Is Dementia Preventable? The Connection Between Cognitive Health, Vascular Health, and Thriving Through Nature Engagement
While no strategy can guarantee the prevention of all types of dementia, research indicates that a significant percentage of cases may be preventable through modifiable lifestyle choices.
A holistic approach centered on maintaining cognitive and vascular health, with a growing emphasis on engaging with nature, offers a promising path toward reducing risk and improving quality of life, even after diagnosis.
Dementia prevention through modifiable risk factors
Heart health: Conditions like high blood pressure, high cholesterol, diabetes, and obesity are major risk factors for both heart disease and dementia. Managing them through diet, exercise, and medication can protect the brain's blood supply.
Physical activity: Regular exercise, particularly aerobic activity, improves blood flow to the brain and is associated with a lower risk of cognitive decline and dementia.
Mental and social stimulation: Engaging in mentally challenging activities like puzzles or learning new skills, and maintaining social connections, builds cognitive reserve, helping the brain withstand damage better.
Hearing loss: Untreated midlife hearing loss is a notable risk factor for dementia, and using hearing aids may reduce this risk.
Vascular health is critical for cognitive function
The brain is a highly active organ that requires a constant supply of oxygen and nutrients through a vast network of blood vessels. The connection between vascular health and cognitive health is direct and significant.
Impact of compromised blood flow: When vascular diseases like high blood pressure or atherosclerosis (plaque buildup) impede blood flow, brain cells can be damaged or destroyed over time. This can lead to vascular cognitive impairment, which includes problems with memory, attention, and executive functions.
Subtle brain injury: Poor vascular health can also cause "silent strokes"—small, symptomless areas of blocked blood flow that accumulate over time and lead to cognitive decline.
Mixed dementia: Vascular dementia and Alzheimer's disease often coexist, with vascular brain pathology potentially promoting the development of Alzheimer's proteins.
Early intervention is key: Changes in the brain can occur decades before dementia symptoms appear. Proactively managing vascular risk factors in midlife can have a major impact on reducing later-life dementia risk.
Nature engagement enhances cognitive and vascular health
Exposure to natural environments offers therapeutic benefits for both brain and vascular health, making it an excellent tool for risk reduction and improving well-being.
Reduces stress: Spending time in nature lowers stress hormones like cortisol and decreases heart rate and blood pressure, promoting a state of physiological relaxation. Stress reduction has been linked to better overall health and improved cognitive function.
Restores attention and creativity: Natural settings engage the brain through "soft fascination" from non-demanding stimuli, like rustling leaves. This allows the brain's "directed attention" system to rest and recover, which improves focus, memory, and creative thinking.
Promotes physical activity: Green spaces encourage physical activity, which supports both cardiovascular and cognitive health. Studies show that those with greater access to green spaces are more physically active.
Increases social connection: Nature-based activities can reduce loneliness and foster a sense of community. Strong social networks are associated with better brain health and reduced risk of cognitive decline.
Benefits across the lifespan: Research shows that greater access to green spaces is associated with higher cognitive function and lower hospitalizations for dementia, especially for older adults.
Thriving with a dementia diagnosis
For those already diagnosed, engaging with nature and prioritizing vascular health remains crucial for maintaining function and maximizing quality of life.
Continuing activity: Individuals in the early stages of dementia can still benefit significantly from regular, gentle exercise like gardening and walking.
Holistic care: Access to green spaces and nature-based programs within memory care settings can provide sensory stimulation, reduce agitation, improve sleep, and reinforce identity.
Community support: Dementia-friendly walking groups and gardens offer social connection and purposeful activity, allowing people to flourish despite memory loss
Recent breakthroughs in Alzheimer's prevention research include advancements in disease-modifying drugs, new therapeutic pathways, improved blood tests for earlier diagnosis, and confirmation of non-pharmacological approaches. While no cure exists, these developments are significantly changing the landscape of prevention and treatment.
New and improved anti-amyloid treatments
Drug development for Alzheimer's is focused on removing or preventing the build-up of amyloid plaque in the brain, which is a key pathological hallmark of the disease.
Donanemab: Approved by the FDA in July 2024, donanemab (brand name Kisunla) slowed cognitive and functional decline in people with early-stage Alzheimer's.
It offers a limited-duration dosing approach, with treatment potentially stopping once amyloid plaques are sufficiently cleared.
An updated dosing schedule was approved in July 2025 to reduce the risk of a common side effect, amyloid-related imaging abnormalities (ARIA).
Lecanemab: Approved by the FDA in July 2023, lecanemab (brand name Leqembi) slows cognitive and functional decline in the early stages of Alzheimer's.
Long-term data presented in July 2025 indicated that patients who started treatment early continued to show sustained benefits over four years.
An at-home, weekly subcutaneous autoinjector for maintenance dosing was made available in October 2025, offering a more convenient way to continue treatment.
Ongoing prevention trials: The AHEAD 3-45 study is currently testing lecanemab in cognitively normal individuals who have elevated brain amyloid but no symptoms yet. Early intervention is being explored as a way to achieve greater benefits.
Non-amyloid therapeutic pathways
Researchers are exploring other biological mechanisms involved in Alzheimer's disease to develop multimodal prevention strategies.
Tau protein reduction: New clinical trials are combining anti-amyloid therapies like lecanemab with tau-targeting therapies. Tau is another protein involved in Alzheimer's pathology.
