Cardiometabolic risk factors in midlife impact risk for dementia in late life

 Between 40-50 my BMI was great. My midlife exercise capability(50-69) was almost reduced to nothing because my incompetent? doctor had nothing to get me 100% recovered.

3 years post stroke at a physical I had a resting heart rate of 54 at age 53, level of an athlete. My doctor asked what exercises I was doing, 'I've done no exercises for the past 3 years'. So now after 20 years of little exercise I'm no longer that athlete.

Cardiometabolic risk factors in midlife impact risk for dementia in late life

Key takeaways:

• Controlling cardiometabolic risk factors can help prevent dementia and Alzheimer’s disease.
• Implementing lifestyle modifications can delay the onset of cognitive decline.

BOSTON — Vascular pathology and changes in midlife play a major role in brain health later in life, suggesting that reducing cardiometabolic risk factors may lower risk for dementia and Alzheimer’s disease, according to a speaker.

“We now know with advances in neuroimaging that most people diagnosed with Alzheimer’s disease also have vascular injury and vice versa,” Rachel Whitmer, PhD, professor of public health sciences and neurology at the University of California, Davis, said during a presentation at the Cardiometabolic Health Congress. “So, this is a multifactorial process with multiple pathways leading to it, which can get complicated when you’re thinking about how to reduce risk and precision medicine, but it also opens up the idea that there are multiple ways to actually lower risk. So, we do a lot of work looking at risk factors over the life course.”

Data derived from Whitmer R. Keynote: 25 years of dementia prevention: From risk factor discovery to prevention trials. Presented at: Cardiometabolic Health Congress; Oct. 14-17, 2026; Boston.  

High BMI between age 40 and 50 years is associated with elevated risk for Alzheimer’s disease late in life, as is smoking in midlife, Whitmer said.

Cardiometabolic risk factors and dementia odds

“There is a midlife dementia risk score that was published in 2006 out of Finland, which shows a combination of mostly modifiable cardiovascular risk factors in middle age are strongly associated with future risk for dementia,” Whitmer said. “We replicated this in Kaiser Permanente in a diverse group of people, and it predicted quite well across different racial and ethnic groups. If you’re looking at midlife, increasing odds of dementia go up the more risk factors that you have, and both of these studies look at high cholesterol, hypertension, diabetes or prediabetes and obesity in midlife.”

The relationship extends throughout the life course, as one study showed that people with CV risk factors early in life had worse cognitive performance later in life, even if they did not have dementia, Whitmer said.

A Lancet commission on dementia prevention, intervention and care identified 14 modifiable risk factors that could greatly reduced risk for dementia and Alzheimer’s if controlled: diabetes, high BP in midlife, obesity in midlife, high LDL cholesterol, physical inactivity, depression, smoking, low education, hearing loss, vision loss, traumatic brain injury, high alcohol consumption, social isolation and air pollution, Whitmer said.

“We know that dementia is a multifactorial process,” Whitmer said. “The thinking was, what can we do when we target several things at once, which of course is challenging to do.”
the U.S. POINTER study of 2,111 older adults to determine whether lifestyle interventions could improve brain health and prevent dementia. Participants were aged 60 to 75 years, had suboptimal diet, did not exercise regularly and had risk for cognitive decline but did not have dementia at baseline.

Participants were assigned to a self-guided intervention in which they met with a study navigator three times per year to receive lifestyle education and support and tools to implement it or to a structured intervention in which they conducted physical activity at a community facility while wearing a Fitbit, received encouragement to follow the MIND diet, underwent home-based computer cognitive training and regular participation in engaging activities and met with a medical advisor once every 6 months.

Both groups improved in cognitive function at 2 years, but the structured intervention group improved to a greater degree, Whitmer said.

‘Wonderful to see’

“And this was the part that was so wonderful to see: It was the same effect whether you were male vs. female,” Whitmer said. “It was the same effect no matter what age group you were in. It was the same effect whether or not you had the APOE4 genotype. And it was the same effect given your heart health. The magnitude of the effect of the study was the same or larger than a lot of the drug trials that are looking at change in cognitive function with medications for Alzheimer’s disease. So in thinking about that change over 24 months, we think about what could that be in a longer lifetime if someone incorporates some of these lifestyle changes.

“I get asked the question, what can you do? You can’t change your family history. You can’t change your genetics,” Whitmer said. “But I want to remind people that you can do things to at least delay the onset. And that’s very powerful as a clinical tool, speaking from a personal level, a health level, and then also on a population level for our community and our world and our country. So if you can delay, it would give huge benefits just in terms of valuing the economics, but also in what you are specifically experiencing.”