Brain health in your 20s to 60s+
Every decade brings its own chances to protect your brain. Start with the one you’re in.
By the numbers
Risks and chances to act, across the decades.
Younger adults
Midlife
Later life
Why every decade counts
Risk builds over a lifetime, and some risks matter more at certain ages.
Nearly half of dementia could, in theory, be prevented or delayed by tackling 14 risk factors. The earlier you lower them, and the longer you keep them low, the better. But it is never too late to start.
Risk builds up over a lifetime, and some risks matter more at certain ages. Each decade below pulls together the actions that matter most at that stage. For a deeper look at each habit, see the Protect your brain for life guide.
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Risk factors tend to cluster in the same person, so the Commission suggests tackling several at once rather than just one.
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In 2014, a two-year study in Finland of older adults at higher risk found that combining exercise, a healthy diet, mental challenges and keeping an eye on heart health had a protective effect on thinking skills.
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U.S. POINTER was a two-year trial in diverse communities across the U.S. It tested a combination of diet, exercise, heart health, mental challenge and social contact in older adults at higher risk of decline.
Both lifestyle programs improved thinking skills. People in the more structured program benefited even more.
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No single food or product has been proven to prevent dementia. The evidence points to combining several healthy habits over time.
Your 20s: build the habits
Protect your head and ears, keep learning, and don’t start smoking.
Midlife risk starts at 18 in the Commission’s model. What you do now counts, and habits you build in your 20s are easier to keep for life.
Focus on
- Build friendships that can last
- Find movement you enjoy so it lasts
- If you smoke or vape nicotine, get help to quit now
- Keep learning: classes, skills, reading, hobbies
- Look after your mood, and get help early for depression
- Protect your hearing at concerts, clubs and with earbuds
- Wear a helmet for biking and contact sports
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Over 1 billion young adults are at risk of permanent, avoidable hearing loss from unsafe listening. Long or repeated sound at or above 85 decibels can damage hearing.
Simple habits
- Move away from speakers at concerts and clubs
- Take breaks from loud places
- Turn the earbud volume down
- Wear earplugs for loud events
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Smoking raises dementia risk, and smoking in midlife seems to matter more than smoking later. Quitting also lowers the risk of stroke, type 2 diabetes and high blood pressure.
Free help to quit: call 1-800-QUIT-NOW (1-800-784-8669) to reach your state’s quitline.
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Drinking too much is one of the 14 risks. The CDC defines moderate drinking as two drinks or less in a day for men and one or less for women, and says drinking less is better than drinking more.
People under 21 shouldn’t drink at all. If you don’t drink, there’s no reason to start.
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Depression was linked to higher dementia risk whether it started in early, middle or later adult life. New evidence suggests treating it may lower that risk.
See the Depression: understanding it guide for signs and support.
Your 30s: fit it into busy years
Fit in movement, know your numbers, keep friendships alive.
Work, family and money can crowd out everything else in your 30s. Short, regular habits fit better than big plans.
Focus on
- Ask whether you should be checked for prediabetes
- Get your blood pressure checked, even if you feel fine
- Keep moving, even in short bursts between work and family
- Keep your mind stretched at work and outside it
- Protect sleep and manage stress
- Stay connected, even when life is full
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Adults need at least 150 minutes of moderate activity a week, like brisk walking, plus muscle-strengthening on at least 2 days.
Ideas for full days
- A brisk walk at lunch
- Active play with kids
- Body-weight moves while dinner cooks
- Walking meetings or calls
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More than 2 in 5 American adults have prediabetes. Lifestyle changes can cut the risk of type 2 diabetes in half.
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Smoking in midlife appears to be a stronger risk for dementia than smoking later in life. It’s a good decade to quit for good.
Free help: 1-800-QUIT-NOW (1-800-784-8669).
Your 40s: midlife numbers matter
Blood pressure and cholesterol, plus hearing and eyes.
High blood pressure in midlife, from the 40s to early 60s, raises the risk of thinking problems later in life. The Commission recommends checking LDL cholesterol and keeping the top blood pressure number at 130 or less from around 40.
Focus on
- Ask about checking your LDL cholesterol, from around age 40
- Get a hearing check if conversations feel harder
- Keep a healthy weight, which also helps prevent diabetes
- Keep up eye exams
- Know your blood pressure and work with your clinical provider to keep it healthy
- Look at your drinking honestly
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High blood pressure often doesn’t cause anything you can see or feel. About half of U.S. adults 45 and older have it.
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High LDL (“bad”) cholesterol in midlife is linked to about 7% of dementia worldwide. A blood test can check your levels.
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Hearing loss is linked to about 7% of dementia worldwide, and the evidence that treating it lowers risk is now stronger.
