Lancet Commision: The 14 Modifiable Risks That Could Delay/Prevent 45% Of Dementia

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We unpack the 2024 Landscape Commission update on dementia and show how 14 modifiable risks add up to a realistic, hopeful prevention blueprint across the life course. Two new risks high LDL cholesterol and untreated vision loss expand the strategy from heart health to sensory health.

• The 14 modifiable risks grouped by education, vascular metabolic, lifestyle mental social, and sensory environmental
• Why midlife is the golden window for hypertension, LDL, obesity, diabetes
• How hearing and vision correction sustain cognitive stimulation and reduce risk
• Cognitive reserve explained and why lifelong learning matters
• Exercise targets and the compounding benefits of movement
• The role of alcohol, depression, social isolation, and TBI
• Air pollution as a systemic target and equity priority
• Observational evidence limits, overlap of risks, and realistic impact ceiling
• Four action areas for listeners to start now
• Integrated care and policy changes to scale prevention

So thinking about that, what systemic changes things beyond just our individual choices do you think are most critical for us to start investing in right now to make that potential a reality?

This podcast is created by Ai for educational and entertainment purposes only and does not constitute professional medical or health advice. Please talk to your healthcare team for medical advice.

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Episode Transcript

SPEAKER_01 (00:00):
Welcome to the deep dive.
Today we're taking on somethingthat is, I think, incredibly
urgent, but also really, reallyhopeful.
We are dissecting the huge 2024update from the Landscape
Commission on DementiaPrevention, Intervention, and
Care.

SPEAKER_00 (00:16):
And it's a landmark report for a reason.

SPEAKER_01 (00:18):
Okay, let's unpack this.
People are calling this a realgame changer, and that's because
it identifies 14 specificmodifiable risk factors.
And the key word there ismodifiable.

SPEAKER_00 (00:30):
That's right.
And that number, 14, is socrucial.
The headline from the commissionis that if these factors were
addressed, you know, across aperson's entire life.

SPEAKER_01 (00:39):
The whole life course.

SPEAKER_00 (00:40):
The whole life course.
We're talking about potentiallypreventing or delaying up to 45%
of dementia cases worldwide.

SPEAKER_01 (00:46):
Aaron Powell 45%?
That is just an astonishingfigure.
Trevor Burrus, Jr.

SPEAKER_00 (00:49):
It is.
It fundamentally shifts dementiafrom being this uh inevitable
fate to something that'sactually highly actionable.

SPEAKER_01 (00:55):
Aaron Powell In this 2024 report, it built on their
previous work, but they didn'tjust rehash old news.
They've added two entirely newfactors to the list.

SPEAKER_00 (01:03):
Aaron Powell Exactly.
And it's not just about the newadditions, it's about the level
of confidence in the evidence.
We now have such strong supportfor prevention from early
childhood all the way to latelife care.

SPEAKER_01 (01:16):
Aaron Powell So let's zoom in on those two new
ones because I think they reallyexpand how we should be thinking
about brain health.

SPEAKER_00 (01:21):
Yes.

SPEAKER_01 (01:22):
The first is high LDL cholesterol.

SPEAKER_00 (01:24):
Aaron Powell Yes, specifically in midlife.
And this is a critical link.
For a long time, we saw highLDL, the bad cholesterol, as
purely a heart problem.
Trevor Burrus, Jr.

SPEAKER_01 (01:34):
Right, a cardiac issue.

SPEAKER_00 (01:35):
But the evidence is now firm.
It contributes to vasculardamage in the brain, amyloid
buildup, all sorts of brainpathology.
If it's bad for your arteries,it is definitely bad for your
brain.

SPEAKER_01 (01:45):
Aaron Powell And that second addition, this one
really surprised me.
Untreated vision loss.
You just don't immediatelyconnect updating your glasses
with dementia prevention.
How does that work?

SPEAKER_00 (01:54):
Aaron Ross Powell Well, it's a powerful idea.
The thinking is that it's a formof sensory deprivation.
If you can't see clearly, youcan't engage with the world as
fully, you're not leading asmuch, you're not navigating
complex environments, and thatreduction in stimulation seems
to accelerate cognitive decline.

SPEAKER_01 (02:09):
Aaron Powell So it's about keeping the brain active
and engaged with input.

SPEAKER_00 (02:13):
Precisely.
To give you some context onimpact, the report uses a metric
called attributable fraction.

SPEAKER_01 (02:19):
Which is basically how much of the problem could
disappear if you remove that onerisk factor.

SPEAKER_00 (02:24):
You've got it.
And for something like hearingloss or high cholesterol, they
each account for around sevenpercent of cases.
Huge numbers.

SPEAKER_01 (02:33):
Wow.

SPEAKER_00 (02:33):
Vision loss is smaller, about two percent.
But when you put vision andhearing together, it tells a
clear story.
Staying connected to the worldthrough our senses is
fundamental.

