Cognitive health in old age is not an inevitable fate, but can be influenced to a relevant extent by modifiable factors. The Lancet Commission 2024 concludes that a significant proportion of dementia cases are potentially preventable or delayable over the course of a lifetime; the estimated proportion is around 45%. Elevated LDL cholesterol levels and untreated visual impairment are newly highlighted as relevant risk factors. At the same time, randomized trials have shown that structured multidimensional prevention programs can have a beneficial effect on cognitive trajectories, especially in people at increased risk (e.g. U.S. POINTER, JAMA 2025). Disease-modifying anti-amyloid antibodies are also available for early stages of Alzheimer’s disease, but their use is subject to clear diagnostic and safety requirements (e.g. lecanemab, NEJM 2023; FDA labeling on ARIA risks).
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