The need for effective dementia risk reduction strategies that help all communities increases by the day. Two-thirds of Americans have at least one major potential risk factor for dementia. Just as public health works to keep people physically healthy across the lifespan, public health must help people stay cognitively healthy. A growing body of evidence shows that addressing certain modifiable risk factors and promoting healthy behaviors can reduce the risk of cognitive decline, possibly reduce the risk of dementia, and protect cognitive health.

For an overview of these issues and other related topics:

• Reducing the Risk of Cognitive Decline Fact Sheet (PDF).
• Reducing Risk of Cognitive Impairment Issue Map (PDF).
• The Alzheimer's Association Public Health Center of Excellence on Dementia Risk Reduction (PHCOE).

Modifiable risk factors

The science on dementia risk reduction is quickly evolving, and the evidence showing a link between certain behaviors/conditions and cognitive health/dementia is growing stronger. The most notable healthier behaviors that can reduce the risk of cognitive decline and possibly dementia include: 

• Being physically active.
• Quitting or never starting smoking.
• Being heart-healthy, which includes managing midlife high blood pressure and avoiding and managing diabetes and midlife obesity.

The following are short summaries on the current state of the evidence on a variety of possible risk factors, including the implications for public health:

• Compiled Report (includes all reports in this list).
• Cardiovascular Health.
• Exercise.
• Diabetes and Obesity.
• Traumatic Brain Injury (TBI).
• Tobacco and Alcohol.
• Diet and Nutrition.
• Sleep.
• Sensory Impairments.
• Social Engagement.

Several videos from the BOLD Center of Excellence on Dementia Risk Reduction outline the evidence behind various modifiable risk factors and what this means for public health:

• Physical Activity: Is It Worth the Sweat to Protect Brain Health?
• Diabetes and Obesity: What We Do Now Affects How We Think Later
• Vascular Risks: What's Good for the Heart is Good for the Brain
• Tobacco Use: Choices Make a Difference
• Mild Traumatic Brain Injury: A Continuum of Prevention to Reduce Risk
• Diet and Nutrition: Healthy Dietary Patterns for a Healthy Brain
• Cognitive Activity: How Today's Habits May Impact Later Life
• Sleep: Important for Brain Health

For additional reviews of the evidence on modifiable risk factors:

• Cognitive Aging: Progress in Understanding and Opportunities for Action report from the National Academies of Science, Engineering, and Medicine.
• A review by the Alzheimer's Association in Alzheimer's & Dementia: The Journal of the Alzheimer's Association on modifiable risk factors for cognitive decline and dementia.
• Dementia Prevention, Intervention, and Care from the Lancet Commission on Dementia.

Prevalence of risk factors for dementia in the U.S.

View national information on the prevalence of risk factors for cognitive decline and dementia (PDF), and select a state below for state-level information. For heat maps of dementia risk factors at the state level by county or county level by Census tract, please contact CenterOfExcellence@alz.org.

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDCDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

 

Risk factor prevalence maps

Hypertension

Obesity

Diabetes

Smoking

Physical inactivity

Poor sleep

Social determinants of health (SDOH)

The risk for dementia, many of the modifiable risk factors for dementia, and the ability to address those risk factors are all affected by social determinants of health (SDOH) — the conditions present where people live, learn, work and play that affect a wide range of health risks and outcomes. The Association's Public Health Center of Excellence on Dementia Risk Reduction is currently undertaking a comprehensive review of the evidence on SDOH related to dementia.

Several studies reported at the 2022 Alzheimer’s Association International Conference (AAIC) demonstrated the impact of inequities on cognitive decline. Experiences of structural, interpersonal and institutional racism are associated with lower memory scores and worse cognition in midlife and old age, especially among Black adults. Socioeconomic deprivation, including neighborhood disadvantages and persistent low wages, are associated with higher dementia risk, lower cognitive performance and faster memory decline. Both summaries are available in English and Spanish.

The Center hosted a four-part SDOH webinar series, featuring public health experts discussing links between SDOH and dementia risk reduction, along with insights from state and local health departments. The SDOH Toolkit for Public Health Agencies (PDF) provides public health agencies with a framework to identify dementia-related SDOH and implement effective strategies in their communities.

A series of short summaries developed by the BOLD Center detail the current state of the evidence on a number of SDOH related to dementia:

• Compiled Report (PDF) — includes all SDOH summaries in this list. 
• Education (PDF).
• Economics (PDF).
• Food Insecurity (PDF).
• Racism, Discrimination, and Inequity (PDF).
• Environment (PDF).

The BOLD Center developed a set of infographics that showcase information on SDOH related to dementia as well as strategies to address these issues:

• Quality Education (PDF).
• Economic Stability (PDF).
• Nutritious Foods (PDF).
• Social Connections (PDF).
• Healthy Environment (PDF). 

The BOLD Center held a SDOH workshop at AAIC 2022 in San Diego. This workshop convened researchers and public health officials to discuss SDOH related to dementia risk. Addressing Dementia Risk Through Social Determinants of Health: A Center of Excellence Workshop (PDF) summarizes the scientific evidence presented at the workshop along with insights for public health.

What public health can do

Emerging research and practice from around the globe have illustrated successful strategies for addressing dementia risk factors and supporting public health in doing so. At AAIC 2023, the BOLD Public Health Center of Excellence on Dementia Risk Reduction held a conversation with international researchers and organizations about the most effective ways to support public health in prioritizing brain health activities. Read a transcript of the conversation.

Include risk reduction in Alzheimer's plans

Addressing risk factors for cognitive decline and dementia should be included in state, local, or tribal Alzheimer's plans. Public health officials should be involved in a jurisdiction's comprehensive planning efforts. Suggested Recommendations for Alzheimer's Plans (PDF) provides examples of risk reduction-related recommendations that could be included in such plans. Our needs assessment tools can also help in the planning efforts.

Integrate messaging

Public health practitioners can integrate information and education (PDF) about cognitive health into existing initiatives and programs targeted at the conditions and unhealthy behaviors that are risk factors for cognitive decline and dementia.

Address hypertension

Some of the strongest evidence about reducing risk for cognitive impairment involves managing hypertension. The Alzheimer's Association has prepared an action brief on hypertension specifically for public health officials. It explores the heart-brain connection and describes tools and resources that can help public health to address the issue.

• Action Brief — Protecting the Heart and the Brain: Managing Hypertension to Reduce the Risk of Cognitive Decline (PDF).
• Executive Summary — Protecting the Heart and the Brain: A Call to Action for Public Health Professionals (PDF).
• Fact Sheet — Hypertension and Risk of Dementia (PDF).