‘There’s plenty you can do’: The lifestyle changes you can make to curb the risk of dementia

“We don’t really know if there are safe levels of drinking,” said Long. “Looking at alcohol consumption is important.”

Conversely, evidence in favour of taking regular exercise to prevent dementia has grown, with the WHO ranking it a “strong recommendation” to prevent cognitive decline. That includes aerobic activity for 150 to 300 minutes a week and resistance or strength training twice a week. Suggested reasons for this benefit include improved neuroplasticity, anti-inflammatory effects and cardiovascular benefits.

Physical activity is also a gateway to improving other risk factors, according to Anstey, and can be as simple as walking or joining a group.

“If people are getting the chance to be physically active, they usually feel better and sleep better,” she said. “Physical activity helps our mood and can also be social so it has many benefits.”

It’s important to note some people will invariably develop dementia despite taking every precaution and living healthily.

That was the case for former psychiatric nurse Robb Ritchens, 67, from Williamstown in Melbourne, who was diagnosed with Lewy body dementia two years ago. In this form of the disease, proteins called Lewy bodies build up in nerve cells and interfere with brain function. The plaques and tangles commonly associated with Alzheimer’s may also be present.

When Robb began experiencing visual hallucinations – a common symptom of this type of dementia – he suspected it was a mental health issue like those he’d witnessed in patients while managing programs at work.

“Initially, the diagnosis came as a bit of a shock,” he said. “I had never heard of it and I didn’t know what to do.”

He threw himself into research, poring over studies, reading books and attending seminars. Robb and his wife Donna, who are vegan and have always kept healthy and active, focused on ways to manage his symptoms and live well with the condition, such as avoiding stress and staying connected with friends and family.

“Being social is important,” said Robb. “It’s almost therapy. I try to catch up with people regularly. I love going to live music with friends. It’s about trying to have meaningful relationships with people, having fun and trying to create memories. I don’t give up.”

Listening to music has been linked to reduced agitation, depression and anxiety in people living with dementia.

Sleep has been identified as important in reducing the risk of dementia, with deep sleep likened to a garbage truck or dishwasher because it may have a role in eliminating metabolic waster from your brain.

But sleep problems are common among people living with dementia. Robb takes sleeping tablets because his hallucinations become especially active at night, which was leaving him exhausted during the day. He also sketches the characters who appear in his hallucinations and writes about his experiences in his journal.

“He uses a lot of humour and wit,” said Donna. “He loves being around his children and grandchildren. He’s got to keep doing the things he loves.”

As a Dementia Australia advocate, Robb also provides support to others and talks about his lived experience to improve awareness and understanding.

“Now I’m very well versed, and I can tell people it’s nothing to be scared about,” he said. “I don’t want to lose myself. I want to be remembered for who I am, not defined by my illness.”

Preventative healthy lifestyle measures don’t become obsolete at diagnosis, according to Brodaty. “I still hear stories where people go to the doctor and are told they should get their affairs in order as there’s nothing that can be done,” he said. “We now think there should be talk about re-enablement, about how to live positively, how people can live well for many years.”

Built around a pedestrian-friendly village centre with a dedicated parking scheme for seniors, the lower north shore region of Lane Cove has one of the lowest age-standardised rates of dementia in Sydney, according to Census data.

Its council was the first in NSW to join WHO’s Global Network of Age-Friendly Cities and Communities in 2014. It offers residents a wide assortment of activities, ranging from choirs, music groups and dance to crafts, aquarobics and gardening.

Social and cognitive activities like these, along with challenges like puzzles or learning a new language, are believed to protect against dementia, as they can help build cognitive reserve and resilience in the brain. They also reduce depression, another significant risk factor for dementia.

At the weekly Chatty Chairs program at Lane Cove Library, a group of seniors gather for conversation over tea and biscuits.

Jean Joss, 90, a former biology professor, says she has been a regular since it began. “It’s really interesting what people know and say,” she said. “I love it here, especially the library and watching the people around me.”

Uniting Aged Care wellness officer Mona Akello brings aged care residents, including some with dementia, to the program each week. “It’s a highlight – they look forward to it,” she said. “It gives them a sense of being in the community. It’s the feeling, the joy, the vibe.”

Cognitive reserve can give people the ability to continue functioning well despite negative changes in the brain.

“No one after the age of 80 has a brain that’s completely free of pathology,” said Brodaty. “About half of people post-mortem have enough pathology for diagnosis, but they are cognitively functional.”

A well-documented case is Sister Mary, a nun who achieved remarkably high cognitive test scores up to her death at the age of 102 in the Nun Study, which monitored the brain health of hundreds of North American nuns over 30 years. A post-mortem autopsy revealed her brain was riddled with the telltale tangles, plaques and lesions of Alzheimer’s disease.

While dementia becoming Australia’s leading cause of death made headlines in 2024, it’s been No.1 for women for a decade. That cannot be explained by women’s higher life expectancy alone.

That’s led to a focus on biological differences, including the potential role of female hormones and menopause on women’s risk of developing dementia.

A hotly contested debate is simmering over whether menopause hormone therapy (MHT) could reduce the risk of dementia.

Anstey says inequality in dementia prevalence has been a neglected area, with a lot of research failing to divide risk by sex or gender.

“Experiencing early menopause is associated with an increased risk of late-life dementia in observational studies,” she said. “The reproductive period – the time between menarche and menopause – seems to be associated with cognitive outcomes in later life – that is longer exposure to endogenous [naturally produced] estrogen seems protective.”

However, research findings are mixed, from those concluding MHT can increase risk to others indicating there may be a window of opportunity to benefit for women who take it early enough.

The new WHO guidelines illustrate the dichotomy: MHT is not recommended for reducing the risk of cognitive decline or dementia in post-menopausal women aged 65 and over. But when it comes to women aged under 65, it’s much less certain: there is “insufficient evidence to advise for or against the use of [MHT].”

“There’s a lot of interest in women’s reproductive health so in the next couple of years I hope to see much clearer findings about women’s reproductive health and how it affects the brain,” said Anstey. “Once we understand that we will be able to intervene much better.”

New breakthroughs in drug treatment and testing for dementia have created hope for a cure on the horizon. But it’s too early for complacency.

Long points out newly approved monoclonal antibodies are only suitable for a relatively small proportion of people with Alzheimer’s disease.

“I do get worried that people think this is going to be a magic cure, which it isn’t,” she said. “Prevention is better than cure. But when there’s no cure, prevention is everything.”

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