Don’t get Dementia

Don’t get Dementia

Prevention Playbook

Don't Get Dementia

A practical, evidence-linked prevention playbook (Medicine 3.0-ish). Built to be readable, actionable, and appointment-ready.

Last updated: Jan 19, 2026 Educational only Not medical advice
Jump to Summary Top 10 What dementia is Attia framework Doctor checklist What works Supplements Myths 40+ action plan Promising research Receipts

Summary — the non-scary truth

Dementia risk is not "all genetics." A big chunk is tied to vascular + metabolic health (blood pressure, cholesterol/apoB, insulin resistance), plus exercise, sleep, hearing, mood, and social connection.

Big idea: what protects your heart generally protects your brain. If you're shopping for a "brain stack" before you've controlled blood pressure, glucose, apoB, sleep apnea, and hearing loss — your priorities are backwards.

If you only do 3 things

  • Get your blood pressure into a truly healthy range (home readings matter).
  • Train: 150–300 min/week aerobic + 2–3 strength days + some intensity.
  • Fix the silent stuff: sleep apnea, hearing loss, depression/isolation.
Top 10

Top 10 dementia prevention tips

  1. Control blood pressure aggressively — aim roughly <130/80; discuss ~120 systolic if tolerated (SPRINT-style).
  2. Lower apoB / LDL — food + training + (sometimes) meds to get into a heart-brain safe range.
  3. Prevent / reverse insulin resistance — waist size, glucose, HbA1c, triglycerides.
  4. Move like your brain depends on it — aerobic + strength + some intensity.
  5. Eat Mediterranean / MIND-style — plants, olive oil, fish, legumes, whole grains; minimal ultra-processed food.
  6. Protect hearing — test midlife; treat early (don't "save" hearing aids for later).
  7. Prioritize sleep — 7–9 hours/night + screen/treat sleep apnea.
  8. Guard mood + connection — treat depression/anxiety; avoid chronic isolation.
  9. Correct obvious deficiencies — vitamin D, B12/folate, omega-3 intake where low.
  10. Supplements are add-ons, not anchors — "maybes" are fine; "musts" are BP, apoB, glucose, sleep, hearing, exercise.

Who should be extra proactive?

  • Strong family history (especially dementia before 65)
  • Hypertension, diabetes/prediabetes, obesity, high apoB/LDL
  • Sleep apnea symptoms, hearing loss, depression, social isolation
  • History of repeated concussions / high-risk head trauma
Genetics (e.g., APOE-ε4) raises risk but does not guarantee disease. Prevention still matters.
What dementia is

What dementia is (and what it isn't)

Dementia is a progressive decline in memory/thinking that affects daily function. Alzheimer's is the most common type. Others include vascular dementia, Lewy body dementia, and frontotemporal dementia.

Key distinction: You can have brain fog, stress, burnout, depression, ADHD, sleep deprivation, or menopause symptoms without dementia. Dementia is about progressive functional decline.
Attia framework

How Dr. Attia thinks about brain health (Medicine 3.0)

Attia treats neurodegenerative disease as a slow killer heavily influenced by the same drivers as cardiovascular disease: blood pressure, atherosclerosis (apoB), metabolic dysfunction, plus sleep, exercise, hearing, and mood.

  • #1 Vascular + metabolic risk first — "what's good for the heart is good for the brain."
  • #2 Exercise as a brain drug (VO₂max + strength + balance).
  • #3 Sleep (especially unrecognized sleep apnea).
  • #4 Hearing + head trauma (treat hearing; avoid repeated concussions).
  • #5 Mood + social connection.
  • #6 Supplements only when there's a specific reason (deficiency / biomarker / low intake).
Doctor checklist

Over-40 doctor checklist — what to ask for

Use this as an advocacy script. Targets are prevention-focused (not "minimum guideline" care).

