Contributors from the Jockey Club Centre for Positive Ageing outline dietary strategies that can help preserve cognitive function and prevent dementia
Factors contributing to dementia include non-modifiable ones, such as sex and age, and modifiable ones. The Lancet Commission identified nine modifiable risk factors of dementia in 2017,(1) three more risk factors were added in the 2020 update,(2) and in 2024, two more risk factors, namely high low-density lipoprotein (LDL) cholesterol and vision loss, were added, making a list of 14 modifiable risk factors of dementia, accounting for 45% of dementia cases.(3) A recent study proposed four additional modifiable risk factors for dementia and increased the estimated reduction percentage to 65%.(4) Among these latest 18 risk factors, four are related to diet, including mid-life high LDL cholesterol, diabetes, hypertension and obesity, highlighting the importance of diet in preserving cognitive function. This article aims to synthesise current evidence on the role of diet in dementia prevention and introduce practical, neuroprotective dietary patterns that can be adapted across diverse cultural contexts.
Chronic disease and dementia risk
High LDL cholesterol contributes to atherosclerosis and cerebrovascular disease, increasing risk of stroke and promoting deposition of brain proteins associated with Alzheimer’s and vascular dementia. Global data indicate that LDL cholesterol level peaks between ages 40 and 59 in most countries, and elevated cholesterol is attributed to approximately 4.3 million deaths in 2019.(5,6) Diabetes accelerates neurodegeneration through insulin resistance, chronic inflammation, and amyloid-β accumulation, making it a strong midlife dementia risk factor. In 2021, diabetes directly caused 1.6 million deaths, with 47% occurring before age 70.(7,8) Hypertension damages cerebral vessels and increases cerebrovascular disease risk, strongly linking it to midlife dementia; globally, 1.4 billion adults aged 30–79 live with hypertension.(9,10) Obesity, often coexisting with diabetes and hypertension, amplifies cardiovascular burden and dementia risk through systemic inflammation and metabolic dysfunction. Nearly 900 million adults worldwide are obese, with prevalence highest in midlife.(11,12) Therefore, midlife is a critical window for dementia prevention.
Prevention strategies
There are various dietary approaches related to the preservation of cognitive functioning. The Mediterranean (MED) diet, recommended by the World Health Organization, is characterised by high consumption of fruits, vegetables, whole grains, legumes, nuts, fish, and olive oil and limited dairy products, red meats, and wine.(13,14) The Dietary Approaches to Stop Hypertension (DASH), designed for hypertension, similarly emphasises the consumption of plant-based food, lean protein, and low-fat dairy products while restricting salt, added sugar, and saturated fat.(15,16) Both diets have shown protective effects against cognitive decline by reducing cardiovascular risk factors, including total cholesterol, blood pressure, inflammatory biomarkers of type 2 diabetes, and body weight.(13,14) However, neither of them is directly designed for the prevention of cognitive impairment.
Recently, extensive studies have shown the positive effects of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet on reducing dementia risks.(17,18) It is a hybrid of the MED diet and the DASH, specifically modified for protecting the brain against neurodegeneration by the addition of evidence-based foods and nutrients beneficial to brain health.(19) The MIND diet suggests adding weekly consumption of berries and green leafy vegetables, which are rich in antioxidants and flavonoids. These additions may further reduce inflammatory biomarkers and suppress neuroinflammation, explaining their greater effect on cognition compared with the MED diet or DASH alone. (15,17,18,20-22) Higher adherence to the MIND diet was found to be associated with a lower risk of dementia in both middle-aged and older adults. (13,15,20,22) However, as culinary culture varies from region to region, modified versions of the MIND diet have been developed to align with regional dietary patterns. These adaptations have also demonstrated comparable neuroprotective effects. (23-30)
Promoting a healthy diet is critical for dementia prevention, as it addresses nearly one-fourth of modifiable risk factors. Comprehensive strategies should integrate dietary interventions and public education to raise community awareness on risk factors for dementia and brain health. The Jockey Club Centre for Positive Ageing (JCCPA) hosted the ‘Echoes of Memory’ exhibition in October 2025 to promote dementia prevention and brain health. Visitors learnt about the brain functions and connection to dementia and experienced everyday challenges faced by individuals living with dementia via games. The exhibition also featured installations and illustrations of dementia risk factors, providing visitors with practical knowledge on maintaining brain health and preventing dementia. The exhibition attracted 3,500 visitors and organised more than 20 tours for elderly and school groups, raising public awareness of dementia and empowering the community through evidence-based strategies for brain health and dementia prevention delivered via multiple approaches.
Dementia Risk Factor Registry
In the exhibition, JCCPA launched Dementia Risk Factor Registry, the first community-wide risk factor survey in the territory to record the risk factor prevalence condition of Hong Kong citizens. Upon completing the online survey, participants would receive an individualised dementia risk profile and tailored recommendations on lifestyle modification. The Registry has recorded over 400 entries since its launch in October 2025, and longitudinal cohort studies on dementia prevention and disease progression in the Hong Kong population are planned to generate locally relevant evidence to inform dementia risk-reduction strategies and care planning in Hong Kong.
To conclude, considering nearly two-thirds of global dementia cases are potentially preventable through targeted risk factor modification, strategies addressing these factors are essential for promoting dementia prevention. Evidence-based healthy diet approaches, such as the MIND diet, can help manage diet-related risk factors and reduce the risk of developing dementia. Further studies on region-specific risk factor prevalence and preventive interventions are needed to provide insights into effective risk-modification interventions and promote sustainable behavioural changes for dementia prevention.
