The Simple Steps That Can Prevent Dementia --- My grandmother was terrified of losing her memory, but in the end she did. Here's what could have helped her -- and can help you.

 

“My beloved grandmother Evelyn lived independently into her 90s. She clutched my arm tightly at every visit, sharing her terror that she would lose her prodigious memory -- she was able to recite long passages of Shakespeare -- and end, undignified, in a nursing home. She pleaded with me to prevent this fate.

 

But that's exactly what happened. I watched helplessly in the early 1990s as dementia consumed the fierce intellect that defined my grandmother. She spent her final years biting at nursing staff, unable to communicate. I felt that I had failed her.

 

Shakespeare wrote of the seven ages of man, ending morosely, "sans teeth, sans eyes, sans taste, sans everything." But these infirmities are not inevitable, and in recent years doctors have learned a lot more about how to prevent dementia. Today, I would be able to do more to help my grandmother. If you or a loved one are getting older, so can you.

 

Evelyn's blood pressure crept up when she was in her 70s -- nothing dramatic, just numbers that doctors called "normal for her age." But high blood pressure -- which two-thirds of Americans have -- substantially increases dementia risk, pounding on artery walls in the heart, brain, kidneys and throughout the body. Had we controlled Evelyn's blood pressure to 130/80 or lower, using medication and a low-sodium, potassium-enriched diet, her cognitive decline might have been delayed or prevented.

 

Her cholesterol, too, was considered acceptable by the standards of her era. Doctors didn't push statins, which had just become available, to control it, and she consumed lots of saturated fat. Switching to foods like olive oil, nuts and fish could have helped. Traditional targets for LDL-C were 150 or 120; if my grandmother could have gotten hers down to less than 70, it might have protected her brain.

 

Unfortunately, now that Health Secretary Robert F. Kennedy, Jr., has canceled the meeting of the U.S. Preventive Services Task Force that independently and rigorously assessed cholesterol management, Americans may not learn about new measures that could protect us.

 

Evelyn started smoking at 65, thinking it wouldn't catch up with her at that age. She was wrong. Tobacco doesn't just lop off years at the end of life; it makes the last part of a shorter life more unpleasant, accelerating cognitive decline and increasing dementia risk. For any smoker, regardless of age, nothing approaches the health benefit of quitting. Tobacco remains the leading preventable cause of health problems. Smoking also at least doubles the risk of macular degeneration, which Evelyn developed. This leads to vision loss and blindness, which in turn greatly accelerates the development of dementia.

 

Evelyn was also sedentary. She read voraciously but rarely walked. Physical activity is the closest thing to a miracle drug: Even if you don't lose an ounce of weight, it reduces the risk of dementia, cancer, heart disease and diabetes. Activities that keep minds sharp don't require athletic prowess -- they require consistency. Four brisk walks weekly for 30 minutes, ideally outdoors, can work wonders.

 

My grandmother supplied my sweet tooth with cookies and chocolate at every visit. There are debates about what healthy nutrition consists of, but simple changes to what she ate could have helped.

 

The best approach isn't to go on a diet, which usually fails, but to eat more of the healthy foods you like: unsalted or lightly salted nuts, vegetables, fruits and fish.

 

Foods high in potassium -- sweet potatoes, salmon, spinach, avocados, bananas -- are also healthy. The ideal is to have as much or more potassium in your diet as sodium, which is very difficult because our food environment is bathed in salt. One slice of bread can have as much sodium as a bag of potato chips; our breakfast cereals have the equivalent of several hefty shakes of salt; and a single restaurant meal can contain more than a day's maximum recommended amount of sodium.

 

One easy step is switching to low-sodium, potassium-enriched salt, which is available online and in many supermarkets. It tastes the same as regular salt and can reduce the chance you'll have a heart attack or stroke by 10-15%, according to a study published in the New England Journal of Medicine in 2021. (People with kidney disease shouldn't use this product unless monitored by their doctor.)

 

Evelyn complained of poor sleep for years. We thought of this as normal aging, but poor sleep increases dementia risk, as well as the risk of obesity, diabetes and depression. Better sleep hygiene could have made a difference. A regular sleep schedule, a dark and cool bedroom, and avoiding caffeine or nicotine close to bedtime all increase the likelihood of getting a good night's sleep. Managing stress through relaxation techniques and limiting screen exposure before bedtime may enhance sleep duration and quality.

 

Finally, my grandmother was hard of hearing and resisted wearing hearing aids regularly. Strong evidence suggests that correcting vision and hearing loss -- including keeping those hearing aids in for nearly all waking hours -- reduces the risk of dementia. Vision and hearing services help prevent dementia and increase independent living, possibly by mitigating sensory deprivation, protecting cognitive energy, and reducing social isolation.

 

When it comes to healthy aging, personal responsibility matters. But American healthcare also suffers from systemic failures. Despite spending more than $4 trillion annually, we get the most important things, such as blood pressure control, right at most half the time. Our system doesn't incentivize doctors to deliver the preventive care that matters most. For instance, they are paid little or nothing for making an effort to control a patient's blood pressure.

 

The tools for a healthy, dementia-free future exist: blood pressure control, appropriate statin and other therapy, smoking prevention and cessation support, and comprehensive primary care focused on prevention. We need a healthcare system that delivers them reliably, for all our sakes.

 

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Dr. Tom Frieden is president and CEO of Resolve to Save Lives and former director of the Centers for Disease Control and Prevention. This essay is adapted from his new book, "The Formula for Better Health: How to Save Millions of Lives -- Including Your Own," published by MIT Press.” [1]

 

1. REVIEW --- The Simple Steps That Can Prevent Dementia --- My grandmother was terrified of losing her memory, but in the end she did. Here's what could have helped her -- and can help you. Frieden, Tom.  Wall Street Journal, Eastern edition; New York, N.Y.. 11 Oct 2025: C5.