<p>Lifestyle interventions for Alzheimer’s disease (AD) can deliver cumulative multisystem benefits when tailored to individual risk profiles. With a significant portion of dementia risk tied to modifiable factors across the life span, personalized multimodal programs can offer meaningful impact and be a practical complement to disease-directed therapies.</p>

The great thing about lifestyle interventions for AD is that they have the potential for multiple benefits. They may bend the curve for the emergence or progression of AD, and they may have a positive impact on other aspects of a patient’s health. Each lifestyle intervention individually may not have an extremely robust effect size, but, if you tailor them to the individual whom you are aiming to treat with a personalized medicine approach, combining multiple interventions may have a meaningful benefit.

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Dementia prevention should be considered across the life span, and there are both societal and individual responsibilities here. The <em>Lancet</em> Commission regularly identifies modifiable risk factors that contribute to dementia risk, and its last report was published in 2024.

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The <em>Lancet</em> Commission reported that 45% of dementia risk is due to potentially modifiable risk factors and that the risk factors could be divided into early-, mid-, and late-life issues. Of the 45% of dementia risk, 5% was attributed to less education in early life. Midlife risk factors were surprising to me. For example, 7% of the risk was attributed to hearing loss, which is a very modifiable risk factor. Also at 7% during midlife was high low-density lipoprotein cholesterol. Other midlife risk factors were untreated depression at 3%, traumatic brain injury at 3%, physical inactivity at 2%, diabetes at 2%, smoking at 2%, untreated or poorly treated hypertension at 2%, obesity at 1%, and excessive alcohol consumption at 1%. In late life, social isolation may occur as friends die or move away, for example. That was a dementia risk factor at 5%, which is surprisingly high. Vision loss was at 2%, and air pollution, which (along with lower educational attainment) may be a societal issue, was at 3%.

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A couple of dementia risk factors that the <em>Lancet</em> Commission did not include in its report—but recognized as being potentially modifiable risk factors—were sleep and diet. It is important to manage sleep disorders such as poor sleep or sleep apnea and diet, which is broader than just managing cholesterol. For example, it has been shown that adherence to a Mediterranean-style diet can have a positive impact on dementia risk.

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Not everyone is going to have all these risk factors for dementia, and that is why a personalized approach is imperative if you are going to add lifestyle-related dementia risk reduction to your AD treatment regimen. I often identify the things that have room for improvement for a patient and then find out what they are willing to change. You need to have buy-in from the patient so that they are more likely to stick with these lifestyle interventions. There are very good studies showing that a multimodal personalized approach targeting these risk factors with lifestyle interventions has a modest but meaningful impact on bending a patient’s risk curve and can provide a multitude of health benefits, not just for cognition. The good thing is that many of these lifestyle interventions have limited side effects. They are low risk and mostly inexpensive.

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We need to build up an infrastructure that can incorporate lifestyle interventions into AD treatment regimens because providers may not feel that they have the time, skill set, or knowledge to fully individualize what might be best for a specific patient and to motivate them to stay with it.