Dementia Prevention: How to Reduce Risk Factors for Cognitive Decline

As we age, physical changes occur in our brains and impact our cognitive function. Some of these changes, like occasional forgetfulness, are normal for some people as they age, but progressive or persistent loss of memory, or other cognitive functions, are not.

Major cognitive decline with aging often indicates some type of neurological change which can be because of a neurodegenerative disease which can often progress to dementia. The most common of the dementias are Alzheimer’s disease (AD) and vascular dementia, and they can often exist together.

Who Is at Risk?

There are a few known risk factors for dementia that are not within our control. These include:


While dementia is not a normal part of aging, it primarily affects people older than 65 years. While cognitive decline does occur in younger people, dementias rarely do. Approximately 1 in 9 people over the age of 65 are living with Alzheimer’s disease, and among these, 73% are 75 years or older.


Presenilin mutations and the APOE4 gene are genetic factors which have been linked to the development of Alzheimer’s disease. Fortunately, even in the presence of these genes, research shows that disease-related cognitive decline can be slowed down, even halted in some cases, and that dementia can be prevented through early interventions and lifestyle factors that are within our control. Many of the providers we work with at the Brain and Behavior Clinic are trained by Dr. Dale Bredesen who developed the Bredesen Protocol which addresses root biological and lifestyle causes for cognitive decline.

Understanding and Modifying Risk Factors

Hearing + Vision Impairment & Cognitive Decline

Understanding the Risk

The exact mechanisms linking hearing and vision impairments to cognitive decline are not yet fully understood, but we do know that decrements in auditory acuity decrease brain processing in the temporal lobes in the brain. While some research suggests that these impairments directly affect the brain’s function, others suggest that hearing and vision impairment contribute to feelings of social isolation and reduced stimulation of the brain, thus resulting in cognitive decline.

Reducing the Risk

While there is a significant link between mid-life hearing impairment (2020 Lancet Commission report) and later risk of cognitive decline, this is one of the easiest risk factors to modify for dementia: optimizing hearing and vision with the use of hearing aids and vision correction can substantially reduce the risk.

Diet & Cognitive Decline

Understanding the Risk

A diet that is high in saturated fat, sugar, and salt can cause a number of health problems that have been identified as risk factors for dementia, including:

Reducing the Risk

Eating a diet that is low in saturated and trans fats and rich in fruits, vegetables, whole grains, and lean proteins can help reduce the risk of cardiovascular illness as well as reduce inflammation more generally. This benefits the immune system. Limiting salt intake can further help to maintain healthy blood pressure, which reduces the risk for dementias caused by cerebrovascular changes. Additionally, a balanced diet can optimize the diversity of the gut microbiome which supports stress resilience.

Alcohol Use  & Cognitive Decline

Understanding the Risk

Excessive alcohol consumption can lead to various health problems, including high blood pressure and heart disease, which are themselves risk factors for dementia. Alcohol itself is a neurotoxin, and excessive use of alcohol impacts the health of neurons. In the Blue Zones, where the world’s greatest number of centenarians live, alcohol use is small and restricted to when people are eating and socializing.

Reducing the Risk

If you do drink alcohol, it is important to limit consumption, and if you drink wine it is best to drink red wine made with organic grapes. While the amount of recommended alcohol use varies, many experts consider one drink per day to be the threshold under average health circumstances. If you are unsure about your level of consumption, talking to your doctor to get a better sense of your personal threshold might be a good first step; and if you have cognitive problems, drinking any amount of alcohol is too much!

Smoking & Cognitive Decline

Understanding the Risk

Smoking has various toxic effects, including the formation of plaque in the blood vessels, which increases the risk of vascular diseases. Many studies have shown that smoking—and second-hand smoke—can directly cause cognitive decline as well. One study, for example, found that in women aged 55–64 years, exposure to second-hand smoke was associated with greater memory deterioration.

Reducing the Risk

If you are a smoker, quitting smoking is one of the most important steps you can take to reduce your risk of cognitive decline and maintain healthy aging. And it is not too late to quit:

One longitudinal study comparing 50,000 men found that those who had stopped smoking for more than four years showed a significantly lower risk of developing dementia than those who had continued smoking.

Air Pollution & Cognitive Decline

Understanding the Risk

Air pollution is increasingly being recognized as a risk factor for cognitive decline and dementia. Numerous studies have linked high concentrations of nitrogen dioxide and fine particulate matter from traffic exhaust and residential wood burning with an increased incidence of dementia. These pollutants can penetrate the blood-brain barrier and cause inflammation and oxidative stress, which are both linked to cognitive decline.

Reducing the Risk

While you may not always be able to control the pollution in your external environment, there are steps you can take to avoid your exposure to it:

  • Get in the habit of checking local air quality indexes to avoid exposure to high toxicity levels.
  • Avoid busy roads when possible, and when driving in high-traffic areas, avoid AC modes that draw outside air into your car.
  • Use an air filter in your home, and limit your use of wood-burning stoves and fireplaces.
Mental Health & Cognitive Decline 

Understanding the Risk

Our emotional wellbeing is directly tied to our cognitive health in both temporary and long-term ways. Chronic stress and anxiety can lead to the production of stress hormones, like cortisol, which can damage brain cells and accelerate the aging process. Similarly, depression can lead to inflammation in the brain, which can cause cognitive decline over time.

