Personalized Prevention: Targeting Modifiable Risk Factors in Cognitive Stewardship
2024 Lancet Commission: 45% of Dementia is Potentially Preventable in the Population
The 2024 Lancet Commission on dementia prevention now identifies 14 modifiable risk factors that collectively account for 45% of dementia cases worldwide—up from 40% in the prior analysis with the addition of high LDL cholesterol and vision loss.
45% represents the theoretical maximum if all risk factors were eliminated across entire populations from early life through late life. This does NOT mean that any individual optimizing their risk factors has a 45% reduced dementia risk.
Midlife Interventions May Be Most Critical
The majority of modifiable risk burden (approximately 60% of the 45%) occurs in midlife when vascular and metabolic risk factors exert their greatest impact on brain health decades later.
Life-Course Risk Factor Model
Early Life (ages <45):
Less education (5%) - Limited cognitive stimulation and cognitive reserve building in formative years
Midlife (ages 45-65):
Hearing loss (7%) - The single largest modifiable risk factor
High LDL cholesterol (7%) - NEW for 2024; midlife dyslipidemia accelerates vascular brain changes
Depression (3%) - May be both risk factor and early symptom
Traumatic brain injury (3%) - Even mild TBI increases long-term dementia risk
Physical inactivity (2%) - Sedentary lifestyle deprives brain of neurotrophic benefits
Diabetes (2%) - Chronic hyperglycemia damages cerebral microvasculature
Smoking (2%) - Vascular damage and oxidative stress
Hypertension (2%) - Uncontrolled BP in midlife drives white matter disease
Obesity (1%) - Metabolic syndrome and chronic inflammation
Excessive alcohol (1%) - >21 units/week associated with brain atrophy
Late Life (ages >65):
Social isolation (5%) - Lack of cognitive stimulation and increased depression risk
Air pollution (3%) - Fine particulate matter (PM2.5) exposure causes neuroinflammation
Vision loss (2%) - NEW for 2024; untreated cataracts and poor vision reduce engagement
2025 US POINTER Trial: Lifestyle Prevention
Published January 2025 in JAMA, the US Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (POINTER) trial represents the first large-scale validation of the Finnish FINGER model in Americans.
Key Findings
Primary Outcome - Global Cognitive Composite: equivalent to 1-2 years of preserved cognitive function
Critical Insights: Any lifestyle intervention, even minimal, provides benefit. However, structured programs deliver ~30% greater cognitive gains (0.24 vs. 0.21 SD/year improvement). The program works, but only if people actually do it. Cognitive Stewardship provides care coordination and evidence-based strategies adherence strategies for maintenance of behavior change to slow decline, not prevent dementia.
Cognitive Stewardship can help translate the Lancet Commission's 14 modifiable risk factors and the US POINTER trial's structured intervention model into a personalized, sustainable program for your brain health. Through continuous monitoring, expert guidance, and intensive support, we can help you implement these evidence-based strategies proven to slow cognitive decline—while also navigating the 10 critical decision points where expert guidance prevents costly mistakes. You get both: (1) Personalized lifestyle intervention for cognitive protection, and (2) Decision-preparedness coaching for life transitions. Together, these maximize your cognitive trajectory and quality of life.
References
Livingston G, Huntley J, Liu KY, et al. Dementia Prevention, Intervention, and Care: 2024 Report of the Lancet Standing Commission. Lancet. 2024;404(10452):572-628. doi:10.1016/S0140-6736(24)01296-0
Yaffe K, Barnes DE, Rosenberg D, et al. Effect of a Multidomain Lifestyle Intervention vs Health Education on Cognitive Function in Older Adults at Increased Risk of Alzheimer Disease: The US POINTER Randomized Clinical Trial. JAMA. 2025;333(3):217-229. doi:10.1001/jama.2024.24157
