Up to 45% of dementia risk is linked to modifiable factors like poor diet, inactivity and isolation.

An estimated 7.2 million Americans over age 65 currently live with Alzheimer’s disease (AD). That number is expected to nearly double to 13.8 million by 2060. These increases reflect more than demographic shifts; they point to a growing public health crisis that requires a new, proactive approach. While chronological age is the strongest known risk factor for cognitive decline, losing cognitive function is not an inevitable part of aging.

As AD and other forms of cognitive decline continue to rise at an alarming rate, researchers from Florida Atlantic University’s Charles E. Schmidt College of Medicine, highlight a powerful and untapped path to prevention. 

In a commentary published in The American Journal of Medicine, the researchers urge clinicians, public health professionals and policymakers to implement coordinated efforts to support lifestyle-based interventions that can help reduce the growing burden of cognitive decline in the United States and worldwide.

“While deaths from cardiovascular disease have declined since 2000, deaths from Alzheimer’s disease have surged by more than 140%,” said Charles H. Hennekens, M.D., FACPM, FACC, co-author, the First Sir Richard Doll Professor of Medicine and Preventive Medicine, and senior academic advisor, Schmidt College of Medicine. “At the same time, it is estimated that up to 45% of dementia risk could be attributed to modifiable lifestyle and environmental factors.”

Lifestyle risk factors like physical inactivity, poor diet, obesity, alcohol use, and conditions such as hypertension, diabetes, depression, and social or intellectual isolation are believed to contribute to cognitive decline. The authors point out that the same therapeutic lifestyle changes proven effective for reducing risks of cardiovascular and other major diseases may also help reduce cognitive decline – potentially with additive effects when multiple risk factors are present.

The commentary highlights the recently published results from POINTER, the first large-scale U.S-based randomized trial to test whether intensive lifestyle changes can improve cognitive outcomes in older adults at high risk of decline. In this trial, participants who were assigned at random to a structured, team-based lifestyle intervention showed statistically significant and clinically meaningful improvements in global cognition over two years. These gains were especially notable in executive functions such as memory, attention, planning and decision-making. The intervention emphasized regular physical activity, a combination of Mediterranean and DASH-style diets, cognitive stimulation and social engagement – reinforced through ongoing professional guidance and group support.

These findings are similar to an earlier Finnish trial, the FINGER trial, in which participants with elevated cardiovascular risk scores assigned at random to a multidomain lifestyle approach experienced cognitive benefits.

“The data from both these landmark, large scale randomized trials demonstrate that lifestyle changes – previously shown to reduce heart disease and cancer – also hold transformative potential for brain health,” Hennekens said.

The researchers also speculated about biological mechanisms that may underlie these benefits. Physical activity, for example, increases brain-derived neurotrophic factor, which supports hippocampal growth, while also improving blood flow and reducing inflammation. Healthy dietary patterns like the Mediterranean and DASH diets can lower oxidative stress and improve insulin sensitivity as well as risks of cardiovascular disease. Quitting smoking may help preserve brain structure and white matter integrity, and regular social and cognitive engagement promotes neuroplasticity and mental resilience.

“The implications for clinical practice, public health and government policy are potentially enormous,” said Parvathi Perumareddi, D.O., co-author and an associate professor of family medicine in the Schmidt College of Medicine. “Clinicians now have powerful, evidence-based tools to help their patients prevent or slow cognitive decline – tools that go beyond medications, are generally low-risk, and are cost-effective. Public health agencies could adopt the framework of trials like POINTER and FINGER to develop brain health programs.” 

On the policy front, the researchers note that potential cost savings are large, particularly when considering the high price and limited effectiveness of many new pharmacologic agents, which may cause common and less serious side effects like nausea, headache and fatigue, as well as more rare but more serious risks like confusion or gastrointestinal bleeding. Modeling studies suggest that reducing key risk factors by even 10% to 20% each decade could lower the burden of cognitive decline by up to 15%.

Beyond the health care system, the societal costs of dementia are staggering. In 2024, nearly 12 million family members and unpaid caregivers provided an estimated 19.2 billion hours of care to individuals living with dementia – amounting to a societal cost of more than $413 billion. Caregiving also takes an emotional toll, often resulting in mental health challenges and caregiver burnout. The researchers emphasize that these realities underscore the need for practical, community-based solutions that support both patients and caregivers and reduce the long-term burden on families and the economy.

“While more research is needed, the current totality of evidence supports a clear path forward: invest in lifestyle-based strategies to protect brain health,” said Hennekens. “Doing so will not only benefit individuals at risk but also serve as a powerful tool for reducing national and global health care burdens related to cognitive decline.”

The first and corresponding author is John Dunn, a medical student at the Schmidt College of Medicine.

-FAU-