Reducing the Risk

For those struggling with depression or anxiety, psychotherapy is an instrumental tool in managing symptoms and supporting healthy cognitive aging. Healing chronic stress by working on old traumas is very important when addressing dementia prevention, and treatment. In addition to treating emotional disorders, you can proactively build emotional resilience through practices like:

  • Meditation or other mindfulness practices
  • Regular exercise, especially in nature
  • Regular social engagement to maintain strong relationships
  • Sharing difficult feelings with people who you trust
  • Working through grief, shame, and self-judgment
  • Building a trusting relationship with a psychotherapist


Sleep & Cognitive Decline

Understanding the Risk

Sleep deprivation has been linked to a wide range of physiological changes that could contribute to cognitive decline, as well as other known risk factors, such as:

  • An increase in β-amyloid (Aβ) proteins, which are associated with Alzheimer’s disease
  • Inflammation
  • Cardiovascular disease
  • Hypoxia (sometimes associated with obstructive sleep apnea) which can damage brain cells and contribute to cognitive decline

Reducing the Risk

A couple of ways to ensure sufficient amounts of sleep to reduce sleep-related risk factors include:

  • Setting consistent routines to help you make this aspect of health a priority
  • Curating an environment that is optimized for comfort and sleep needs
  • Investing time in your emotional health to reduce stress and support better sleep

For people who have sleep disorders such as sleep apnea, it is important to seek treatment to support sufficient sleep and promote long-term cognitive health. Many patients who have cognitive decline and sleep apnea benefit from using a specially fitted CPAP machine.

Brain Injury & Cognitive Decline

Understanding the Risk

Brain injury can cause inflammation, oxidative stress, and neuronal damage, which can eventually lead to the development of dementia. The risk of injury-related dementia increases with the severity of damage, the age at which the injury (or injuries) are sustained, and the frequency of traumatic brain injury or concussion.

Reducing the Risk

If you have sustained a mild brain injury, there is often so much you can do to reduce its lasting impact on your brain health—especially when you act early. It is important to seek medical attention immediately and to receive a customized treatment plan.

Of course, the best way to reduce injury-related risk is to actively prevent head injury by taking steps like:

  • Engaging in road-safe practices like wearing your seatbelt, ensuring a well-maintained vehicle, and only driving when you are well rested and sober
  • Always wearing the proper protective gear like helmets while engaging in high-risk sports or other activity like biking or skiing
  • Taking precautions to prevent falls, like installing handrails, removing tripping hazards, and improving lighting
Exercise & Cognitive Decline

Understanding the Risk

Lack of Physical Exercise:

Multiple studies, including longitudinal studies spanning 1–21 years and a HUNT study of about 30,000 participants demonstrate a link between MVPA (moderate to vigorous physical activity) and reduced risk of dementia.

Lack of Mental & Social Stimulation:

Lack of social activity is also considered a risk factor for cognitive decline. Social isolation can lead to a decrease in mental stimulation, which may have negative effects on cognitive functioning. A systematic review and meta-analysis of 51 longitudinal cohort studies found that high social contact was associated with better late-life cognitive function. Retirement is only beneficial for cognitive function if you have other ways to remain engaged with novelty and new stimulating activities.

Reducing the Risk

While the nature of these activities will likely fluctuate as you age and change, it is important to maintain regular stimulation of your brain and to regularly exercise enough to get your heart rate up for at least 160 minutes per week. Here are a few ways to maintain social, mental, and physical activity:

  • Attend group exercise classes.
  • Engage with your community by attending local events, volunteering, or joining a club or meet-up group.
  • Learn a new skill or set of knowledge, like a second language.
  • Go dancing or play board games with friends.
  • Do online cognitive training daily.

Preventing Cognitive Decline with the Brain & Behavior Clinic

Taking early action is the best way to prevent dementia, and a brain check-up is a great place to start. At the Brain and Behavior Clinic, we offer a Healthy Brain Check-up, which involves a personalized scientific evaluation of your unique history and emotional, biological and cognitive profile. We do a careful analysis of your sleep, exercise, nutrition, stress, and other lifestyle patterns and then individualize your neuroplasticity plan.  

With this knowledge, we can help you understand and mitigate your personal risk factors and coach you to prevent Alzheimer’s or help you optimize your peak cognitive performance. Trauma healing and stress optimization are the goals when it comes to feeling hopeful about your health and good about yourself.

The Healthy Brain Program

Following your personalized functional medicine brain check-up, our doctors will develop a customized program, including cognitive training, lifestyle coaching, and wellness therapies, to support your brain’s healthy aging and provide targeted dementia prevention. We treat many patients who have chronic environmental illness as well.

Customized to the individual’s needs, our program can include:

Cognitive Training
  • HeartMatha type of biofeedback that helps you learn how to regulate your heart rate variability to improve cognitive function and emotional regulation
  • Neurofeedbacka type of brain training that helps you learn how to regulate your brain activity for improved cognitive function
  • Meditation training: a technique that promotes relaxation, stress reduction, and improved cognitive function through focused attention on the present moment
Lifestyle Coaching
  • Nutrition treatments
  • Sleep and movement support
  • Mindfulness practices
Trauma and Resilience Therapies

If you want to sharpen your mind and deal with healing trauma, depression, fears, anxiety or other mental health issues, please contact us at the Brain and Behavior Clinic.

If you or someone you care about is at risk for dementia or is struggling to manage cognitive or trauma-related symptoms with chronic illness, we are here to help. Contact our clinic anytime.