Modifiable Dementia Risk: What the Research Actually Shows

The best current evidence on dementia risk comes from the Lancet Commission on dementia prevention, intervention, and care — a standing group of dementia researchers who periodically review the global evidence and publish population-level estimates. Their 2024 update lists 14 modifiable risk factors — less education, hearing loss, high blood pressure, high LDL cholesterol, obesity, excessive alcohol, traumatic brain injury, physical inactivity, smoking, diabetes, depression, social isolation, air pollution, and untreated vision loss — that together are associated with an estimated 45% of dementia cases worldwide, in the sense that eliminating all of them, at a population level, could theoretically prevent or delay that share of cases.¹ Notably, sleep is not on that official list — we're not going to pretend otherwise. And nothing here is a case for taking a supplement to prevent dementia; no supplement, Proco's or anyone else's, has been shown to do that. This article is about what the research actually says, and where the honest limits of it are. If you want the shorter version focused on where to start, we've written that separately as the 45% dementia figure: what it actually means.

What the Lancet Commission actually found

The Lancet Commission isn't a single study — it's a standing panel of dementia researchers, led by Professor Gill Livingston at University College London, that reviews the global evidence base every few years and models how much of dementia's population-level burden is theoretically attributable to modifiable factors versus factors that can't currently be changed (age and genetics being the biggest of those). The 2020 report identified 12 modifiable factors. The 2024 update added two more — high LDL cholesterol in midlife and untreated vision loss in later life — bringing the list to 14 and the modelled total to 45%.¹³

That 45% figure is a population attributable fraction — a statistical estimate of how much disease burden theoretically traces back to a set of factors across an entire population, assuming those factors are causal and could be fully removed. It's not a promise that any individual who fixes their blood pressure or quits smoking cuts their personal risk by 45%, and the Commission itself is explicit that dementia has non-modifiable drivers too, starting with age and genetics, that this estimate doesn't touch.

Why we won't give you a per-factor league table

This is the part most write-ups get wrong, and where an earlier version of this article got it wrong too. You will find articles — and you will find charts — assigning each of the 14 factors its own percentage: hearing loss x%, education y%, cholesterol z%. We are not going to print one, for three reasons.

First, published summaries of the 2024 report disagree with each other about those per-factor numbers. Second, population attributable fractions for overlapping risk factors do not simply add up: high blood pressure, diabetes, obesity and physical inactivity cluster in the same people, so the Commission weights them to avoid double-counting, and a table of unweighted per-factor figures will sum to something other than 45%. Third, and most concretely: a previous version of Proco content published exactly such a table, and the numbers in it summed to 47% — more than the headline total the table was supposed to break down. That's a tell that the figures were wrong, and we'd rather explain that than quietly republish a tidier-looking version of the same error.

The 14 factors, and where they sit across life

The Commission groups the factors by the stage of life where the evidence for their impact is strongest — though the general principle is that brain health accumulates across a lifetime, not just in old age.

Early life: less education.
Midlife: hearing loss, high blood pressure (hypertension), high LDL cholesterol, obesity, excessive alcohol consumption, traumatic brain injury, physical inactivity, smoking, diabetes, depression.
Later life: social isolation, air pollution, untreated vision loss.¹³

None of these are supplement targets in any direct sense. The interventions the Commission actually recommends are things like hearing aid access, blood pressure treatment, cholesterol management, smoking cessation support, corrective lenses and cataract surgery, hearing protection and head-injury prevention, cleaner air, and treatment for depression. Several of them overlap heavily with cardiovascular risk more broadly — the same territory covered in the ten things that cause nine in ten strokes.

Every intervention on this list is a hearing aid, a prescription, a pair of glasses, a habit or a policy. Not one of them is a capsule.

What about sleep?

We said upfront that sleep isn't on the Commission's official list, and it genuinely isn't — not in 2020, not in the 2024 update. That's a real gap worth naming rather than glossing over, because sleep and brain health are connected in other ways.

A separate observational study — not part of the Lancet Commission's analysis — followed 7,959 UK civil servants over a 25-year period (the Whitehall II cohort), recording 521 dementia diagnoses.⁴ Compared with a 7-hour night, sleeping six hours or less was associated with higher dementia risk at age 50 (hazard ratio 1.22, 95% CI 1.01–1.48) and at age 60 (HR 1.37, 95% CI 1.10–1.72); at age 70 the estimate was imprecise and did not reach significance (HR 1.24, 95% CI 0.98–1.57). The widely quoted "30% higher risk" figure comes from a different comparison in the same paper: persistent short sleep across all three ages — 50, 60 and 70 — versus persistently normal sleep.⁴ That distinction matters, and an earlier version of this article attached the 30% figure to "their 50s and 60s," which is not what the paper measured.

