Brain
Protect Your Brain as You Age
A 2024 expert commission named 14 modifiable dementia risk factors. Trials show modest cognitive gains from managing them; none guarantees prevention.
If you’re hoping to live longer, you probably want your memory and independence to come along. Fair enough. Brain-health advice can make that wish sound like a shopping list of supplements, puzzles and clever tricks. Humanic Blue starts with a simpler question: what does the research actually support?
The Lancet Commission on dementia identifies everyday health and life circumstances that may affect risk, including blood pressure, hearing, vision, activity and social connection. Trials of programs that address several factors together have found small improvements in thinking skills. That is encouraging information to understand, but it isn’t a guarantee against dementia—and better test scores don’t automatically mean a longer life.
Key Takeaways
- The Lancet Commission connects brain health with heart health, the senses and daily life.
- Lifestyle programs have produced small thinking-test gains; those trials do not establish dementia prevention.
- Blood-pressure treatment has evidence for reducing some cognitive problems. Hearing-treatment results depend on the group studied.
- A risk factor describes a possibility, not your future.
Why the brain shares the heart’s checklist
The Lancet Commission, led by University College London’s Gill Livingston, groups potentially changeable dementia risks across life. We can make its list easier to picture:
- Health checks: blood pressure, cholesterol, diabetes and depression.
- The senses: hearing and vision loss.
- Daily life: activity, smoking, excessive alcohol and obesity.
- Our surroundings and opportunities: education, social connection, head injuries and air pollution.
The list contains familiar health concerns rather than a hidden brain switch. Several items are familiar from a routine appointment; others depend on access to care, support and safer surroundings. They aren’t all things one person can simply decide to change.
The connection matters because the brain relies on healthy blood vessels and on information coming in from the world. Our blood-test guide and hearing article unpack those pieces separately.
Does a risk factor predict your future?
No. The commission’s estimate of preventable dementia describes what might change across populations under ideal conditions. It doesn’t calculate one person’s odds or promise that following a checklist will prevent disease.
Much of the evidence comes from observing people’s lives, which can reveal a link without proving its cause. A Wisconsin research team also questioned how well the commission’s estimates held up in a different population. The estimate and its limitations are below, alongside that challenge.
It’s worth pausing over a personal question: when you hear that a risk is changeable, does it sound like an opportunity—or an obligation to control something you can’t fully control?
What happens when several habits change together?
The Finnish FINGER trial and the US POINTER trial tested programs combining movement, diet, mental challenges and health monitoring. POINTER also included social activity. Researchers found small gains in thinking-test performance, with more structured support doing somewhat better in POINTER.
That gives us a useful distinction to decipher together. A program can improve performance on a test without yet showing that it prevents dementia. And when several things change at once, we can’t award all the credit to one ingredient.
These programs also require time and support; FINGER reported more muscle and joint discomfort in its intervention group. The Alzheimer’s Association funded POINTER, and some investigators disclosed commercial relationships. The trial details explain the results and disclosures.
What does blood-pressure care add?
In SPRINT MIND, researchers found fewer cases of mild cognitive impairment—noticeable thinking difficulties that don’t necessarily take away independence—with more intensive blood-pressure treatment. The dementia result itself was less clear.
The parent trial also found fewer cardiovascular events and deaths. That’s a separate connection to living longer: protecting the heart and reducing early thinking problems are different outcomes, even when they come from the same treatment study. Targets and treatment risks need individual clinical judgment. Blood Pressure and Brain Aging explains that balance.
What about hearing aids?
The ACHIEVE trial found no overall slowing of cognitive decline with hearing treatment, but a higher-risk group did benefit. That doesn’t make hearing care a dementia-prevention promise. It also doesn’t erase its everyday purpose: helping people hear and participate in conversation. The hearing evidence is available below.
Which outcome would matter most in a brain-health conversation: fewer symptoms now, independence later, or a lower chance of developing disease?
What can an ordinary health visit cover?
The National Academies described prevention evidence as encouraging but inconclusive. More recent US blood-pressure guidance includes cognitive health among the reasons to treat hypertension.
Those sources leave room for useful conversations without promising certainty. A clinician can explain what blood pressure, cholesterol, diabetes, mood, hearing and vision mean in your own circumstances.
What’s Interesting
The brain doesn’t appear to have an entirely separate maintenance department. Many of the risks in this research overlap with heart health, and the lifestyle trials combine several parts of ordinary life. The interesting question is how those parts work together—not which single habit deserves a cape.
