The need for effective dementia risk reduction strategies that help all communities increases by the day. Two-thirds of Americans have at least one major potential risk factor for dementia. Just as public health works to keep people physically healthy across the lifespan, public health must help people stay cognitively healthy. A growing body of evidence shows that addressing certain modifiable risk factors and promoting healthy behaviors can reduce the risk of cognitive decline, possibly reduce the risk of dementia, and protect cognitive health.

For an overview of these issues and other related topics:

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Modifiable risk factors

The science on dementia risk reduction is quickly evolving, and the evidence showing a link between certain behaviors/conditions and cognitive health/dementia is growing stronger. The most notable healthier behaviors that can reduce the risk of cognitive decline and possibly dementia include: 

  • Being physically active.
  • Quitting or never starting smoking.
  • Being heart-healthy, which includes managing midlife high blood pressure and avoiding and managing diabetes and midlife obesity.

The following are short summaries on the current state of the evidence on a variety of possible risk factors, including the implications for public health:

Several videos from the BOLD Center of Excellence on Dementia Risk Reduction outline the evidence behind various modifiable risk factors and what this means for public health:
  For additional reviews of the evidence on modifiable risk factors:

Prevalence of Risk Factors for Dementia in the U.S.

Prevalence Of Dementia Risk Factors
Current Smokers
Hypertension
Physical Inactivity
Less Sleep
Diabetes
Obesity

View national information on the prevalence of risk factors for cognitive decline and dementia (PDF), and select a state below for state-level information. For heat maps of dementia risk factors at the state level by county or county level by Census tract, please contact CenterOfExcellence@alz.org.

 

Dementia Risk Reduction Summit Recording Now Available

A free recording of the Alzheimer's Association Public Health Center of Excellence on Dementia Risk Reduction’s first-ever Dementia Risk Reduction Summit is now available. The Dementia Risk Reduction Summit explored how public health can address the risk factors for cognitive decline and dementia across the public health prevention spectrum.

Watch the Summit

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Social determinants of health (SDOH)

The risk for dementia, many of the modifiable risk factors for dementia, and the ability to address those risk factors are all affected by social determinants of health (SDOH) – the conditions present where people live, learn, work and play that affect a wide range of health risks and outcomes. The Association's Public Health Center of Excellence on Dementia Risk Reduction is currently undertaking a comprehensive review of the evidence on SDOH related to dementia.

Several studies reported at the 2022 Alzheimer’s Association International Conference (AAIC) demonstrated the impact of inequities on cognitive decline. Experiences of structural, interpersonal and institutional racism are associated with lower memory scores and worse cognition in midlife and old age, especially among Black adults. Socioeconomic deprivation, including neighborhood disadvantages and persistent low wages, are associated with higher dementia risk, lower cognitive performance and faster memory decline. Both summaries are available in English and Spanish. 

A series of short summaries developed by the BOLD Center detail the current state of the evidence on a number of SDOH related to dementia:

The BOLD Center developed a set of infographics that showcase information on SDOH related to dementia as well as strategies to address these issues:

The BOLD Center held a SDOH workshop at AAIC 2022 in San Diego. This workshop convened researchers and public health officials to discuss SDOH related to dementia risk. Addressing Dementia Risk Through Social Determinants of Health: A Center of Excellence Workshop (PDF) summarizes the scientific evidence presented at the workshop along with insights for public health.
 
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What public health can do

Emerging research and practice from around the globe have illustrated successful strategies for addressing dementia risk factors and supporting public health in doing so. At AAIC 2023, the BOLD Public Health Center of Excellence on Dementia Risk Reduction held a conversation with international researchers and organizations about the most effective ways to support public health in prioritizing brain health activities. Read a transcript of the conversation.

Include risk reduction in Alzheimer's plans

Addressing risk factors for cognitive decline and dementia should be included in state, local, or tribal Alzheimer's plans. Public health officials should be involved in a jurisdiction's comprehensive planning efforts. Suggested Recommendations for Alzheimer's Plans (PDF) provides examples of risk reduction-related recommendations that could be included in such plans. Our needs assessment tools can also help in the planning efforts.


Integrate messaging

Public health practitioners can integrate information and education (PDF) about cognitive health into existing initiatives and programs targeted at the conditions and unhealthy behaviors that are risk factors for cognitive decline and dementia. 


Address hypertension 

Some of the strongest evidence about reducing risk for cognitive impairment involves managing hypertension. The Alzheimer's Association has prepared an action brief on hypertension specifically for public health officials. It explores the heart-brain connection and describes tools and resources that can help public health to address the issue.
 

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State success: Promoting brain health in South Carolina

The South Carolina Department of Health and Environmental Control implemented a multi-media campaign focused on brain health and reducing the risk of cognitive decline. Read the case study to learn more or visit South Carolina's Take Brain Health to Heart website.