SPEAKER_01 (02:44):
It really forces you to see brain health not as this
separate thing, but as a directresult of total body health from
your arteries right down to youreyeballs.

SPEAKER_00 (02:53):
That's the new blueprint.

SPEAKER_01 (02:54):
Okay, so that's the groundwork.
Let's get into the full list of14.
To make this easier, we'vegrouped them by theme.
Where should we start?

SPEAKER_00 (03:00):
Let's start at the very beginning.
Early life and what's calledcognitive reserve.
There's only one factor here.
And that is less education inearly life.

SPEAKER_01 (03:09):
I hear that term cognitive reserve a lot.
Can you break down what thatactually means?

SPEAKER_00 (03:15):
Of course.
Think of it like your brain'ssavings account or a buffer
zone.
The more complex thinking youdo, especially early on, the
more neural pathways andconnections you build.

SPEAKER_01 (03:26):
So you have more routes for your brain to take if
one pass gets damaged later inlife.

SPEAKER_00 (03:30):
Aaron Powell That's the perfect analogy.
Less education means a smallerbuffer, making the brain more
vulnerable down the road.
It's why lifelong learning is soencouraged.

SPEAKER_01 (03:39):
Keep building that reserve.
Okay.
Moving on to the biggestcategory.

SPEAKER_00 (03:43):
Yes, this is vascular and metabolic health.
There are six factors in thisbucket.

SPEAKER_01 (03:47):
Six.
That alone tells you how much ofthis is tied to cardiovascular
health.

SPEAKER_00 (03:51):
Aaron Powell Absolutely.
We'll start with the big onehypertension, high blood
pressure.

SPEAKER_01 (03:55):
Aaron Powell And the report says controlling this in
midlife is especially critical.

SPEAKER_00 (03:59):
Aaron Powell It is.
It causes direct chronic damageto the brain's tiny blood
vessels.
It's a major driver of what wecall silent strokes.

SPEAKER_01 (04:08):
Aaron Powell And then there's that metabolic trio
that often comes as a packagedeal.

SPEAKER_00 (04:12):
Aaron Powell Right.
You have obesity in midlife,type 2 diabetes, and that new
factor we just mentioned, highLDL cholesterol, they feed off
each other.

SPEAKER_01 (04:21):
Trevor Burrus And having two or three of them
isn't just additive, it'smultiplicative, right?
The risk shoots way up.

SPEAKER_00 (04:27):
It really does.
Managing that cluster in your40s and 50s is probably the
single most powerful thing youcan do.
Aaron Powell Okay.

SPEAKER_01 (04:33):
What are the last two in the vascular group?

SPEAKER_00 (04:35):
Aaron Powell Two lifestyle pillars.
First, physical inactivity.
Exercise is just magic for thebrain.
It improves blood flow, reducesinflammation.
The list goes on.

SPEAKER_01 (04:45):
And they give a specific target, don't they?

SPEAKER_00 (04:46):
They do.
150 to 300 minutes of moderateexercise a week plus some
strength training.

SPEAKER_01 (04:51):
Aaron Powell And the last one is smoking.
No surprise there.

SPEAKER_00 (04:54):
No surprise at all.
It's a direct toxin for yourvascular system, and that
includes secondhand smokeexposure, too.

SPEAKER_01 (05:00):
Okay.
So let's pivot now away frommetabolism and more into our
daily lives.
The next category is lifestyle,mental health, and social
engagement.

SPEAKER_00 (05:10):
Four factors here.
First, excessive alcoholconsumption.
We're talking heavy or bingedrinking patterns.

SPEAKER_01 (05:17):
Then there's depression.

SPEAKER_00 (05:18):
Yes, especially midlife depression.
The relationship is complex.
It might be both a risk factorand an early symptom of
underlying changes.

SPEAKER_01 (05:26):
And the third one is social isolation.

SPEAKER_00 (05:28):
Mmm.
So important.
We are social creatures.
When you reduce that social andcognitive stimulation, you're
not exercising your brain in thesame way.
It hurts that cognitive reserve.

SPEAKER_01 (05:38):
Aaron Powell And the last one in this group is a bit
different traumatic brain injuryor TBI.

SPEAKER_00 (05:43):
Yes.
A crucial reminder aboutprevention.
Simple things, wearing a helmet,driving safely.
It's about protecting thehardware.

SPEAKER_01 (05:50):
Aaron Powell It's a really sobering thought that an
accident you could prevent witha helmet could change your
cognitive future.

SPEAKER_00 (05:56):
It is.

SPEAKER_01 (05:57):
Okay, last category: sensory and environmental.
Three factors here.

SPEAKER_00 (06:01):
And we're back to the senses.
First, hearing loss, especiallyin midlife, which is a very
strong link.