Signs worth a check: turning the TV up, asking people to repeat themselves, or struggling in noisy places.
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Obesity in midlife is one of the 14 risks. Regular meals with plenty of vegetables, fruit, whole grains and fish, and less salt, sugar and solid fat, help weight, blood pressure and blood sugar.
See the Food, drinks & mood guide for more.
Your 50s: keep it steady
Keep heart numbers steady, treat hearing loss, plan for purpose ahead.
In a large study, people age 50 and older who brought their blood pressure down to a lower target with their care team had a lower risk of mild cognitive impairment over five years.
Focus on
- If hearing loss is found, ask about hearing aids
- If you care for a parent, protect your own health too
- Keep exercising, including strength work
- Keep working with your clinical provider on blood pressure, cholesterol and blood sugar
- Notice low mood, and get support
- Start thinking about what will give you purpose after work
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Fewer than 20% of Americans with hearing loss get hearing aids, and cost has been a big barrier. Since late 2022, lower-cost over-the-counter hearing aids have been available in the U.S.
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Many people in their 50s are caring for a parent. Keeping your own check-ups, movement and friendships going protects your brain too.
See the Family caregivers and Caring for yourself as a long-term carer guides. If your parent has dementia, see Dementia runs in my family.
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Social contact, volunteering and learning new skills are all linked to better thinking in later life. It can help to start building them before work ends.
Your 60s and beyond: stay engaged
Stay social, see and hear well, prevent falls, keep learning.
Social isolation, air pollution and untreated vision loss matter most in later life. Hearing, movement and learning still count too.
Focus on
- Check the air quality and limit time in heavy pollution
- Keep moving most days, with balance and strength work
- Make regular plans with people, and join groups
- Prevent falls: balance work, good lighting, no trip hazards
- Treat hearing and vision problems
- Try something new and challenging, like a craft, language or instrument
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Each week (CDC, 65+)
- At least 150 minutes of moderate activity, like brisk walking
- Balance activities, like walking heel-to-toe or standing up from a chair
- Muscle-strengthening on at least 2 days
If health conditions make that hard, be as active as you can. Some activity is better than none.
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When sight goes untreated, people often stop driving, reading, going out and exercising. Glasses or cataract surgery can help, and nearly 100,000 U.S. dementia cases might have been prevented with existing vision treatments.
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Older adults who learned quilting or digital photography had more memory improvement than those who only socialized or did less demanding activities.
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In a study of more than 7,000 adults over 65, those with high social engagement had better thinking skills later in life. Regular video chats helped adults over 75 in a small trial.
See the Loneliness & loss in later life guide for more.
Protect your head at every age
Brain injury at any age raises risk. Sport is still good for you.
Traumatic brain injury, at any age and from any cause, is a risk factor for dementia. It may bring dementia on 2 to 3 years earlier. Sports with frequent head contact carry more risk.
But the Commission was clear: this shouldn’t hide the fact that sport is generally good for health. The aim is to play smarter, not to stop playing.
What the Commission recommends
- Cut down high-impact collisions and heading practice in training
- Don’t play again straight after a head injury
- Wear helmets and head protection in contact sports and on bikes
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There is no concussion-proof helmet. A helmet can still help protect against serious brain or head injury, so you should still avoid hits to the head when wearing one.
A helmet should be
- The right kind for the activity
- A proper fit
- Well looked after
- Right for the person’s age
- Certified for use
- Worn every time, the right way
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More than one in four adults 65 and older fall each year, but fewer than half tell their doctor. Falls are the most common cause of traumatic brain injury in older adults.
Falls can be prevented. Many risks, like weak legs, vision problems and hazards at home, can be changed.
Simple steps
- Add handrails and good lighting on stairs
- Do balance and strength work each week
- Get your eyes checked
- Remove loose rugs and clutter
- Tell your clinical provider if you’ve fallen or feel unsteady
Cleaner air
Air pollution is a risk factor. Some of it you can limit.
Fine particle air pollution, from traffic, smoke and burning fuel, is linked to higher dementia risk. Indoor smoke from wood and coal stoves counts too. New evidence shows that cleaner air is linked to better thinking and lower dementia risk.
Most of the change has to come from strict clean air policies. But you can check daily air quality and plan around the worst days.
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- Green (0–50): good
- Yellow (51–100): moderate; unusually sensitive people may be affected
- Orange (101–150): unhealthy for sensitive groups
- Red (151–200): unhealthy for everyone
- Purple (201–300): very unhealthy, a health alert
- Maroon (301+): hazardous
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Check AirNow.gov or a weather app for your local AQI. On red or worse days, consider moving your workout indoors, and see AirNow’s activity guides for more.
