The World Health Organisation’s 19 ways to prevent dementia

According to the WHO, following them can reduce the incidence of dementia or cognitive decline by up to 45%.

This second edition of the guidelines was released in mid-July, seven years after the first.

One interesting addition this time around is a recommendation against using menopausal hormone therapy for brain health.

It’s not a recommendation against MHT in general, but a statement that it can’t justifiably be prescribed to reduce the risk of dementia.

It’s also recommended that we don’t take supplements (such as vitamins B and E, omega-3, or multivitamins) for the purpose of dementia prevention given the lack of evidence. Unnecessary supplements can also cause harm.

Another important point made by the authors is that dementia risk is shaped by a range of factors throughout our lives. Too often it’s regarded as a disease of old age, and although age is a risk factor, and it might not show up until late in life, dementia develops gradually over several decades.

Here are the 19 prevention strategies.

Alcohol reduction — the document notes that alcohol has no health benefits, and that research consistently links heavy drinking to increased risk of cognitive impairment and dementia.

Tobacco cessation — ‘Tobacco use should be avoided entirely,’ say the authors. Hard to argue.

Physical activity — another no-brainer, though the recommendations for brain health are no different from the general physical activity guidelines that each country publishes.

Healthy diet — nothing new here either. The kind of diet that reduces the risk of diabetes and heart disease also benefits the brain. But note the advice against taking supplements for this purpose.

Social activity — this is strongly linked with health and well-being throughout life.

Cognitive activity — doing things that stimulate our mind are clearly important, though there’s not much evidence for any specific activities.

Hypertension (high blood pressure) — this is a well-established risk factor for dementia and needs to be managed.

Diabetes — people with type 2 diabetes have a 50–100% increased risk of dementia compared with people who aren’t diabetic.

Dyslipidemia (high cholesterol) — again, the view is that what’s good for the heart is good for the brain.

Obesity — and again, being a healthy weight seems to support a healthy brain as well as cardiovascular health.

Stroke — this is a risk factor for dementia, but in addition, stroke and dementia share several common risk factors including high blood pressure, air pollution, obesity, high cholesterol, inactivity, and harmful use of alcohol.

Depression — this has been linked to increased dementia risk, though it’s hard to know whether this is because of the direct effect of depression on the brain or because depression can result in social isolation or a loss of interest in self-care activities such as exercise or eating healthily.

Hearing loss — unmanaged this can result in social isolation, lack of engagement, and a loss of mental well-being.

Vision impairment — like hearing loss this can give rise to social isolation and a loss of sensory input to the brain.

Sleep — disordered sleep has been linked with cognitive decline, but poor sleep can also be aligned with other risk factors such as physical inactivity and depression.

Traumatic brain injury (e.g. from accidents, falls, violence, sports injuries) — although this is associated with an increased risk of dementia, at this stage no one knows how to reduce that risk once the injury has occurred.

Use of Menopausal hormone therapy — a new recommendation against using hormone therapy for reducing the risk of dementia on the basis that there’s not enough evidence.

HIV — globally almost 41 million people live with HIV. Cognitive impairment is often a complication of the disease, especially in countries where drug treatment is hard to access.

Air pollution — industrial air pollution is toxic and has been implicated in chronic diseases such as dementia and cardiovascular disease, but inhaling smoke from domestic fireplaces is also a risk factor.

It’s interesting to note that although we know more about dementia than ever before, we’re still grappling to understand the big picture of what causes it.

These are a sensible collection of risk factors based on what we know, but much of that comes from studies that show a connection to dementia rather than anything causal.

For example, when heavy drinking is in the mix, dementia shows up, but we don’t know how it happens or how much one might have to drink for this to occur.

Can alcohol have that effect by itself, or are other factors needed? We’re still short of answers.

Which means our job is to do the best we can with the knowledge we have right now.

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