SPEAKER_01 (06:06):
And the new one we already talked about, untreated
vision loss.

SPEAKER_00 (06:09):
That's right.
And the final 14th factor is abig one: air pollution.

SPEAKER_01 (06:13):
So this one feels less about individual choice and
more about public policy.

SPEAKER_00 (06:18):
It is.
It's about chronic exposure tothose fine particles in the air
we breathe.
It requires systemic change.
So that's the full list.

SPEAKER_01 (06:25):
Aaron Powell, and what's really vital, as you
mentioned, is this life courseapproach.
The timing of when you intervenereally matters.

SPEAKER_00 (06:32):
It matters a lot.
For example, education has itsbiggest impact in early life.
For hypertension, obesity,hearing loss, midlife is the
golden window.

SPEAKER_01 (06:42):
Aaron Powell So if I start exercising in my 70s, is
it too late?

SPEAKER_00 (06:45):
Aaron Powell Not at all.
It's never too late tointervene.
But the biggest population levelbenefits come from acting
earlier.
In later life, the focus mightshift more towards things like
tackling social isolation andmanaging any further sensory
loss.

SPEAKER_01 (06:58):
Aaron Powell That's a really hopeful message.
Now we have to talk about theevidence.
That 45% figure is a projection.
Most of the data for thesefactors comes from observational
studies, not randomizedcontrolled trials.
How solid is that number?

SPEAKER_00 (07:11):
That's a very important question.
It's solid as a theoreticalmaximum a call to action.
You're right, we can't randomlyassign people to smoke for 20
years to prove causality.

SPEAKER_01 (07:19):
Well, of course not.

SPEAKER_00 (07:20):
So the strength of the evidence for each factor
does vary.
And they all overlap.
If you exercise more, you'remore likely to reduce obesity,
hypertension, and diabetes risk.

SPEAKER_01 (07:29):
So it's hard to pull them apart.

SPEAKER_00 (07:31):
Exactly.
But that's also the good news.
They are mutually reinforcing.
Improving one often improvesseveral others.
That 45% is the ceiling, buteven if we achieve half of that,
it would be a massive globalhealth victory.

SPEAKER_01 (07:44):
So let's translate this into action.
What does all this mean for you,the listener, sitting here right
now?

SPEAKER_00 (07:50):
Okay, we can boil it down to four main action areas.
First, sensory action.
Prioritize it.
Get regular hearing and eyeexams.
And if there's a problem,correct it.
Get the hearing aids, get theglasses.

SPEAKER_01 (08:02):
Don't just put up with it.
Second, the cardiometabolicbucket.
This requires being proactive.

SPEAKER_00 (08:07):
Absolutely.
Active management of your bloodpressure, your LDL cholesterol,
your weight, your blood sugar.
That means working with yourdoctor and committing to diet
and exercise.

SPEAKER_01 (08:15):
Third, what you call cognitive investment.

SPEAKER_00 (08:17):
Yes, building that reserve, lifelong learning,
reading, picking up a new skill,staying socially engaged.
Don't let your brain get static.

SPEAKER_01 (08:26):
And the fourth area is safety and environment.

SPEAKER_00 (08:29):
Minimize your risk of head injury helmets,
seatbelts, preventing falls athome.
And on the environment side,support policies that reduce air
pollution.
Your individual health is tiedto community health.

SPEAKER_01 (08:40):
The big takeaway for me is that you don't have to be
perfect.
You don't have to address all 14flawlessly.

SPEAKER_00 (08:46):
Not at all.
Tackling just a few, especiallythe big ones like hypertension
or hearing loss, canmeaningfully lower your personal
risk.

SPEAKER_01 (08:54):
And this all has huge implications for our health
systems.

SPEAKER_00 (08:57):
It does.
We have to stop treating thingslike hearing loss and diabetes
in silos.
They have to be integrated intoa single long-term plan for
brain health.

SPEAKER_01 (09:05):
And there's a real equity piece here, too.
Lower income communities oftenbear the brunt of these factors.

SPEAKER_00 (09:10):
They do.
And that means addressing thesemodifiable factors and
disadvantaged populations couldgive us the biggest return on
investment for society as awhole.

SPEAKER_01 (09:19):
So to recap this deep dive, the commission's list
of 14 factors is thisincredible, actionable
blueprint.
It really confirms that ourdementia risk isn't just written
in our genes, it's shaped acrossour whole life.

SPEAKER_00 (09:29):
It is.
And maybe the final thought toleave with you, the listener, is
this the research shows thishuge potential in tackling
factors like air pollution oruntreated hearing loss to hit
that 45% reduction.
So thinking about that, whatsystemic changes things beyond
just our individual choices doyou think are most critical for
us to start investing in rightnow to make that potential a

(09:50):
reality?