Dementia isn’t inevitable. That’s worth saying plainly, because many people still think of it as something that just happens with age, bad luck, bad genes – nothing to be done.
The reality is more hopeful. The best current evidence suggests that about 45% of dementia cases worldwide could be delayed or prevented by addressing health and lifestyle factors across our lives. The 2024 Lancet Commission identified 14 modifiable risk factors, from education in early life through to untreated vision and hearing loss in older age.
That’s scientifically sound, but it’s also a lot to keep track of. This is where frameworks like SHIELD become useful. Developed by neuroscientist Rudolph Tanzi at Massachusetts General Hospital, SHIELD condenses the major dementia risk factors into six memorable pillars: Sleep, Handle stress, Interact with friends, Exercise, Learn new things, and Diet.
Sleep: Prioritise 7+ Hours of Restful Sleep to Lower Dementia Risk
As you sleep, your brain flushes out waste material, including beta-amyloid, which can clump together and form the plaques of Alzheimer’s disease. You need seven to eight hours that includes both dream sleep and deep sleep.
Getting less than five hours per night, particularly in midlife, increases the risk of cognitive decline and also increases the likelihood of obesity, high blood pressure and depression, all of which raise dementia risk. If you can’t get seven hours at night, naps that include deep sleep give your brain an extra cleaning cycle.
Handle Stress: Find ways to gain relief from Stress
Stress activates brain areas where you internalise emotion, potentially increasing amyloid production. Stress also produces cortisol, which can kill brain cells and trigger brain inflammation.
The goal isn’t to eliminate stress but to find ways to gain relief: meditating, walking, gardening, or doing a hobby you love. Depression, closely linked to chronic stress, is one of the Lancet Commission’s 14 risk factors. Managing stress isn’t about achieving zen; it’s about not letting your brain marinate in cortisol for extended periods.
Interact with Friends: Stay Socially Connected
Loneliness and social isolation roughly double dementia risk. Research suggests it helps to see one or two relatives or close friends (people you feel close to and can confide in) at least once per month. Phone or video calls count if those people aren’t nearby.
If you don’t currently have people in your life, it’s worth making the effort: talk to your neighbours, join a club, volunteer. It’s okay if you like being alone sometimes, but if solitude causes stress and loneliness, that becomes a brain health issue worth addressing.
Exercise: Stay Physically Active with 150 Minutes Weekly
Aerobic exercise, the kind of exercise that gets your heart and lungs pumping, promotes the birth of new brain cells and increases production of enzymes that break down amyloid. People in the highest physical activity groups have about 20% lower dementia risk than the least active.
The Australian guideline of at least 150 minutes of moderate activity per week works out to about 22 minutes per day. Start with just a few minutes and build up gradually.
Exercise isn’t just heart medicine; it’s brain medicine too.
Learn New Things: Engage Your Mind: & Build Your Cognitive
Learning new information creates new connections (synapses) between brain cells. We lose these connections as we age, but we can increase synapses at any age through learning: listening to audiobooks, trying new recipes, taking classes online.
This concept “cognitive reserve” is one of the strongest protective factors against dementia. A recent Australian study found that regular music listening was linked to 39% lower dementia risk. The more synapses you make now, the more you can afford to lose later.
Diet: Follow a Brain Healthy, Plant-Based, Anti-Inflammatory Diet
Sugary, salty and processed foods promote inflammation. Instead, eat a diet rich in vegetables, fruits, legumes, nuts and seeds. The Mediterranean diet is consistently associated with 20-30% lower risk of cognitive decline, and trials show it improves cognitive performance compared with low-fat diets.
No single food prevents dementia. What matters is the overall pattern: whole foods, minimal processing, plenty of plants.
Our passion shows up as partnership, too. Partnership with you, because you know your own life best. And with each other, because great healthcare isn’t a solo act..
Beyond SHIELD: hearing, vision, head injuries, and vaccinations
Hearing and vision: Untreated hearing loss is associated with 60% higher dementia risk, but hearing aids nearly halved cognitive decline in the recent ACHIEVE trial. If you need hearing aids or glasses, use them… they’re brain-health tools.
Vaccinations: A 2025 systematic review found that herpes zoster vaccination was associated with 24% lower dementia risk, influenza vaccination with 13% lower risk, and pneumococcal and tetanus-diphtheria-pertussis vaccinations with 36% and 33% lower Alzheimer’s risk respectively. Staying current with recommended adult vaccinations appears to be another practical step worth taking.
Head injury prevention: Concussions and head trauma are linked to higher Alzheimer’s risk, and damage accumulates over time. Wear helmets, address fall risks at home, and take safety seriously. (Professor Donald Weaver at the University of Toronto developed an alternative SHIELD framework that replaces stress management and social interaction with head injury prevention, highlighting just how important this factor is.)
Essential Caveats and Realities of Dementia Prevention
Start now, whatever your age. In midlife, focus particularly on sleep, exercise, and stress management. In later life, it’s not too late because Australian trials show older adults in their 70s and 80s still gain cognitive benefits from lifestyle changes.
But even if you do everything right, dementia can still occur. Genetics matter. Age matters. Prevention lowers risk; it doesn’t eliminate it. The 45% figure assumes we completely eliminate risk factors across whole populations. For an individual person, your personal risk reduction depends on which factors you have and how well you can modify them.
This isn’t false hope, and it’s not a miracle cure. It’s evidence, and it’s reason enough to act.
What to Discuss with Your GP About Dementia Prevention
If you’re concerned about dementia risk, talk to your GP. They can assess cardiovascular risk factors, review sleep quality, discuss hearing or vision concerns, check your vaccination status, and help identify whether memory concerns need further assessment.
This isn’t about turning life into an anxious optimisation project. The SHIELD framework works because most of these things make life better now (not just decades from now), including:
- sleeping well
- managing stress
- staying connected
- moving your body
- learning new things, and
- eating well.
Take it slowly if you need to. Focus on one habit at a time. And it’s never too late for these habits to make a difference.
Developing dementia prevention habits gradually allows you to build a sustainable routine without feeling overwhelmed. Even small, consistent changes in your daily life, such as incorporating a short walk, choosing healthier meals, or setting aside time for social interaction, can collectively contribute to reducing your risk of developing dementia. Remember, each positive step supports your brain health and overall well-being, no matter your age or current lifestyle.
The key is persistence and making these habits a natural part of your everyday life, which can lead to meaningful improvements in cognitive function and quality of life over time.
Start today by choosing one habit to improve and commit to it, your brain will thank you for it in the years to come.
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