languages for English speakers to learn as the grammar and construction are allegedly similar. I’ve got to say, it doesn’t look at all familiar or easy to me!
You reminded me of some made-up German words in our school magazine a very long time ago, mimicking the German fashion for combining words to form new one. The one that sticks in my mind is das flippen-flappen-mucken-spredden - for windshield wiper!
Learning a language is said to be a great way to create new brain connections and preserve cognitive function.
This past spring, I experienced a mild TBI from a car wreck. It has taken all summer to gradually experience fewer headaches, less dizziness and nausea, better balance and proprioception. I fear what this might mean for risk of dementia.
Recently, I read about magnesium L threonate as a form of magnesium supplement that crosses the blood brain barrier more easily than the glycinate form I had been taking. I also read this might have benefit for reducing dementia risk. So, I started taking this last week.
I'm sorry to hear about your accident, RJ. Those ongoing symptoms have to be unpleasant, and I can understand your concerns.
Since you were already taking magnesium supplements, you likely know that half of us don't get the recommended amount of magnesium in our diet. The consequences affect most organ systems, including more cardiovascular disease, metabolic disturbances like type 2 diabetes, sleep disruption, anxiety and depression, osteoporosis and yes, a higher incidence of cognitive decline and dementia.
The association between magnesium levels and cognitive decline/dementia may be U-shaped. In some studies, a higher risk is seen with low and high levels, suggesting a middle ground may be the best strategy. The recommended daily intake is 410mg for men and 310mg for women.
What's unclear is whether taking magnesium supplements can help prevent dementia. A meta-analyses from 2024 found that evidence from randomised controlled trials is insufficient to conclude that magnesium supplements prevent dementia or cognitive decline. Maintaining adequate magnesium status may be beneficial for overall health, but supplementation for dementia prevention is not currently supported by high-quality human research. If the U-shaped curve theory is correct, it's important to stick to recommended doses as taking excess magnesium might even increase risk.
Magnesium threonate is the darling of the magnesium world at the moment as it crosses the blood brain barrier more easily. In mouse models of Alzheimer's, it reduces amyloid deposition, protects synapses and improves cognitive function. So, this is all promising but very early. There's currently no evidence of effectiveness at preventing or treating dementia in humans. A single study that did show some improvement in cognitive scores was so methodologically flawed that it can't be taken as evidence of effectiveness.
Ensuring you get sufficient but not excess magnesium seems a defensible strategy, but there's no current evidence that it will reduce your risk of dementia in the future. It would be wise then to also give your attention to other factors that have been shown to reduce the risk. The most recent Lancet Commission on Dementia gave the following 15 modifiable risk factors for dementia (listed in order of effect):
Depression
Type 2 diabetes
Traumatic brain injury
Smoking
Lack of cognitive stimulation
Loneliness
Poor social connections
Visual impairment
High blood pressure
Hearing loss
Particulate air pollution
High LDL cholesterol
Obesity
Lack of exercise
Excessive alcohol
If you think you may be affected by any of those, they might be a better focus than the potential unproven effects of magnesium threonate.
Well done sir! These are all excellent guidance and dementia is a really cruel disease for both the sufferer and family.
A bit of anitpick, I was surprised not seeing any mention of vaccination. More specifically recombinant shingles vaccine ( Shingrix (recombinant zoster vaccine or RZV)) that have been associated with lower risk of dementia. https://www.nature.com/articles/s41591-024-03201-5 Also with seen with Zostervax "live" attenuated herpes zoster, though discontinued https://www.nature.com/articles/s41591-024-03201-5
As if you need another reason for getting the vaccine and avoiding shingles. It is as bad as advertised from my own anecdotal experience and can be even worse as you know.
Thanks for the encouragement! You're right; dementia is grim and scary. It's touched my family as it has so many others.
Given that my newsletter is intended as a five minute guide to one practical step readers can make each week to improve their long-term health (a reading time limit that I never manage to keep to!), I kept to the definitive guidance from the Lancet Commission rather than the many other interventions likely to also lower dementia risk.