What This Means in Practice
For living longer and better, the commission’s framework offers topics to discuss with a primary care clinician: which risks apply, which are already being treated, and where hearing, vision or mood need attention. Benefits from different approaches cannot simply be added together into a promise of extra years.
Memory changes that disrupt familiar tasks, safety or independence belong in a separate evaluation. What Is Normal Memory Loss With Aging? explains the distinction. Support and access matter here; brain health isn’t a test of willpower.
Bottom Line
The commission and the trials point toward a connected picture of brain, heart and everyday health. They offer evidence for risk reduction and small thinking-test benefits, with important limits. A clinician can help translate that picture into your circumstances; no checklist can guarantee the outcome.
A NOTE FROM LONGEVITY365
We read research, consult expert perspectives and work to make complicated health information easier to understand. What you’re reading here reflects how we’ve interpreted and organized that information. It is educational content—not personal medical advice, diagnosis or treatment guidance.
We’re not perfect, and neither is the available research. Evidence changes, new studies emerge and what’s appropriate for one person may not be appropriate for another.
Use this article as a starting point for your own research and conversations with qualified professionals. Always talk with your doctor or another trusted healthcare professional before making decisions that could affect your health, particularly if you take medications, are receiving treatment, have existing health conditions, are pregnant or have other circumstances that could affect what’s appropriate for you.
Reader Questions
A few questions to carry into the comments or your next conversation. Please leave out identifying or personal medical details.
- 01Which part of this picture would you want explained more clearly: heart health, the senses or everyday support?
- 02What would help a brain-health conversation feel useful rather than like another checklist?
Extra Insights & Sources
For readers who want the details behind each claim above.
What We Know
- The 2024 Lancet Commission identifies 14 potentially modifiable risk factors and a 45% theoretical reduction in dementia if all were eliminated. Supported (observational basis).
- Multidomain lifestyle programs modestly improve thinking scores in at-risk older adults. Supported (two large randomized trials).
- Intensive blood pressure control reduced mild cognitive impairment in adults with hypertension. Supported.
- The National Academies called the evidence for cognitive training, blood pressure control and physical activity “encouraging but inconclusive” in 2017, and the 2025 AHA/ACC guideline sets a blood pressure goal partly to prevent cognitive impairment and dementia.
What We Don’t Know
- Whether any intervention prevents dementia itself, rather than improving test scores or reducing mild impairment. Unknown.
- Whether the small score differences seen in FINGER and US POINTER make a noticeable difference in daily life. The US POINTER authors named functional outcomes as the next question. Unknown.
- How much of the commission’s 45% is causal. A replication in a single US cohort found only a few factors held up. Contested.
- Whether protecting the brain in these ways lengthens life. None of the brain trials measured lifespan. Unknown.
The Lancet Commission’s list and estimate
The 2024 report of the Lancet standing Commission (The Lancet, volume 404, pages 572–628) has 27 authors; the first is Gill Livingston of University College London’s Division of Psychiatry. Her 2025 summary is a conference abstract in Alzheimer’s & Dementia.
Alzheimer’s Disease International’s summary of the report (August 1, 2024) names the two new factors as failing eyesight and elevated LDL cholesterol, taking the total from the 12 in the 2020 report to 14, and says “45% of cases of dementia could potentially be delayed or reduced.”
The full list of 14, as given in a 2025 BMJ Open study from the Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin: lower educational attainment, hearing loss, high LDL cholesterol, hypertension, physical inactivity, diabetes, social isolation, excessive alcohol consumption, air pollution, smoking, obesity, traumatic brain injury, depression and visual loss. In that nationally representative study of community-dwelling adults 50 and over in Ireland, 70.6%, 61.1% and 54.2% had four or more of the risk factors at three successive survey waves (the latest in 2021–2023).
Disclosures. Several commission members declared consulting or advisory roles with companies that make Alzheimer’s drugs (including Eli Lilly, Eisai, Roche and Biogen), according to the report’s declaration of interests. Livingston declared support from the Alzheimer’s Society and UK Research and Innovation for the manuscript, and National Institute for Health and Care Research funding.
