Fourteen modifiable factors — the Lancet’s map for dementia prevention

The 2024 Lancet Commission’s fourteen factors — and the everyday habits (movement, meals, hearing aids, sleep, conversation) that carry them out.

Dementia grows more common with age — but a great deal of it may be preventable. The 2024 report of the Lancet Commission on dementia prevention estimated that improvements in daily-life factors could prevent or delay roughly 45% of dementia cases.

1. The fourteen modifiable risk factors

The Commission’s 2024 update expanded the list from twelve to fourteen. They span the lifespan:

• Early life: 1. Low education.
• Midlife: 2. Hearing loss · 3. High blood pressure · 4. Obesity · 5. Excessive alcohol · 6. Traumatic brain injury · 7. High LDL cholesterol (added 2024).
• Later life: 8. Smoking · 9. Depression · 10. Social isolation · 11. Physical inactivity · 12. Diabetes · 13. Air pollution · 14. Untreated vision loss (added 2024).

Each of these has evidence supporting the direction — and, importantly, the possibility — of intervention.

2. Food — the Mediterranean and MIND diets

The Mediterranean diet — vegetables, fish, olive oil, whole grains — is the best-studied dietary pattern for lower risk of cognitive decline. The MIND diet, a brain-specific hybrid (leafy greens, berries, nuts, beans, whole grains, fish), has been reported in observational studies to reduce Alzheimer’s risk by as much as 53% in the highest-adherence groups.

3. Movement — aerobic + strength + cognitive activity

The WHO recommends at least 150 minutes of moderate aerobic activity per week. Add two strength sessions and — where possible — an activity that combines cognition and movement, such as yoga or tai chi. All are linked with maintenance of hippocampal volume.

4. Sleep

During deep sleep, the brain clears amyloid beta and other metabolic debris (the glymphatic system). Six to eight hours of good-quality sleep supports lower long-term dementia risk. If sleep apnea is present, treat it promptly.

5. Social participation and conversation

Loneliness carries the health equivalent of smoking fifteen cigarettes a day. At least one face-to-face contact a week, participation in hobby groups, and involvement in community gathering places all support cognitive maintenance. Family, friends, and volunteering all count.

6. Hearing and vision

Hearing loss is one of the single largest modifiable risk factors. Early adoption of hearing aids preserves conversation and social ties. Cataract surgery and appropriate eyeglasses similarly protect cognition.

7. Managing blood pressure and diabetes

Midlife hypertension and diabetes raise the risk not only of vascular dementia, but of Alzheimer’s disease as well. Salt reduction, movement, and appropriate medication together do the work.

8. Alcohol and tobacco

Quitting smoking helps at any age. For alcohol, the practical target is no more than about 21g of pure alcohol per day (roughly one can of beer). Heavy drinking raises dementia risk substantially.