By Wendy Haaf
Dementia is not a normal part of aging, and you can take steps to reduce your risk
An estimated 348 Canadians a day were diagnosed with some form of dementia in 2020, according to a 2022 report from the Alzheimer Society; by 2030, that number is expected to rise to 512. “Dementia” is an umbrella term that refers to more than 100 different conditions that cause progressive problems with thinking, memory, mood, communication, and behaviour, and many experts consider it the greatest health challenge facing Canada’s aging society, since age is the primary risk factor for these disorders.
Many still mistakenly believe that dementia is a normal part of aging— two-thirds of nearly 70,000 respondents agreed with that idea in a 2019 Alzheimer’s Disease International survey—but research has made it increasingly clear that even those with high-risk genes for Alzheimer’s can influence their chances of developing dementia in future.
For example, the authors of a comprehensive 2020 review published in The Lancet concluded that a dozen potentially modifiable risk factors accounted for 40 per cent of dementia cases worldwide. And earlier this year, a similar Canadian study found that in Canada, “nearly 50 per cent of cases could be attributed to 12 risk factors,” says Nicole Anderson, director of the Ben & Hilda Katz Interprofessional Research Centre in Geriatric and Dementia Care at Toronto’s Baycrest Academy for Research and Education.
Here’s what you can do to help keep your brain as sharp and healthy as possible.
Exercise Regularly
In the Canadian report mentioned above, “the number one modifiable risk factor was physical inactivity,” Anderson says.
Exercise appears to protect brain health in multiple ways, from stimulating the release of substances that promote the growth of new nerve cells within its networks to bulking up areas involved in memory that otherwise shrink with age. Regular physical activity also helps prevent and manage a range of risk factors linked with increased dementia risk, including obesity, high blood pressure, sleep difficulties, depression, and dia- betes—all of which appear on the Canadian list of potentially mutable contributors to dementia risk.
Studies have found that when people with risk factors for dementia participate in an exercise program, as part of a suite of interventions including socialization and specific types of brain training, not only are they less likely to develop dementia but their scores on tests of different mental abilities actually rise. In the landmark 2015 FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) study, after two years, the rate of dementia in the control group was 30 per cent higher than in the treatment group, and the latter saw much greater gains on measurements of several different types of cognitive performance.
In addition, growing evidence indicates that regular exercise, combined with other lifestyle measures, can even improve brain function in those who have already started down the path to dementia.
For instance, in the SYNERGIC Trial (part of the Canadian successor to FINGER), 175 adults with mild cognitive impairment (MCI, a potential pre- cursor to dementia) were randomly sorted into five groups to test the effects of various combinations of exercise (60 minutes of aerobic plus strength training three times per week), cognitive training, and vitamin D supplementation over 20 weeks. The study, published in July 2023, found that “the combination of [aerobic and strength] exercise plus cognitive training was better at improving cognition than exercise alone, or other kinds of exercise, such as stretching and balance exercises,” says lead author Dr. Manuel Montero-Odasso, a geria- trician and director of the Gait and Brain Lab at St. Joseph’s Health Care’s Parkwood Institute and a professor in the Schulich School of Medicine & Dentistry in London, Ont. (Vitamin D supplementation had no effect.)
Similarly, a July 2024 randomized trial (albeit one with only 51 participants) “was able to show that people with mild cognitive impairment or early-stage Alzheimer’s were able to have significant cognitive improvement with lifestyle changes within a five-month period,” notes Saskia Sivananthan, a neuroscientist, affiliate professor at McGill University, and executive director of the Brainwell Institute, an independent dementia- focused think tank. What’s more, Sivananthan notes, “the more likely people were to stick to all of the changes fully, the higher gains they had. The changes in cognition were really big.”
Moderate exercise was one of the five lifestyle interventions followed by participants in the active-treatment part of the study. “It wasn’t anything extreme—just 30 minutes a day of aerobic exercise, like walking, and mild strength training,” Sivananthan explains. (The other components included a stress-management program that comprised yoga and breathing exercises and group support.)
Detect and Address Hearing Loss
A Canadian study published in June of this year identified hearing loss as the second-leading modifiable risk factor for dementia, accounting for an estimated 6.5 per cent of cases in Canada.
Research has shown that even mild hearing loss is linked with a marked increase in the likelihood of developing dementia. For instance, in a study of 2,413 older adults, published in 2023, the rate of dementia among those with normal hearing was just six per cent, compared to nine per cent for those with mild hearing loss and 17 per cent in the group with moderate-to-severe loss. (There are a number of possible explanations for this relationship, one being that when people don’t hear well, they’re more likely to become socially isolated—another established risk factor for dementia.)
