The Lancet Dementia Commission: Dementia Risk Isn’t “Just Genetics”
- Nikhil Sharma
- Jan 13
- 4 min read
Dementia is one of the most feared diagnoses in medicine.
Not just because of the memory loss — but because it feels like something that happens to you, not something you can influence.
People often talk about dementia the way they talk about ageing:
“It’s in my family… there’s not much you can do.”
But in the past few years, something important has happened.
A team of world-leading researchers brought together decades of evidence and produced a landmark conclusion:
Up to ~45% of dementia cases could potentially be prevented or delayed by addressing 14 modifiable risk factors across the life course. (The Lancet)
That is a game changer.
It means dementia isn’t only a story about amyloid plaques, genetics, or bad luck.
It’s also about blood pressure, smoking, hearing, sleep, depression, movement, education, cholesterol… and the environment we live in.
And crucially, those are things we do have control over.
The Lancet Commission on Dementia Prevention, Intervention and Care is a major, recurring scientific project led by global experts (including UCL - London) that reviews the strongest available evidence on:
what causes dementia risk to rise
what lowers risk
and what societies can do to prevent cases at scale
The most recent major update (2024) expanded the model to 14 modifiable risk factors, adding two new ones based on emerging evidence:
✅ High LDL cholesterol (new for 2024)✅ Untreated vision loss (new for 2024) (The Lancet)
This 2024 update also reaffirmed a core message:
Dementia prevention starts in childhood and continues throughout life.
Dementia Prevention Playbook:
The 14 modifiable risk factors
Here’s the list of factors — and this is the part that should make everyone reading this sit up:
Early life
Low education
Midlife
Hearing loss
High blood pressure
Obesity
Smoking
Depression
Physical inactivity
Diabetes
Excessive alcohol
Traumatic brain injury
Air pollution
Later life
Social isolation / infrequent social contact
Untreated vision loss
High LDL cholesterol
Why this is so powerful (and why it’s hopeful)
If you look closely, this list is not a list of rare neurological diseases.
It’s not “brain chemistry.”
It’s largely:
vascular health
metabolic health
sensory input (hearing/vision)
mental health
movement
and environment
In other words:
Brain disease is often down to lifestyle.
This is why modern prevention medicine is starting to treat dementia less like an unpredictable neurological bolt-from-the-blue, and more like a lifelong brain health trajectory.
The “big two” that most people miss
If you asked most people:
“What are the biggest dementia prevention interventions?”
They’ll answer:
puzzles
brain training
blueberries
fish oil
But the Lancet Commission points to much more potent levers.
1) Treat hearing like brain health
Hearing loss is not “just hearing.”
It drives:
reduced social contact
cognitive load (your brain working harder just to understand speech)
accelerated cognitive decline
This is why hearing is such a high-leverage prevention target — because it’s measurable and treatable.
If you want a single “hidden gem” action:
Get your hearing tested in midlife.
2) Cholesterol is now officially dementia prevention
This is one of the biggest upgrades in the 2024 report:
High LDL cholesterol is now a recognised modifiable dementia risk factor
This matters because it aligns dementia prevention with what stroke doctors, like me, have been saying forever:
what’s good for arteries is good for brains
It also strengthens the argument for early ApoB/LDL assessment and treatment when appropriate — not just for heart attacks, but for brain longevity.
The Stroke-Proof insight: stroke and dementia are overlapping diseases
A huge chunk of “dementia” is either:
vascular dementia, or
mixed dementia (vascular + Alzheimer’s pathology)
Meaning:
Silent small vessel strokes today becomes cognitive impairment tomorrow
That’s why blood pressure control, metabolic health, movement and sleep aren’t “general wellness ideas.”
They are dementia prevention strategies.
And the best part?
They are also:
stroke prevention strategies
heart disease prevention strategies
frailty prevention strategies
It’s the ultimate prevention overlap.
So what should you actually do? (The actionable playbook)
If INTERSTROKE gave us the stroke playbook, the Lancet Commission gives us the dementia playbook.
Here are the core prevention moves that matter most:
1) Control blood pressure early
Not “when it’s really high”
Early.
Because cumulative exposure matters.
And never accept "fine". Fine isn't fine enough when it comes to protecting your brain.
2) Protect your metabolic health
Aim to reduce insulin resistance:
consistent activity
resistance training
sleep quality
waist-to-height improvement
3) Don’t ignore hearing and vision
This is the most underutilised area of dementia prevention.
4) Move every day
Exercise is brain fertiliser:
increases blood flow
improves vascular function
supports neuroplasticity
5) Treat depression and stress as medical risks
Not weakness.
Not personality.
A modifiable risk factor.
6) Reduce vascular risk as early as possible
Now includes:
LDL cholesterol
smoking cessation
alcohol moderation
7) Build cognitive reserve
It’s not about Sudoku.
It’s about:
learning
challenge
novelty
social engagement
Dementia is not inevitable
To be clear — prevention doesn’t guarantee immunity.
But the Lancet Commission completely dismantles the idea that:
“There’s nothing you can do.”
In fact the best-supported message is the opposite:
There is a lot you can do — and the earlier you start, the more powerful it is. Tip the odds in your favour.
This is why dementia prevention should become a normal part of everyday healthcare — just like blood pressure, cholesterol, and cancer screening.
Because protecting your brain isn’t a luxury.
It’s the foundation of everything else.
If this interests you get in touch at www.proactivelongevity.co.uk to book a stroke and dementia risk reduction consultation.
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