Lowering dementia risk starts in midlife

Dementia usually shows up after 65, but the changes in the brain that lead to it can start decades earlier. That makes midlife, roughly ages 40 to 64, a key time to protect your brain. Many of the things that raise dementia risk, such as high blood pressure, high cholesterol and hearing loss, are common in midlife and can be treated.

This guide explains what the 2024 Lancet Commission on dementia found, which risks matter most now, and what you can start doing this year. It is part of our midlife guide. For the full set of brain health pages, see lower your risk of dementia.

The 14 risk factors

The Lancet Commission is a group of world experts who review dementia research. Its 2024 report lists 14 risk factors that people and societies can change. Together, they are linked to nearly half of dementia cases worldwide.^1,2

The life stages above follow the Commission's report and summary. Head injury can happen at any age, and air pollution acts over a lifetime.^2,1 Checking hearing and staying active matter at every adult age.

Some of the largest shares, according to the Commission:¹

• Hearing loss: about 7% of cases
• High LDL cholesterol: about 7%
• Less education in early life: about 5%
• Social isolation in later life: about 5%
• Untreated vision loss: about 2%

These numbers should not simply be added together. Risks cluster in the same people, and the Commission adjusted for this overlap.² What matters for you is that each risk you lower may help.

You can check your own habits with our brain health and dementia risk quiz.

Why midlife matters

Many risk factors do the most harm when they are present in midlife. High blood pressure, high cholesterol, diabetes, obesity, smoking, depression and heavy drinking in midlife are all tied to higher dementia risk later.² The Commission found that higher LDL cholesterol was linked to dementia risk mainly in people under 65.²

These same factors damage blood vessels in the brain and the heart. That is why "what is good for your heart is good for your brain" is a fair summary. See heart, brain and mood.

Signs worth checking

Dementia risk factors often have no symptoms. You find them only by checking. Signs you should get checked for:

• You often ask people to repeat themselves, or turn the TV up loud.
• You have trouble reading, driving at night or seeing faces clearly.
• You have not had your blood pressure or cholesterol checked in the past year or two.
• You feel low, flat or hopeless most days.
• You drink more than you would like.
• You spend most days alone.

Memory slips are normal at any age. If you are worried about your memory, see normal aging or not and try the normal aging or dementia quiz.

What helps

Steps to start this year

1. Know your numbers. Get your blood pressure, LDL cholesterol and blood sugar checked. Ask your doctor what your targets should be.
2. Test your hearing. If you have hearing loss, try hearing aids and wear them every day. Protect your ears from loud noise.¹
3. Get your eyes checked and keep glasses up to date. Treat cataracts if your eye doctor advises it.¹
4. Move most days. Work up to 150 minutes a week, such as a brisk 20-minute walk each day.³ Our walking path can help.
5. Drink less and do not smoke. Heavier midlife drinking (more than 21 UK units a week, roughly 12 U.S. standard drinks) was linked to higher dementia risk.² See alcohol in midlife. Quitting smoking at any age helps.³
6. Treat low mood. Take our depression test and talk with your doctor if your score is high.
7. Keep your mind and social life busy. Learn new things, keep up friendships and join groups. See mind and social life.
8. Protect your head. Wear a helmet for cycling and contact sports.¹
9. Sleep well. See our midlife sleep guide and sleep, alcohol and smoking.

For partners, family and friends

Brain health is easier as a team. Walk together, cook together and plan regular social time. If a partner keeps turning up the TV or misses parts of conversations, gently suggest a hearing test. Offer to go along.

If you are caring for a parent with dementia, you may worry about your own risk. That worry is common. These steps help you whatever your family history. See caregiving in midlife.

Special situations

Family history and genes. If dementia runs in your family, lowering your risk factors is still worth it. See genetic testing before deciding on a gene test.

New blood tests for Alzheimer's. In May 2025, the FDA cleared the first blood test to help diagnose Alzheimer's disease. It is for adults 55 and older who already have signs and symptoms, and it is not a screening test.⁸ In August 2026, another blood test was cleared for people with signs of thinking problems, in primary care and specialty care.⁹ These tests are not meant for people with no symptoms who want to know their risk. See blood tests for Alzheimer's.

Diabetes and weight. Both are on the list of 14 factors. See diabetes and weight.

Common questions

If dementia runs in my family, is there any point?

Yes. The 14 risk factors apply to everyone. Lowering them is good for your brain, heart and overall health, whatever your genes.^3,4

Do brain games prevent dementia?

Structured training improves the skills that were practiced, but commercial brain games have not been shown to match those results or to prevent dementia.⁴ Learning real new skills and staying social are good choices.

Should I get an Alzheimer's blood test now, just to know?

Not if you have no symptoms. The FDA-cleared tests are for people who already have signs of memory or thinking problems.^8,9 Talk with your doctor about your concerns.

Is it too late if I am already 60?

No. Many factors, such as blood pressure, hearing, vision, isolation and activity, matter in later life too.¹ It is never too late to start.

When to get help

See your doctor if you or people close to you notice memory or thinking changes that affect daily life, such as getting lost in familiar places, repeating questions or trouble managing money. Early checks can find treatable causes such as medicine side effects, thyroid problems, low vitamin B12, depression or sleep problems. See conditions that can look like dementia and the first doctor visit.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.