The commission report also details other potential risk factors they considered, but felt there was insufficient evidence to include in their report this time. These include:
- Sleep
- Diet and microbiome
- Infections and systemic inflammation - which includes vaccinations
- Other mental health conditions, such as bipolar disorder, schizophrenia, anxiety and PTSD
- Menopause - I'm surprised this didn't make the cut
Hopefully, these will be included in subsequent reports. In the meantime, they've given us plenty of ammunition in the fight against dementia. We just need to make those changes.
Not that there isn't enough reaons to get these vaccines, just a little cherry on the top so to speak. From various papers and research I've seen, the infection/dementia link evidence is growing. Especially in herpesviruses and even Non-neurotropic viruses and bacteria have been linked. This article has an excellent overview and a link to second one on the BBB. https://asm.org/articles/2025/may/dementia-risk-infectious-diseases
Great article, Ben. I've given it a prominent link in an update to my post:
https://drmick.substack.com/p/a-brain-healthy-lifestyle
Thank you, Mick. That's a great article. I've re-stacked it so hopefully more people will have the opportunity to see it.
There's a real opportunity to reduce our risk of dementia. Given what a terrible disease it is, I hope that as many Substackers as possible will learn about the simple changes that can cut dementia risk. It's not inevitable, and it's not just luck. Half our risk of dementia is within our control.
Ben, this is an absolutely magnificent and vital piece of work. You've taken the entire, complex landscape of dementia risk and distilled it into a clear, empowering, and actionable blueprint. This is public service journalism of the highest order.
As a biochemist, what's so striking is how every single one of these 15 factors is, at its core, a lever for controlling systemic inflammation and metabolic health. Whether it's the insulin dysregulation from diabetes, the inflammatory signaling from social isolation, or the oxidative stress from air pollution, they all point back to the same fundamental biochemical pathways.
Your "Mind Matters" section is particularly brilliant. It's a powerful reminder that our psychological state has a direct, measurable, and profound physiological consequence.
The link between depression, untreated hearing loss, and cognitive decline is a perfect example of how the brain is not an isolated organ, but an integrated system that relies on rich, high-quality inputs to maintain its structural integrity.
A truly masterful and important article. Thank you for creating such a clear roadmap for proactive brain care.
Thank you so much for this generous feedback - it means a great deal, especially coming from a biochemist. You’ve put your finger on something I wrestled with while writing: the through-line of systemic inflammation and metabolic health that underpins so many of these risk factors.
I sometimes worry that if I hammer too hard on “inflammation” as a unifying theme, I’ll lose readers in the abstraction. But you’re right, whether it’s insulin resistance, loneliness-driven stress hormones, or oxidative stress from air pollution, they’re all pulling on the same biochemical threads.
And I completely agree with you on Mind Matters. We still tend to treat mood and cognition as somehow separate from “real” physiology, when in fact the brain is utterly dependent on high-quality inputs from both the body and our relationships.
I’m grateful for your perspective - it helps me think about how to keep drawing those connections without overwhelming readers with jargon. Please keep jumping into the comments; your scientific framing adds much to the conversation.
I just signed up to learn the German language on Babbel. My great grandfather came from Germany and I always enjoy seeing their long funny sounding words.
Good for you, John. I always hear that German is one of the easier languages for English speakers to learn as the grammar and construction are allegedly similar. I’ve got to say, it doesn’t look at all familiar or easy to me!
You reminded me of some made-up German words in our school magazine a very long time ago, mimicking the German fashion for combining words to form new one. The one that sticks in my mind is das flippen-flappen-mucken-spredden - for windshield wiper!
Learning a language is said to be a great way to create new brain connections and preserve cognitive function.
Viel Glück!
This past spring, I experienced a mild TBI from a car wreck. It has taken all summer to gradually experience fewer headaches, less dizziness and nausea, better balance and proprioception. I fear what this might mean for risk of dementia.
Recently, I read about magnesium L threonate as a form of magnesium supplement that crosses the blood brain barrier more easily than the glycinate form I had been taking. I also read this might have benefit for reducing dementia risk. So, I started taking this last week.
What is your knowledge on this?
I'm sorry to hear about your accident, RJ. Those ongoing symptoms have to be unpleasant, and I can understand your concerns.
