Can You Prevent Dementia, Even If It Runs in Your Family?

Six evidence-based tools to protect your brain 🧠

Aug 19, 2025

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A 63-year-old woman sat in my office looking worried. She'd been noticing small memory lapses over the past year—misplacing her keys more than usual, forgetting acquaintances' names, occasionally losing her train of thought mid-sentence. Sound familiar?

What made these changes particularly worrisome was that her mother’s dementia symptoms at age 72. So, she was terrified that despite doing everything she could think of—from taking hormone therapy to eating salmon and blueberries—she might be destined for the same fate as her mother.

Her fear is understandable. It’s shared by millions of Americans who watch their parents struggle with dementia. For decades, we believed brain health was largely predetermined—that you either had "good genes" or "bad genes" and your cognitive fate was essentially sealed. But through discoveries in neuroplasticity, we now know the brain has a remarkable ability to change, adapt, and even regenerate throughout life.

Your brain at age 80 isn't simply the result of your genes at birth; it's the product of thousands of daily choices you make about how you move, connect, challenge yourself, and care for your overall health. Even more remarkably, some people develop the brain pathology associated with dementia yet never experience cognitive symptoms. How so? Their lifestyle choices (plus a dose of good luck) create enough cognitive reserve to maintain function despite underlying disease.

This shift from genetic determinism to lifestyle empowerment represents one of the most hopeful developments in modern medicine. While we can't change our family history, we have enormous influence over how our genetic predispositions are expressed.

a sculpture of a man's head made of colored wires — Photo by Luke Jones on Unsplash

What Family History Actually Means

Let's start with facts. Genetics do play a role in your risk for dementia. Having a parent with dementia roughly doubles your risk of developing the condition. What that means in reality is that if your baseline risk was 10%, it becomes about 20%. That's still an 80% chance you won't develop the disease. (Of course, the actual risk for a particular individual varies widely person to person.)

Moreover, family history reflects both genetics and shared environmental factors. Families often share dietary patterns, exercise habits, social behaviors, and stress management approaches. When we see dementia "running in families," we're often seeing the cumulative effect of lifestyle patterns passed down through generations, not just genetic predisposition.

While Alzheimer's disease causes 60-80% of dementia cases, about 10% result from vascular dementia—cognitive decline caused by reduced blood flow to the brain due to atherosclerosis. This distinction matters because it expands your prevention toolkit. The lifestyle strategies that protect against Alzheimer's (exercise, nutrition, social connection) also guard against vascular dementia, while cardiovascular risk management—controlling blood pressure, cholesterol, diabetes, and avoiding smoking—provides additional protection for your brain’s important blood vessels.

Normal Memory Changes vs. Red Flags

Part of my patient's anxiety stemmed from not knowing whether her memory changes were normal aging or early signs of dementia. Understanding the difference is crucial for both peace of mind and taking appropriate action.

Normal aging typically involves slower processing speed. For example, you might need a moment longer to recall a name or find the right word. These "tip-of-the-tongue" moments increase with age but don't interfere with daily functioning. You might walk into a room and forget why you came, but you remember eventually.

Red flags include getting lost in familiar places, significant personality changes, trouble managing complex tasks you've always handled easily, or memory problems that interfere with work or relationships. If you're concerned enough about memory changes to bring them up with family members or friends, that subjective worry deserves professional evaluation, even if formal testing appears normal.

Six Evidence-Based Tools to Protect Your Brain

The good news is that the most powerful interventions for brain health are often within your control and cost little money. Research has identified six key pillars that work together to build cognitive resilience and protect against decline.

1. Exercise: Movement for Your Mind

Physical activity consistently emerges as one of the most powerful protectors of cognitive health. Exercise improves blood flow to the brain, stimulates growth factors that support new brain cell formation, reduces inflammation, and enhances the brain's ability to form new connections. Even moderate activity like brisk walking for 30 minutes several times a week can improve cognitive performance and reduce dementia risk. The key is consistency and enjoyment—find movement you can sustain over time.

2. Nutrition: Feed Your Noggin

Your brain consumes about 20% of your body's calories despite making up only 2% of your body weight, so the quality of fuel you provide directly impacts function. Research supports the Mediterranean and MIND diets, which emphasize vegetables (especially leafy greens), fruits (particularly berries), whole grains, fish, olive oil, and nuts while limiting red meat and processed foods. These eating patterns provide anti-inflammatory compounds that support brain function and reduce cognitive decline risk.

3. Quality Sleep: The Brain's Maintenance System

Sleep represents your brain's primary restoration period. During sleep, your brain consolidates memories, transfers important information to long-term storage, and clears metabolic waste products including amyloid plaques associated with dementia. Chronic sleep deprivation impairs virtually every aspect of cognitive function—attention, working memory, decision-making, and emotional regulation all suffer without adequate rest.

4. Social Connection: Relationships as Medicine

People with stronger social ties consistently show better cognitive outcomes as they age, including lower rates of dementia and slower cognitive decline. Social interaction provides cognitive stimulation that no individual mental exercise can replicate, challenging language processing, working memory, attention control, and the ability to understand others' perspectives. Quality matters more than quantity—a few meaningful relationships provide more benefit than numerous superficial contacts.

5. Mental Stimulation: Use It or Lose It

Mental challenge builds cognitive reserve through neuroplasticity—the brain's ability to form new connections throughout life. However, not all mental activities provide equal benefit. The key is genuine difficulty and novelty. Learning a new language, musical instrument, or complex skill challenges your brain in ways that crossword puzzles and "brain training" apps can't match. Choose activities that genuinely interest but challenge you, requiring effort and concentration to form new neural pathways.

6. Stress Management: Protect Your Cognitive Resources

Chronic stress keeps cognitive resources allocated to threat detection rather than available for complex thinking, learning, and memory formation. Effective stress management involves developing healthy responses rather than eliminating stress entirely. Mindfulness practices, relaxation techniques, time management strategies, and strong social support all help maintain optimal function. Even grief, depression, and anxiety can impair cognitive performance in ways that mimic dementia, making emotional wellbeing crucial for brain health.

My Patient’s Wake-Up Call

When my patient returned six months later, she was feeling much better. She'd started strength training at the gym and joined a book club. Most importantly, she'd finally had the sleep study I’d been urging her to have for years! She was diagnosed with sleep apnea. After a few weeks using CPAP, her memory issues decreased significantly.

The biggest change was psychological. Her memory lapses didn't disappear entirely, but they no longer dominated her thoughts. Instead of anxious helplessness, she was approaching her brain health with a sense of agency. Her family history still worried her, but it motivated her, too.

My Advice

If you're concerned about memory changes or family history of dementia, formulate a game plan:

This week: Schedule 20-30 minutes of movement most days of the week. Start today! Walking counts. Reach out to someone for meaningful social connection. Choose one new skill to learn that genuinely challenges you. Exercise your brain like you do your muscles.

This month: Get your sleep evaluated if you have concerns about sleep quality. Have your hearing checked—hearing loss accelerates cognitive decline but is highly treatable. Consider how you can add more purpose and meaning to your weekly routine.

This fall: Schedule your annual check up with your doctor. Build exercise into a sustainable routine you actually enjoy. Deepen social connections and consider volunteer work or community involvement. Consider dusting off your high school French or diving into Moby Dick. Commit to lifelong learning in areas that interest and challenge you.

The Upshot

While you can't control your genes, you absolutely can influence how they're expressed. Every day you move your body, connect meaningfully with others, and challenge your mind, you're literally reshaping your brain and rewriting your cognitive future.