Brain health is a team effort
Families, workplaces and communities can make healthy choices easier.
Every one of the 14 risks can be lowered on a large scale through policy, and these changes often save money. Communities can help by making healthy choices the easy ones.
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- Age-friendly communities and housing that bring people together
- Eye tests and treatment for everyone
- Good-quality education for every child
- Hearing aids people can access, and less harmful noise
- Less smoking, through price, age limits and smoke-free places
- Less sugar and salt in food sold in stores and restaurants
- Strict clean air policies
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Ideas
- Book hearing or eye checks for a parent and yourself on the same day
- Learn something new with a grandchild
- Share this guide with a parent, partner or friend
- Take a family walk each week
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Ideas
- Check in on a neighbor who lives alone
- Speak up for safe bike lanes, parks and clean air where you live
- Start a lunchtime walking group at work, school or your place of worship
When and where to get help
Bring brain health into your check-ups at every age.
Talk with your clinical provider if
- A close relative developed dementia, especially before 65
- Low mood, worry or poor sleep have lasted more than a couple of weeks
- You haven’t had your blood pressure, cholesterol or blood sugar checked in a while
- You notice you’re missing parts of conversations, or the TV keeps getting louder
- You’ve fallen, or feel unsteady on your feet
- You’ve had a head injury and still don’t feel right
- Your eyesight has changed, or it’s been years since an eye exam
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Sleep apnea and some other conditions can cause dementia-like symptoms and improve with treatment.
See the Dementia: understanding it guide for warning signs, and the Living with early dementia guide for first steps. For routine screenings, see Checkups, hormones & mood.
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Call or text 988 to reach the 988 Suicide & Crisis Lifeline.
Text HOME to 741741 to reach a trained Crisis Text Line counselor.
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findahelpline.com lists free, confidential helplines by country. If you are in danger, call your local emergency number.
📝 Worksheets for this guide
Fill these in privately in the app. Your answers stay on your phone.
Sources
- The Lancet (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (Livingston G, et al., Lancet 2024; 404: 572–628)
- University of Washington Memory and Brain Wellness Center (2024). New Recommendations to Reduce Dementia Risk Worldwide; Untreated High Cholesterol and Vision Loss Linked to Raised Risk
- World Health Organization (WHO) (2026). Dementia (fact sheet)
- World Health Organization (WHO). Deafness and hearing loss (fact sheet)
- Centers for Disease Control and Prevention (CDC). Reducing Risk for Dementia
- Centers for Disease Control and Prevention (CDC) (2022). Modifiable Risk Factors for Alzheimer Disease and Related Dementias Among Adults Aged ≥45 Years — United States, 2019 (MMWR)
- Centers for Disease Control and Prevention (CDC). Physical Activity Guidelines: Adults
- Centers for Disease Control and Prevention (CDC). Physical Activity Guidelines: Older Adults
- Centers for Disease Control and Prevention (CDC). Prediabetes: Your Chance to Prevent Type 2 Diabetes
- Centers for Disease Control and Prevention (CDC). About Moderate Alcohol Use
- Centers for Disease Control and Prevention (CDC). Older Adult Falls Data / Facts About Falls
- Centers for Disease Control and Prevention (CDC) (2025). HEADS UP: Safety Guidelines: Helmets
- Centers for Disease Control and Prevention (CDC). Tips From Former Smokers: How to Quit Smoking
- Smokefree.gov, National Cancer Institute. Speak to an Expert (quitlines)
- National Institute on Aging (NIA), NIH. Cognitive Health and Older Adults
- National Institute on Aging (NIA), NIH. Take care of your senses: The science behind sensory loss and dementia risk
- National Institute on Aging (NIA), NIH. Participating in Activities You Enjoy As You Age
- National Institute on Deafness and Other Communication Disorders (NIDCD), NIH. Noise-Induced Hearing Loss
- AirNow (U.S. Environmental Protection Agency and partners). Air Quality Index (AQI) Basics
- Alzheimer’s Association. U.S. POINTER Study
- Alzheimer’s Association. Myths About Alzheimer’s and Dementia
- Find A Helpline (ThroughLine). Find A Helpline
- 988 Suicide & Crisis Lifeline. 988 Suicide & Crisis Lifeline
- Substance Abuse and Mental Health Services Administration (SAMHSA). 988 Suicide & Crisis Lifeline
- Crisis Text Line. Crisis Text Line
- Substance Abuse and Mental Health Services Administration (SAMHSA). Crisis Text Line (behavioral health resource listing)
This guide is for education and self-care. It is not a diagnosis or a substitute for professional care. Please talk to a counselor or clinical provider about your health. Reviewed October 2026.