Since you were already taking magnesium supplements, you likely know that half of us don't get the recommended amount of magnesium in our diet. The consequences affect most organ systems, including more cardiovascular disease, metabolic disturbances like type 2 diabetes, sleep disruption, anxiety and depression, osteoporosis and yes, a higher incidence of cognitive decline and dementia.
The association between magnesium levels and cognitive decline/dementia may be U-shaped. In some studies, a higher risk is seen with low and high levels, suggesting a middle ground may be the best strategy. The recommended daily intake is 410mg for men and 310mg for women.
What's unclear is whether taking magnesium supplements can help prevent dementia. A meta-analyses from 2024 found that evidence from randomised controlled trials is insufficient to conclude that magnesium supplements prevent dementia or cognitive decline. Maintaining adequate magnesium status may be beneficial for overall health, but supplementation for dementia prevention is not currently supported by high-quality human research. If the U-shaped curve theory is correct, it's important to stick to recommended doses as taking excess magnesium might even increase risk.
Magnesium threonate is the darling of the magnesium world at the moment as it crosses the blood brain barrier more easily. In mouse models of Alzheimer's, it reduces amyloid deposition, protects synapses and improves cognitive function. So, this is all promising but very early. There's currently no evidence of effectiveness at preventing or treating dementia in humans. A single study that did show some improvement in cognitive scores was so methodologically flawed that it can't be taken as evidence of effectiveness.
Ensuring you get sufficient but not excess magnesium seems a defensible strategy, but there's no current evidence that it will reduce your risk of dementia in the future. It would be wise then to also give your attention to other factors that have been shown to reduce the risk. The most recent Lancet Commission on Dementia gave the following 15 modifiable risk factors for dementia (listed in order of effect):
Depression
Type 2 diabetes
Traumatic brain injury
Smoking
Lack of cognitive stimulation
Loneliness
Poor social connections
Visual impairment
High blood pressure
Hearing loss
Particulate air pollution
High LDL cholesterol
Obesity
Lack of exercise
Excessive alcohol
If you think you may be affected by any of those, they might be a better focus than the potential unproven effects of magnesium threonate.
Well done sir! These are all excellent guidance and dementia is a really cruel disease for both the sufferer and family.
A bit of anitpick, I was surprised not seeing any mention of vaccination. More specifically recombinant shingles vaccine ( Shingrix (recombinant zoster vaccine or RZV)) that have been associated with lower risk of dementia. https://www.nature.com/articles/s41591-024-03201-5 Also with seen with Zostervax "live" attenuated herpes zoster, though discontinued https://www.nature.com/articles/s41591-024-03201-5
As if you need another reason for getting the vaccine and avoiding shingles. It is as bad as advertised from my own anecdotal experience and can be even worse as you know.
In fact, more evidence suggests routine vaccination is also protective. https://journals.sagepub.com/doi/10.3233/JAD-221231 Zoster and respiratory syncytial virus (RSV) vaccine https://www.sciencealert.com/huge-study-reveals-2-vaccines-that-appear-to-reduce-dementia-risk
Really spot on.
Thanks for the encouragement! You're right; dementia is grim and scary. It's touched my family as it has so many others.
Given that my newsletter is intended as a five minute guide to one practical step readers can make each week to improve their long-term health (a reading time limit that I never manage to keep to!), I kept to the definitive guidance from the Lancet Commission rather than the many other interventions likely to also lower dementia risk.
The commission report also details other potential risk factors they considered, but felt there was insufficient evidence to include in their report this time. These include:
- Sleep
- Diet and microbiome
- Infections and systemic inflammation - which includes vaccinations
- Other mental health conditions, such as bipolar disorder, schizophrenia, anxiety and PTSD
- Menopause - I'm surprised this didn't make the cut
Hopefully, these will be included in subsequent reports. In the meantime, they've given us plenty of ammunition in the fight against dementia. We just need to make those changes.
All good, still a jolly good show. :)
Not that there isn't enough reaons to get these vaccines, just a little cherry on the top so to speak. From various papers and research I've seen, the infection/dementia link evidence is growing. Especially in herpesviruses and even Non-neurotropic viruses and bacteria have been linked. This article has an excellent overview and a link to second one on the BBB. https://asm.org/articles/2025/may/dementia-risk-infectious-diseases