The Wisconsin replication
Victoria Williams and colleagues at the University of Wisconsin–Madison replicated the commission’s model in 5,526 participants of the Wisconsin Longitudinal Study with known dementia status, drawing on 70 years of data. It was published as a 2025 Alzheimer’s & Dementia conference abstract, not a full peer-reviewed paper; as of September 25, 2026, no full paper reporting it had appeared in PubMed or Europe PMC. The authors noted several possible weaknesses: studies with striking results may be more likely to be published; different studies may define the same risk factor or adjustment differently; and genetic differences may change the relationships. Much of the underlying research measured risk factors and dementia at the same time, rather than tracking which came first.
In their full model, only hearing loss, diabetes and hypertension remained statistically significant, and midlife hypertension was linked to lower odds of dementia, the opposite of what the model predicted. They concluded the results raise concern that publication bias may inflate the risk estimates in meta-analyses. The abstract describes the commission’s figure as nearly 40%; the commission’s own figure, via Livingston, is 45%.
The lifestyle trials in detail
Reading the numbers. Cognitive means relating to thinking and memory. A multidomain program addresses several areas of life or health together. SD means standard deviation, a unit based on how widely scores vary; a change of 0.029 SD is not a 2.9% improvement. A 95% confidence interval (CI) describes uncertainty around an estimate. Hazard ratio (HR) compares how quickly an outcome occurs over time: 1 means no difference, below 1 a lower rate and above 1 a higher rate. MCI means mild cognitive impairment. Blood-pressure targets refer to the systolic, or top, number in millimeters of mercury (mm Hg). A person-year is one person followed for one year, allowing studies to combine different follow-up lengths.
FINGER (2015). The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (The Lancet; first author Tiia Ngandu, senior author Miia Kivipelto) randomly assigned 1,260 people aged 60 to 77 with a dementia risk score of at least 6 on the CAIDE scale to a two-year multidomain intervention (n=631) or general health advice (n=629). The between-group difference in change on the neuropsychological test battery total score was 0.022 per year (95% CI 0.002–0.042, p=0.030). Adverse events occurred in 46 (7%) of the intervention group and 6 (1%) of controls; the most common was musculoskeletal pain (32 people versus none). The authors concluded that the findings suggest a multidomain program could improve or maintain thinking skills in older people from the general population who are at raised risk. Funders were public bodies and foundations, including the Academy of Finland and the Alzheimer Association.
US POINTER (2025). The US POINTER trial (JAMA; first author Laura Baker, senior author Maria Carrillo of the Alzheimer’s Association) enrolled 2,111 adults aged 60 to 79 (mean age 68.2; 68.9% female) at five US sites. Inclusion required a sedentary lifestyle and suboptimal diet plus at least two further risk criteria. Participants were randomized to a structured intervention (n=1,056) or a self-guided one (n=1,055); both encouraged physical and cognitive activity, healthy diet, social engagement and cardiovascular health monitoring, but “differed in structure, intensity, and accountability.” The structured program included moderate- to high-intensity exercise and the MIND diet, a dietary pattern developed around brain health.
Global cognition rose by 0.243 SD per year in the structured group and 0.213 SD per year in the self-guided group, a difference of 0.029 SD per year (95% CI 0.008–0.050; P=.008). The benefit was consistent for people with and without APOE ε4, a gene variant linked to Alzheimer’s risk (P=.95 for interaction) but appeared greater with lower baseline cognition (P=.02). Serious adverse events were fewer in the structured group (151 versus 190). The authors wrote: “Further investigation of functional outcomes, biomarkers, and ongoing extended follow-up will help address clinical relevance and sustainability of the observed cognitive benefits.”
US POINTER disclosures. The trial was funded by the Alzheimer’s Association, and “The US Highbush Blueberry Council provided monthly rebates for participants assigned to the structured intervention.” Two Alzheimer’s Association employees (Heather Snyder and Maria Carrillo) took part in design, conduct, analysis and manuscript preparation. Miia Kivipelto, senior author of FINGER and a US POINTER co-author, reported serving on scientific advisory boards for Combinostics, Eisai, Eli Lilly and Nestlé. Mark Espeland reported personal fees from Annovis Bio, Acumen Pharma and Nestlé. Other investigators reported grants or fees from drug companies including Biogen, Eisai and Lilly.
