Preventing dementia: a focus on Lifestyle and hearing health

Lifestyle includes diet and physical activity including ways to manage and prevent obesity and hypertension

The 2024 Lancet Commission on dementia has reinforced the understanding that dementia, a leading cause of disability and dependency among older adults, is not an inevitable consequence of ageing. In fact, addressing certain modifiable risk factors can prevent or delay the onset of dementia.
This recent update highlights hearing loss as a critical new area of focus, adding it to a growing list of modifiable risk factors, alongside issues such as hypertension, obesity, and lack of physical activity.
By addressing these areas early, particularly in midlife, we can reduce the global burden of dementia significantly.

Hearing Loss: A New Frontier in Dementia Prevention

One of the key updates in the 2024 report is the emphasis on hearing loss, which now accounts for about 7% of the modifiable risk factors for dementia. This is a notable increase from previous estimates and positions hearing loss as a major contributor to cognitive decline.
Hearing loss, particularly in midlife, can result in reduced social engagement and increased cognitive load, leading the brain to work harder to understand speech. This added strain on cognitive resources may accelerate neurodegeneration over time. Fortunately, the Commission's findings show that addressing hearing loss early on—through interventions like hearing aids—can significantly reduce this risk.
The evidence is becoming increasingly robust: even long-term studies confirm that using hearing aids can decrease the risk of dementia. Hearing aids not only improve communication and quality of life but also help maintain cognitive function by reducing the mental strain associated with hearing loss. Implementing strategies to promote hearing health, including regular screening for hearing loss in midlife, could therefore be a simple but highly effective method of dementia prevention.

Addressing Lifestyle-Related Risk Factors

While hearing loss has garnered much attention in this update, other lifestyle-related factors remain central to dementia prevention. Obesity, high blood pressure, and physical inactivity are major contributors to cognitive decline, particularly when these factors manifest in midlife.

Obesity: Excess body weight, particularly central or abdominal obesity, is closely linked with increased dementia risk. The mechanisms underlying this association include inflammation, insulin resistance, and vascular damage, all of which can affect brain health. A diet rich in whole foods, particularly those with anti-inflammatory properties like omega-3 fatty acids and antioxidants, is vital in managing body weight and preventing associated risks.
Hypertension: High blood pressure, if left unmanaged, can damage blood vessels in the brain, leading to a higher risk of stroke, white matter lesions, and neurodegeneration. Controlling blood pressure through lifestyle interventions—such as a diet low in salt and high in potassium rich fruit and vegetables, regular physical activity, and stress management—can significantly reduce the risk of cognitive decline.
Physical Activity: Regular exercise is one of the most well-established ways to protect brain health. Physical activity promotes blood flow to the brain, enhances the production of neurotrophic factors that support brain cell growth, and reduces the risk of conditions like obesity and hypertension that contribute to cognitive decline. Encouraging adults to engage in moderate-to-vigorous physical activity on a regular basis is a simple yet powerful intervention for dementia prevention.

The Role of Diet and Nutritional Interventions

From a dietary perspective, there is increasing evidence supporting the role of nutrition in dementia prevention. Diets rich in fruits, vegetables, whole grains, lean proteins, and healthy fats (such as the Mediterranean diet) have been shown to reduce inflammation and oxidative stress, both of which are implicated in the development of dementia. Specific nutrients, including B vitamins, omega-3 fatty acids, and antioxidants, are particularly important for maintaining brain health.
Fostering healthy eating habits early in life can also contribute to better long-term cognitive outcomes. Nutritional interventions that target obesity and hypertension—such as reducing the intake of processed foods, sugars, and unhealthy fats—are essential for preventing not only cardiovascular diseases but also cognitive decline.

Conclusion

The updated Lancet Commission report underscores the importance of a comprehensive, multi-disciplinary approach to dementia prevention. By addressing both hearing loss and other modifiable lifestyle factors such as obesity, hypertension, and physical inactivity, we can make significant strides in reducing the global impact of dementia. Early intervention is key, and the evidence shows that even simple changes—like adopting a healthier diet, staying active, managing stress, and protecting hearing—can have long-lasting benefits for brain health.
For further reading, you can access the full text of the Lancet Commission report at The Lancet.

Reference

Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2024 update of the Lancet Commission. Lancet. 2024;PIIS0140-6736(24)01296-0. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01296-0/fulltext