Neuroprotection

Roughly 40% of dementia cases are attributable to modifiable risk factors according to the Lancet Commission, which reframes cognitive decline from an inevitability to a partially preventable condition. The mechanisms overlap heavily with cardiovascular disease: small-vessel damage, chronic inflammation and impaired glymphatic clearance during poor sleep. Because the pathology accumulates 15-20 years before symptoms, the effective window for intervention is midlife, not after complaints begin.

Control midlife blood pressure — this is the single largest modifiable contributor. Treat hearing loss with aids, which is associated with meaningfully reduced dementia risk. Exercise both aerobically and with resistance. Stop smoking and moderate alcohol. Screen and treat sleep apnoea, since glymphatic clearance of amyloid occurs predominantly during slow-wave sleep. Maintain social and cognitive engagement. Nutritionally, keep omega-3 index above 8% and homocysteine below 10 umol/L — the VITACOG data suggest B vitamins slow atrophy specifically in people with raised homocysteine and adequate omega-3. Citicoline has the deepest clinical dataset among supplements, established in vascular cognitive impairment and glaucoma rather than in healthy prevention.

• •Treat hypertension from midlife
• •Correct hearing loss
• •Aerobic and resistance exercise
• •Stop smoking
• •Treat sleep apnoea
• •Maintain social engagement
• •Limit alcohol
• •Manage diabetes and lipids