| Trial | Who | Comparison | Main result | Label |
|---|---|---|---|---|
| FINGER (2015) | 1,260 Finns aged 60–77 at raised risk | 2-year program vs health advice | +0.022 per year on test battery; adverse events 7% vs 1% | Supported (modest) |
| US POINTER (2025) | 2,111 sedentary US adults aged 60–79 | Structured vs self-guided program | +0.029 SD per year for structured | Supported (modest) |
| SPRINT MIND (2019) | 9,361 adults with hypertension | Systolic target <120 vs <140 | MCI HR 0.81; dementia HR 0.83 (not significant) | Supported for MCI |
| ACHIEVE (2023) | 977 US adults aged 70–84 with hearing loss | Hearing intervention vs health education | No overall difference; differed by cohort | Mixed |
The SPRINT MIND numbers
SPRINT MIND (JAMA, 2019; first author Jeff D. Williamson) enrolled 9,361 adults aged 50 or older with hypertension but without diabetes or history of stroke, at 102 sites in the US and Puerto Rico (mean age 67.9; 35.6% women). The trial “was stopped early for benefit on its primary outcome (a composite of cardiovascular events) and all-cause mortality” in August 2015; cognitive follow-up continued to July 2018. The median intervention period was 3.34 years and median follow-up 5.11 years.
Probable dementia occurred in 149 people in the intensive group and 176 in the standard group (7.2 versus 8.6 cases per 1,000 person-years; HR 0.83, 95% CI 0.67–1.04). Mild cognitive impairment was significantly lower with intensive treatment (14.6 versus 18.3 per 1,000 person-years; HR 0.81, 95% CI 0.69–0.95), as was the combined outcome of MCI or probable dementia (20.2 versus 24.1; HR 0.85, 95% CI 0.74–0.97). The authors wrote: “Because of early study termination and fewer than expected cases of dementia, the study may have been underpowered for this end point.” Several authors reported NIH research support and some reported pharmaceutical fees.
The ACHIEVE numbers
ACHIEVE (The Lancet, 2023; first author Frank Lin of the Johns Hopkins Bloomberg School of Public Health) randomly assigned 977 adults aged 70 to 84 with untreated hearing loss (mean age 76.8; 88% White) to audiological counselling with hearing aids or to health education, at four US sites. Three-year cognitive change was −0.200 SD with the hearing intervention and −0.202 SD with health education (difference 0.002; p=0.96). A prespecified sensitivity analysis found the effect differed between participants recruited from the Atherosclerosis Risk in Communities study, who were older with more risk factors, and new community volunteers (p for interaction 0.010). The authors concluded that a hearing intervention might slow cognitive change over three years in older adults at higher risk of cognitive decline, but not in those at lower risk. The trial was funded by the US National Institutes of Health. Lin reported consulting fees from Frequency Therapeutics and Apple, among other ties, and Sonova/Phonak donated hearing technology in kind to Johns Hopkins University for the study.
The official wording
The 2017 National Academies committee concluded that, “when communicating with the public, these three classes of interventions can be described as supported by encouraging but inconclusive evidence.” It added that the inconclusive finding “raises the possibility that future research may show that one or more of these interventions do not prevent cognitive decline or dementia.”
The American College of Cardiology’s August 14, 2025 release on the AHA/ACC guideline (writing committee chaired by Daniel W. Jones of the University of Mississippi School of Medicine) says: “The guideline recommends early treatment for people diagnosed with high blood pressure with a goal of systolic blood pressure (top number) goal of <130 mm Hg for adults with high blood pressure to prevent cognitive impairment and dementia.”
Sources
- Livingston G, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, The Lancet, 2024: PubMed 39096926
- Livingston G. Prevention of dementia: a necessary worldwide agenda, Alzheimer’s & Dementia, 2025: PMC12725832
- Alzheimer’s Disease International: Lancet Commission identifies two new risk factors for dementia (2024)
- McGarvey C, et al. Modifiable dementia risk factors in Ireland (TILDA), BMJ Open, 2025: PMC12606470
- Williams VJ, et al. Replicating the 2024 Lancet Commission model, Alzheimer’s & Dementia, 2025: PMC12726475
- Ngandu T, et al. FINGER, The Lancet, 2015: PubMed 25771249
- Baker LD, et al. US POINTER, JAMA, 2025: PubMed 40720610
- Williamson JD, et al. SPRINT MIND, JAMA, 2019: PubMed 30688979
- Lin FR, et al. ACHIEVE, The Lancet, 2023: PubMed 37478886
- National Academies of Sciences, Engineering, and Medicine: Preventing Cognitive Decline and Dementia: A Way Forward (2017)
- American College of Cardiology: 2025 AHA/ACC high blood pressure guideline release
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