Dementia Prevention Research Expands Beyond Traditional Vascular Risk Factors

A greater burden of vascular risk factors in midlife was associated with fewer years lived free of dementia or death in a new prospective analysis of the Atherosclerosis Risk in Communities (ARIC) Neurocognitive Study. The analysis included 12 409 adults from 4 US communities who were alive and dementia-free at age 55. Investigators assessed hypertension, diabetes, and current smoking at a single midlife visit and calculated vascular risk burden based on the number of factors present. Dementia was identified through cognitive assessments, informant interviews, and continuous surveillance through 2022. Participants were followed for a median of 26.3 years, during which 3008 developed dementia and 5238 died without dementia.

Dementia-free survival declined as vascular risk factors accumulated. Participants with none of the 3 risk factors averaged 30.1 dementia-free survival years between ages 55 and 95, compared with 26.3 years among those with 1 risk factor, 21.0 years among those with 2, and 17.5 years among those with all 3. The findings underscore the long-term association between vascular health in midlife and the number of years a person may live without dementia. However, because the study was observational and risk factors were assessed at a single time point, additional research is needed to determine how changes in risk over time—and interventions targeting those risks—may affect cognitive outcomes.

In this video, corresponding author Josef Coresh, MD, PhD, discusses the questions that should guide the next phase of dementia-prevention research. He explores the potential role of biomarkers in identifying patients at increased risk, the need to better understand which preventive interventions have the greatest effect, and emerging evidence surrounding hearing correction and cognitive health.

Josef Coresh, MD, PhD, is the founding director of the Optimal Aging Institute and a professor of Population Health and Medicine at the NYU Grossman School of Medicine. Coresh has no relevant disclosures.

References:

1. Hu J, Coresh J, Smith JR, et al. Midlife vascular risks burden and dementia-free survival years: The Atherosclerosis Risk in Communities Neurocognitive study. Neurol Open Access. Published online August 5, 2026. doi:10.1212/WN9.0000000000000152
2. Wright JD, Folsom AR, Coresh J, et al. The ARIC (Atherosclerosis Risk In Communities) Study: JACC focus seminar 3/8. J Am Coll Cardiol. 2021;77:2939-2959. doi:10.1016/j.jacc.2021.04.035