More recently, a randomized controlled trial confirmed what hearing specialists have long suspected: treat- ing hearing loss can whittle down those odds, at least among those with cardiovascular risk factors linked with higher rates of dementia. However, it’s important to note that the treatment studied didn’t solely involve supplying people with hearing aids. “The program also included gold-standard hearing rehabilitation, which meant participants got education and counselling about good communication strategies,” explains Marilyn Reed, an audiologist and clinical researcher at Baycrest Health Sciences in Toronto.
Reed points out that fact to emphasize that prescription hearing aids aren’t the be-all and end-all. People with hearing loss who don’t want to wear or can’t afford prescription hear- ing aids can try other options that can potentially help them communicate more clearly and easily. These include speech-reading classes, hearing- health clinics, relatively simple amplification devices, and over-the-counter hearing aids. Learning about the range of possible assistive tools can help people understand that “there’s still value in having a hearing test,” Reed stresses, regardless of whether hearing aids might be part of the equation.
The World Health Organization recommends that people get their hearing checked every five years between the ages of 50 and 65 and every one to three years thereafter.
Manage Vascular and Metabolic Risk Factors
Research suggests that untreated high blood pressure and type 2 diabetes are each individually linked with increases in dementia risk—of roughly 40 per cent and 100 per cent, respectively. This is at least partly because both conditions can lead to impaired blood flow to the brain due to the formation of tiny blood clots. The so-called vascular dementia that can occur as a result is the second-most-common form of dementia after Alzheimer’s, and the two frequently occur together.
Current participants in the ongoing SYNERGIC-2 trial receive personalized coaching on how to control these and other vascular and metabolic risk factors, such as elevated cholesterol and body weight. While the study is far from completed, Montero-Odasso says, “I can see how participants are improving—reducing weight, cholesterol, and waist circumference. And I think the secret is because we provide effective coaching. We created a digit- al platform, and every two weeks a Mayo Clinic-trained coach speaks with them via Zoom, motivating them on how to improve their diet and how to do more exercise and get more active.”
Two other vascular risk factors that are tied to dementia risk—also num- bering among Canada’s top 12—are smoking and excessive alcohol consumption. (The latter is defined as more than 21 UK units of alcohol per week, with 250 millilitres of wine equalling three units. Canada’s low-risk drinking guidelines now recommend consuming far less—a maximum of two standard drinks, or roughly 3.5 UK units.) Consequently, if either applies to you, this may be the nudge you need to consider turning over a new leaf.
Stay Socially Engaged
The type of coaching Montero-Odasso describes “also provides socialization,” he says, which can help counter social isolation, another of the top 12 modifiable risk factors for dementia. (Loneliness has been tied to impaired memory, too. In a recent study probing the effects of combinations of social isolation and loneliness on middle-aged and older adults over a six- year period, people who reported both experienced the greatest decline in memory; the second-greatest drop occurred in participants who reported loneliness alone.)
Similarly, in the small study looking at people with MCI and early Alzheimer’s dementia, participants in the intervention group “attended group-therapy sessions to support them and their partners three times a week,” Sivananthan says.
Challenge Your Brain
One benefit of socializing is that it’s a complex, cognitively stimulating activity—in other words, it engages and exercises the brain in multiple ways.
Not all cognitively stimulating activities are equal. “Any type of mental exercise is good, but for example, if you do a lot of crosswords, you improve the way you do crosswords, but you don’t improve your memory,” Montero-Odasso says.
By contrast, brain training programs that have been shown to affect brain function or dementia risk—such as Neuropeak, the one used in SYNERGIC— have much broader effects.
“When we do cognitive training with Neuropeak, there’s evidence that you improve not only your perform- ance on Neuropeak but also executive function and memory,” Montero- Odasso says. To achieve this phenomenon, known as the transfer effect, “cognitive training exercises need to have two components,” he explains. “You need to do tasks in which you switch your attention very quickly but also inhibit yourself from doing something wrong.”
Unfortunately, such programs are typically available only to researchers. But there’s reason to believe that other activities might offer similar benefits, though they aren’t supported by the same level of evidence. “In general, if you want to improve your cognition do an activity that will challenge your brain but that you’re not familiar with,” he says. Examples include learning to play an instrument if you’ve never taken music lessons and learning a new language. “In the beginning, it’s very challenging when you are trying to learn a new activity, and we know that that period is very good for building new neural connections and improving your brain health.”
Combine Strategies
“Sometimes, people will think ‘I’ll eat healthy, but I’ll drink as much as I want,’” Sivananthan observes. However, she adds, “changing one risk factor isn’t enough—it’s a couple of these factors working together.” Consequently, your best bet is to gradually incorporate several of these habits, “as part of an overall lifestyle approach.”
“The power of addressing lifestyle factors is that the benefit is equivalent regardless of genetic risk,” Anderson says. “Even if you have a family history of dementia, you get the same benefit.”