Test / topic Why it matters for dementia Prevention target If off-target
Blood pressure
home + clinic 		Midlife hypertension is one of the strongest modifiable risk factors. Intensive control reduced cognitive outcomes in SPRINT-MIND. <130/80 minimum; discuss ~120 systolic if tolerated. Home BP series, reduce salt/ultra-processed food, lose weight, aerobic exercise, reduce alcohol. If still high: discuss medication.
Lipids
LDL/non-HDL + apoB 		Atherosclerosis and vascular disease raise dementia risk. apoB is a better particle measure than LDL alone. Risk-dependent. Many prevention-focused clinicians aim apoB <60 mg/dL in higher-risk people. Mediterranean/MIND eating + fibre, exercise, weight loss; discuss statins/other lipid meds if needed.
Glucose + insulin
fasting glucose, HbA1c, ± CGM 		Type 2 diabetes and insulin resistance raise dementia risk; earlier onset = higher lifetime risk. Keep HbA1c in normal range (<5.7%) if possible; avoid big glucose swings. Cut sugary drinks/refined carbs, protein + fibre at meals, post-meal walks. Discuss meds if prediabetes/diabetes.
B12 / folate
± homocysteine 		High homocysteine linked to faster brain atrophy; targeted B vitamins may help in MCI with elevated homocysteine. B12/folate normal–high normal; homocysteine <10–12 μmol/L if safely achievable. If low B12/folate or high homocysteine: treat the cause, consider targeted therapy with re-testing.
Vitamin D Low D associated with higher dementia risk in cohorts; supplementation data mixed but correcting deficiency is reasonable. Sufficient range (>75 nmol/L or >30 ng/mL — lab-dependent). If low: discuss dose plan (often 1,000–2,000 IU/day, individualized) and re-check.
Hearing
audiology 		Midlife hearing loss is a major modifiable risk factor; treating hearing loss slowed cognitive decline in the ACHIEVE trial (higher-risk subgroup). Baseline test by ~50 (earlier if symptoms). Treat hearing loss early. If missing words/TV is loud: book audiology. If advised, wear hearing aids consistently.
Sleep apnea Sleep disturbance and apnea linked to cognitive decline; apnea is a fixable oxygen + sleep quality problem. 7–9 hours quality sleep; if symptoms, request a sleep study. Sleep hygiene + push for testing. If diagnosed, use CPAP/oral device as prescribed.
Exercise
cardio + strength + balance 		Aerobic fitness (VO₂max) is one of the strongest correlates of lower dementia risk. Resistance training protects muscle/metabolic health/cognition in aging. 150–300 min/week moderate aerobic + 2 VO₂max sessions + 2–3 strength days + balance work. Start small; build consistency before intensity. Even walking counts.
Mood / depression Depression/social isolation are risk factors and often precede dementia; treating depression matters for brain health. Screen for depression/anxiety. Meaningful social contact ≥ once/week. Therapy (CBT etc.), meds if appropriate, community connection — don't dismiss persistent low mood as "normal aging."
Head trauma Repeated concussions raise risk; even one severe TBI matters. Helmets, avoid high-risk sports with prior concussions, treat balance/fall risk in older age. If you've had concussions: extra tight on BP, apoB, exercise, sleep, hearing.
Evidence tiers

What actually works — evidence tiers

Tier 1 — Strong, actionable evidence

  • Blood pressure control (SPRINT-MIND + observational data)
  • Treating hearing loss (ACHIEVE trial)
  • Exercise (especially aerobic fitness / VO₂max)
  • Mediterranean / MIND diet
  • Avoiding / treating diabetes + insulin resistance
  • Lowering apoB / LDL (vascular protection)
  • Sleep quality + treating apnea

Tier 2 — Likely helpful (weaker/mixed RCTs, strong observational)

  • Treating depression / avoiding isolation
  • Correcting B12/folate deficiency (especially with high homocysteine)
  • Omega-3 intake (food > supplements; modest signal in some trials)
  • Cognitive engagement (learning new skills, not just puzzles)
  • Reducing alcohol (excess intake is harmful; safe threshold unclear)

Tier 3 — Speculative / insufficient data

  • Creatine (some pilot signals for brain energy; not definitive)
  • Vitamin D supplementation in non-deficient people (mixed data)
  • Ginkgo, curcumin, resveratrol, "nootropic" stacks (inconsistent or negative RCTs)
Supplements

Supplements — the honest take

Most "brain supplements" are either unproven or addressing a deficiency that food could fix.