Cellular senescence: Studies in mice show that drugs targeting senescent ("zombie") immune cells may reverse age-related cognitive decline by reducing inflammation and improving cognitive function.
Genetic protection: Research identified that a rare mutation inherited with the high-risk APOE4 gene variant can protect against Alzheimer's. Understanding this mechanism could lead to new therapies.
Nanotechnology: Promising preclinical studies have used nanoparticles to effectively clear amyloid-beta and restore vascular balance in the brains of mice.
Repurposed drugs: Clinical trials are investigating if existing drugs for other conditions, such as the diabetes drug metformin, can slow cognitive decline in individuals with mild cognitive impairment.
Innovations in diagnosis and screening
New tools are allowing for earlier and more accessible detection of Alzheimer's pathology, which is crucial for maximizing the effectiveness of early-stage treatments.
Advanced blood tests: In 2025, new blood tests were introduced by C2N that measure specific tau biomarkers more closely linked to Alzheimer's symptoms. This helps identify individuals who would most benefit from anti-amyloid treatments.
Organ aging metrics: Stanford researchers have developed a blood-based method to measure how quickly individual organs, including the brain and vasculature, are aging. This provides another indicator to predict Alzheimer's progression.
Predictive screening: A Harvard study suggests that measuring natural lithium levels in the brain could one day help screen for early Alzheimer's risk.
Non-drug interventions with validated benefits
Recent clinical trials continue to demonstrate the power of lifestyle modifications in preventing cognitive decline.
Structured lifestyle interventions: The U.S. POINTER study released findings showing that interventions focusing on physical activity, diet, cognitive challenges, and health monitoring improved cognition in older adults at risk for dementia.
Hearing aids: The ACHIEVE study found that using hearing aids slowed cognitive decline by nearly 50% in older adults with hearing loss and specific dementia risk factors.
Multivitamins: An NIH-funded trial found that a daily multivitamin-mineral supplement improved global cognition in older adults.
Personalized health coaching: A trial showed that personalized coaching on lifestyle factors like diet and exercise improved cognition and reduced dementia risk over two years
Robust research confirms that healthy lifestyle interventions, particularly when addressing multiple areas simultaneously, can significantly improve cognitive function and reduce the risk of dementia. Recent clinical trial results from the U.S. POINTER study and others demonstrate the effectiveness of structured programs focused on exercise, diet, and cognitive and social engagement.
Multi-domain lifestyle programs
The landmark 2025 U.S. POINTER study found that multi-domain interventions with higher intensity provided greater cognitive benefits than self-guided efforts. The program included four key components:
Physical exercise: Participants performed moderate-to-vigorous aerobic exercise four times a week, plus resistance and flexibility training twice a week. Research consistently shows that exercise improves cognition, increases blood flow to the brain, and reduces stress.
Nutrition: Adherence to the MIND diet was emphasized. This diet is a hybrid of the Mediterranean and DASH diets, rich in leafy greens, berries, nuts, whole grains, olive oil, and fish, while limiting unhealthy fats and sugars. Studies continue to find that diets like MIND and Mediterranean are associated with slower cognitive decline.
Cognitive and social engagement: Participants engaged in computer-based brain training, other intellectually challenging activities, and social interactions. Social engagement, in particular, promotes cognitive reserve and reduces stress and depression, which are risk factors for dementia.
Cardiovascular health monitoring: Regular monitoring of blood pressure, weight, and other vascular risk factors was a key part of the program. This confirms the strong connection between vascular and cognitive health.
Sleep and brain health
Research continues to strengthen the link between sleep quality and cognitive health, suggesting that prioritizing restorative sleep is a key preventive strategy.
Quality over quantity: A 2024 UCSF-led study found that midlife "sleep fragmentation"—tossing and turning—was associated with higher dementia risk decades later, regardless of total sleep time.
Insomnia risk: A 2025 Mayo Clinic study revealed that chronic insomnia can accelerate brain aging and increases the risk of developing dementia or mild cognitive issues by 40%.
Targeting sleep architecture: A 2025 study highlighted the association between specific sleep stages and long-term brain health, suggesting that sleep architecture may be a modifiable risk factor.
Other key interventions
Treating hearing loss: The 2023 ACHIEVE study found that using hearing aids slowed cognitive decline in older adults with hearing loss and other risk factors. This confirms earlier research showing that uncorrected hearing loss is a notable risk factor for dementia.
Managing chronic health conditions: The Alzheimer's Association and other health organizations emphasize that managing conditions like diabetes, high blood pressure, and high cholesterol is critical for brain health.
Addressing environmental risks: Reducing exposure to air pollution and preventing head injuries by wearing protective gear during high-risk activities are important preventive measures.
Applying interventions in daily life
Even for individuals already at risk for cognitive decline, these interventions can make a difference.
Structure your approach: Consider adopting a more structured program with measurable goals and support, similar to the U.S. POINTER model, for greater accountability and benefit.
Start small and build: If current activity levels are low, even small amounts of moderate-to-vigorous physical activity are associated with significantly lower dementia risk.
Combine activities: The most effective lifestyle interventions combine physical, cognitive, and social elements. A dance class, for example, can be an excellent way to combine all three.
Use health coaching: Consider working with a health coach or care provider to set personalized goals and monitor progress, addressing cardiovascular and metabolic risk factors regularly.
