Dementia Risk and the Power of Everyday Choices

Yesterday I shared something I haven’t spoken about publicly before: that I carry two variants of the APOE4 gene, placing me at significantly higher risk of developing Alzheimer’s disease.

I want to be clear about what that means — and what it doesn’t.

It doesn’t mean dementia is inevitable. It doesn’t mean my fate is written. And it certainly doesn’t mean the way I live my life is irrelevant.

In fact, the science points firmly in the opposite direction. While genetics play a role in dementia risk, research suggests that around 40% of dementia cases worldwide may be preventable or delayed through modifiable lifestyle factors. That is not a small number. That is an enormous amount of agency sitting in our own hands.

This piece is about those factors — what they are, what the evidence says, and what I personally do with that information. Not as a prescriptive plan. But as an honest account of the small, consistent choices that research suggests add up to something significant over time.

The Lancet Commission on dementia prevention identifies a number of factors across the life course that meaningfully affect risk — including physical inactivity, poor sleep, social isolation, smoking, excessive alcohol consumption, obesity, hypertension, diabetes, hearing and vision loss, depression, and exposure to air pollution. What strikes me about that list is not how medical it sounds. It’s how human it is.

Sleep

I have spent years working on my sleep, and I want to be honest about what made the most difference.

Stopping alcohol was transformative — and not just on the nights I drank. Even moderate, regular alcohol disrupts sleep architecture in ways most people don’t realise. You may fall asleep faster, but the restorative stages of sleep — the ones that matter for memory consolidation, emotional regulation, and cellular repair — are compromised. When I stopped, the quality of my sleep changed noticeably within days.

Beyond that, I follow what most sleep researchers would recognise as solid sleep hygiene: consistent timing, a dark and cool room, and a wind-down routine that signals to my nervous system that the day is done. I also take magnesium, which supports muscle relaxation and has been shown in some studies to support sleep quality.

Sleep is not a passive state. It is when the brain does its housekeeping — clearing metabolic waste, consolidating memories, regulating the systems that keep us well. Chronic poor sleep is one of the most significant and underappreciated risk factors for cognitive decline. It is also one of the most addressable.

If you change nothing else, start here.

Movement — and specifically, lifting weights

I have been weight training three to four times a week for fifteen years. I want to be clear about why: it is not about how I look. It is about ageing with strength, grace, and cognitive resilience.

Resistance training has a growing body of evidence behind it in relation to brain health. It supports the production of BDNF — brain-derived neurotrophic factor — which promotes the growth and maintenance of neurons. It improves insulin sensitivity, reduces inflammation, supports cardiovascular health, and builds the physical reserves that protect us as we age.

You do not need to lift heavy. You do not need a gym membership. You need to load your muscles consistently and progressively over time. Bodyweight exercises, resistance bands, free weights — all of it counts.

The goal is not aesthetics. The goal is to be strong enough to live well for as long as possible — physically and cognitively.

Cardiovascular exercise matters too — walking, cycling, swimming, anything that raises your heart rate regularly. But I’d encourage anyone who hasn’t explored resistance training to look at it seriously. The evidence is compelling, and the benefits extend far beyond what most people associate with lifting weights.

Diet

I’m vegetarian by personal choice, but my dietary approach to brain health isn’t really about that.

The single most impactful change most people can make is reducing ultra-processed food. Not eliminating it overnight. Not following a complex protocol. Just reducing it — gradually, consistently.

Ultra-processed foods drive inflammation, disrupt the gut microbiome, destabilise blood sugar, and contribute to the metabolic conditions — obesity, hypertension, type 2 diabetes — that significantly increase dementia risk. The research on this is increasingly robust, and the impact of reducing UPF can often be felt quickly — in energy, sleep, mood, and cognitive sharpness.

A broadly Mediterranean-style approach — plenty of vegetables, legumes, whole grains, healthy fats, and minimal processed food — has the strongest evidence base for brain health. But I’d resist making this complicated. Less processed food, more whole food. That’s the starting point, and for most people it’s enough to make a meaningful difference.

Social connection

This is the one I find myself talking about most in my coaching work — and the one most often quietly neglected by the people I work with.

Leaders in health and social care are, almost by definition, people who give. They are skilled at holding others, supporting others, showing up for others. And they are often, underneath that, running on empty — their own connections deprioritised, their own need for genuine human contact going unmet.

Social isolation is a significant risk factor for cognitive decline. Not just loneliness in the clinical sense, but the gradual erosion of quality connection that happens when people are too busy, too tired, or too conditioned to believe that their own needs are secondary.

Meaningful social connection builds what researchers call cognitive reserve — the brain’s resilience and ability to compensate as it ages. It is not a luxury. It is a biological necessity, as fundamental to brain health as sleep or movement.

We cannot look after others if we do not look after ourselves. That is not a platitude. It is a clinical reality.

Protect your connections. Invest in them deliberately. And if you are a leader reading this who cannot remember the last time you spent genuine, unhurried time with someone who matters to you — let that be the thing you act on first.

A final thought

I am not sharing any of this as someone who has it all figured out. I share it as someone who received a piece of information that could have been frightening, and chose instead to let it be motivating.

The research on dementia prevention is genuinely hopeful. We have more agency than we think. And the things that protect our brains are, almost without exception, the same things that make life richer, fuller, and more sustainable in every other way too.

Small choices, made consistently, over a long time. That is the whole story.

If any of this has resonated and you’d like to explore what it might look like to build some of these habits more intentionally — whether for yourself or in the context of your team’s wellbeing — I’d be glad to have that conversation.

Claire

#DementiaActionWeek #DementiaPrevention #BrainHealth #APOE4 #SocialCare #LeadershipWellbeing #Sleep #Nutrition #StrengthTraining