Supplement Evidence summary Practical take
Omega-3s
EPA + DHA 		Mixed RCT data for dementia prevention; some benefit in MCI or APOE-ε4 carriers in selected studies. Food sources (fish) show stronger observational data. Eat fatty fish 2–3×/week. If you don't: consider 1–2 g/day EPA+DHA (high-quality tested product).
B vitamins
B12 / folate / B6 		Targeted B vitamin therapy reduced brain atrophy in MCI patients with high homocysteine (VITACOG). Generic "B-complex for everyone" is not supported. Test B12/folate/homocysteine. If deficient or elevated, treat with clinician guidance. Don't DIY megadoses.
Vitamin D Low D linked to worse cognition in cohorts; RCTs of supplementation are mixed. Correcting deficiency is reasonable. Test levels. If low, supplement to target range (discuss dose). If normal, routine high-dose D for dementia prevention is not proven.
Creatine Pilot data show brain creatine increases on imaging; cognitive benefit data are limited. May help during energy stress (e.g., sleep deprivation). 3–5 g/day creatine monohydrate is safe and cheap. Brain benefit is a possible bonus, not a guarantee.
Everything else
ginkgo, curcumin, resveratrol, "nootropics" 		Evidence is weak or inconsistent. Low priority compared with BP, apoB, glucose, exercise, sleep, and hearing. Spend first on movement, food, sleep, and hearing care before boutique brain pills.
Rule: Don't DIY high-dose stacks. If you can't explain what biomarker you're correcting (or what diet gap you're filling), it's probably not worth it.
Myths

Brain training, crosswords & myths

  • Crosswords alone don't guarantee dementia prevention. The broader signal: keep learning new, challenging skills.
  • "Brain games" can improve the specific skill you train — they're not a substitute for BP, exercise, metabolic health, sleep, and hearing.
  • Myth: "It's all genetics." Reality: genetics loads the gun; lifestyle often pulls (or doesn't pull) the trigger.
40+ action plan

Over-40 action plan — simple + doable

Step 1 — Know your numbers (yearly)

  • Blood pressure (home + clinic)
  • Lipids including apoB (if available)
  • Fasting glucose + HbA1c (consider insulin/CGM if at risk)
  • B12 + folate (± homocysteine if vegan, on metformin, or concerned)
  • Vitamin D (especially winter/high latitude)
  • Hearing baseline by ~50 (earlier if symptomatic)
  • Sleep apnea screen if snoring/gasping/exhaustion
  • Mood + social connection check-in

Step 2 — Weekly prevention checklist

  • Exercise: 150–300 min/week aerobic + 1–2 VO₂max-ish sessions + 2–3 strength sessions.
  • Diet: Mediterranean-leaning pattern; minimize ultra-processed foods.
  • Hearing: wear hearing aids if prescribed — consistency matters.
  • Sleep: protect 7–9 hours/night whenever possible.
  • Brain work: new learning 3+ times/week (skills > puzzles).
  • Social: at least one meaningful connection weekly that isn't doom-scrolling.

Step 3 — Targeted supplement strategy (optional)

  • Base: food-first Mediterranean pattern + correct deficiencies (vitamin D, B12/folate) if present.
  • Consider: omega-3 if low fish intake; creatine for muscle/aging (possible cognitive benefit).
  • Only with labs + supervision: B vitamins aimed at high homocysteine.
  • De-prioritize: pricey "brain boosters" until the core levers are nailed.
Promising research

"Promising brain research" — watch this space

Interesting early data ≠ permission to DIY experimental stacks.

Creatine in Alzheimer's + brain energy

  • Human pilot data suggest high-dose creatine can increase brain creatine on imaging; functional outcomes are still not definitive.
  • Small studies suggest creatine may help cognition during sleep deprivation (energy stress).

Other "watch list" items

  • Nicotinamide riboside (NR)/NAD⁺ boosters: biomarkers/perfusion changes; cognitive outcomes mixed so far.
  • Ketogenic/ketone strategies: may help some measures in MCI/early AD; long-term adherence/safety unclear.
  • Spermidine: small pilot RCT signals; larger trials underway.
  • Urolithin A: mostly frailty/mitochondria/muscle; brain-specific data limited.
  • Micro-dose lithium: intriguing epidemiology; not ready for routine unsupervised use.
If you're going to experiment: do it with a clinician, a rationale, and a way to monitor safety.

Key sources

Foundational risk + prevention evidence

Supplements / biomarkers

Attia primary pages

Medical disclaimer: This sheet is for education/advocacy. Bring it to your clinician. Don't self-diagnose dementia or self-prescribe medications.
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