Learn More

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Featured Resources

Alzheimer's Association 10 Healthy Habits for Your Brain
Alzheimer's Association Risk Reduction Messaging for Health Education
Alzheimer's Association Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective
Alzheimer's Association & Centers for Disease Control and Prevention Reducing Risk of Cognitive Impairment — A Healthy Brain Initiative Issue Map
Department of Health and Human Services alzheimers.gov
Health Resources and Services Administration Training Curriculum: Alzheimer’s Disease and Related Dementias
National Institutes of Health Mind Your Risks
The Lancet Commission Dementia prevention, intervention, and care

 
Risk Reduction Resources
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Risk Reduction Implementation
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KS Kansas Department of Health and Environment Increased public awareness of risk reduction messages to enhance early detection and reduce stigma via a partnership with the Kansas State Extension Office; trained almost 50 Extension Officers to educate Kansans about Alzheimer’s and brain health in counties across the state.
ME Maine Department of Health and Human Services Maine Department of Health and Human Services published county-specific health profiles including metrics on subjective cognitive decline.
MN Minnesota Department of Health Developed a framework to identify high-risk communities with data analyses, help prioritize resources, and expand cognitive health partnerships throughout the health department.
MN Minnesota Department of Health Informed efforts to make communities more supportive of people living with dementia and their caregivers by integrating cognitive and caregiver surveillance data and related resources into county fact sheets; MDH prioritized counties that have a high proportion of at-risk older adults.
MN Department of Health With legislative support, Minnesota Department of Health created new program focused on providing outreach and dementia education to African-Americans, African-born residents, and Asian and Hispanic populations.
MO Missouri Department of Health and Social Services Enhanced public awareness of cognitive health and dementia among African Americans in the southeast region of Missouri by conducting a multi-faceted social marketing campaign that provides culturally appropriate messaging and information on risks, early diagnosis, treatment, and community resources.
MO Missouri Department of Health and Social Services Promoted cognitive assessments and early diagnosis in partnership with Washington University and the existing Community Health Worker Advisory Body through incorporation of these topics into existing community health worker programs for diabetes, cardiovascular health, and women’s health.
MT Montana Department of Public Health and Human Services In monthly newsletter — Health in the 406 — Montana Department of Public Health and Human Services included cognitive health including how to recognize early warning signs, how to access services, and where to find more information.
NE Nebraska Department of Health and Human Services Nebraska Department of Health and Human Services distributed early warning signs and resources for people with cognitive concerns to 120 LivingWell program leaders statewide
NJ New Jersey Department of Health Department of Health, Office of Minority and Multicultural Health partnered with the Alzheimer's Association to conduct a brain health event in conjunction with African-American Brain Health Initiative (AABHI) and Rutgers University-Newark. AABHI promoted healthy aging among older African Americans at the Newark Classic Car Show (April 2017) by teaching older men about brain health, potential ways to reduce the risk of cognitive decline, and how to participate in aging research at RU-Newark.
NM New Mexico Department of Health Educated the public about ways to protect brain health by developing three PSAs based on the Alzheimer’s Association’s 10 Ways to Love Your Brain campaign; PSAs began airing on local TV station in fall 2017 and have been adapted for other media markets.
NY New York State Department of Health New York State Department of Health, through its partnership with the University of Albany, conducted an online training for health care providers: Determining Caregiver Needs and Well Being.
OK Oklahoma County Health Department Included Alzheimer's in analysis of all-cause mortality and published the results in the Oklahoma City-County Wellness Score 2017 report.
OR Aging and Disability Resource Center (ADRC) of Oregon To promote early detection of Alzheimer’s disease among Hispanic populations, the Aging and Disability Resource Center (ADRC) of Oregon adapted an English-language fotonovela -- an educational tool with photos and a story narrative -- for Spanish-language communities. Involvement of promotoras enhanced cultural relevance. The Alzheimer's Association, Oregon Chapter, the Oregon Health Authority, and many other partners now promote and distribute the fotonovela to Spanish-speaking communities, in part through public health networks.
RI Rhode Island Department of Health Established a new program — Alzheimer's Disease and Related Disorders — within the Rhode Island Department of Health to better assess and track state progress on risk reduction of cognitive decline and meeting the needs of people with dementia.
SC South Carolina Department of Health and Environmental Control Dept. of Health and Environmental Control developed a ‘Take Brain Health to Heart’ webpage with information, tools, and other resources about brain health. As part of the state’s brain health campaign, the department and partners developed a set of PSAs to promote the new webpage and educate the public.
SC South Carolina Department of Health and Environmental Control South Carolina Department of Health and Environmental Control is integrating messages about brain health into existing health education campaigns.
TN Tennessee Department of Health As part of their Healthy Brain Toolkit, the Tennessee Department of Health ran ads and PSAs about cognitive health and ways the public can reduce their risk of cognitive decline
TN Tennessee Department of Health Educated public health professionals about cognitive health, health indicators, diagnosis, and community resources via an issue brief developed from original data analyses and conducted a live training webinar to discuss findings and implications for public health practice.
TX Texas Department of State Health Services Texas Department of State Health Services is developing a print, social, and television ad campaign about risk reduction of cognitive decline and early warning signs. The campaign will focus on increasing early detection efforts among people individuals experiencing cognitive complaints
TX Dallas County Public Health Department (TX) Adapted and promoted a public service announcement to educate the public about brain health and ways to protect cognition.
TX Harris County Public Health Department (TX) Adapted and promoted a public service announcement to educate the public about brain health and ways to protect cognition.
WA Washington State Department of Health Implementing the Healthy Brain Initiative Road Map: A Toolkit for Public Health Organizations
WA Washington State Department of Health Educated African Americans about brain health by partnering with the Center for MultiCultural Health in Seattle; the Center identified African American churches as promising venues to speak about brain health and distribute hand fans with culturally-appropriate messages that promote brain health.
WA Washington State Department of Health With the National Asian Pacific Center on Aging, the Washington State Department of Health tested University of Pennsylvania media messages with Asian American adults who may have concerns about changes in their aging parents’ memory or cognition.
WI Wisconsin Department of Public Instruction Introducing the Brain Health curriculum for middle and high school students.

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