Either way, it's an association from observational data, not a controlled trial. It doesn't establish that poor sleep causes dementia, or that improving sleep prevents it. The Lancet Commission's reviewers have not judged the evidence strong or consistent enough to add sleep to the formal factor list, and reverse causation is a live possibility — early, undiagnosed neurodegeneration can itself disrupt sleep years before symptoms appear, which makes the causal direction genuinely hard to untangle. On what a normal night actually looks like, and how wide that range is, see how much sleep adults actually need.

What this has — and doesn't have — to do with supplements

Read back through the 14 factors and the honest answer is: nothing, directly. This is a list of things addressed by hearing aids, blood pressure medication, quitting smoking, moving more, drinking less, wearing glasses, treating depression, staying socially connected, and reducing head injury and air pollution exposure. No supplement — Proco's or any other brand's — belongs on that list, and we're not going to imply otherwise by parking one next to it.

Two of the factors do sit near areas where specific ingredients have their own, separate research — and this is precisely where an earlier version of this article overstepped, so it's worth walking through carefully.

Blood pressure. Hypertension is one of the 14 factors. Separately from any dementia research, magnesium supplementation has been studied for its effect on blood pressure: a 2016 meta-analysis of 34 randomized, double-blind, placebo-controlled trials in 2,028 participants found that magnesium at a median dose of 368 mg/day for a median of 3 months reduced systolic blood pressure by 2.00 mmHg (95% CI 0.43–3.58) and diastolic by 1.78 mmHg (95% CI 0.73–2.82).⁵ Two things follow from that, neither of them a sales pitch. The reductions are small — around 2 mmHg. And the doses studied sit above the 350 mg/day upper level for supplemental magnesium and above the 275 mg elemental magnesium in our own product, as we set out in how much magnesium is too much. Proco's Magnesium Glycinate is formulated for sleep and nervous-system support, not blood pressure, and we make no blood pressure claim for it.

Depression. Depression is also one of the 14 factors. Separately, a 2016 systematic review and meta-analysis in the American Journal of Psychiatry found a moderate-to-strong effect for omega-3 — primarily EPA or ethyl-EPA — used adjunctively alongside antidepressants in people already being treated for depression. The same paper reported marked heterogeneity between studies and funnel-plot asymmetry indicating potential publication bias, which the authors flagged themselves.⁶ The trials in that literature typically used EPA in the region of a gram or more per day. Proco's Omega-3 provides 180 mg EPA and 120 mg DHA per softgel — well below those trial doses — and it is not an adjunct to antidepressant treatment. The dose-response question for omega-3 and the brain is a real one, and we've gone into it properly in omega-3 and cognitive aging.

Neither ingredient is a reason to expect a measurable change in dementia risk. The research connecting magnesium to blood pressure or EPA to adjunctive depression treatment is real and separately established; the research connecting either of them, or any supplement, to dementia risk reduction does not exist, and we're not going to manufacture it by association. That posture is the whole reason we don't sell brain blends.

What actually moves the needle

Based on the Commission's own recommendations, the highest-leverage actions are unglamorous and mostly outside a supplement aisle entirely: getting hearing checked and using a hearing aid if needed, managing blood pressure and LDL cholesterol with a clinician, not smoking, staying physically active, limiting alcohol, protecting the head during contact sports and high-risk activities, correcting vision problems, treating depression, staying socially engaged, and — where it's within someone's control — reducing exposure to air pollution.¹ Education earlier in life is on the list too, which is a reminder that dementia risk isn't only shaped by what someone does in their 50s and 60s — it accumulates across an entire lifetime. On the exercise side specifically, we've compared the evidence directly against supplements in exercise vs supplements for brain health, and on alcohol in moderate drinking and your brain.

One thing worth separating from all of this: risk reduction is not the same question as "is my memory a problem now." If that's the actual worry, the useful next step is an assessment, not a risk-factor checklist — which is what memory worries: what's normal ageing and what needs an assessment is for.

Bottom line

The current Lancet Commission list of 14 modifiable dementia risk factors is: less education, hearing loss, high blood pressure, high LDL cholesterol, obesity, excessive alcohol, traumatic brain injury, physical inactivity, smoking, diabetes, depression, social isolation, air pollution, and untreated vision loss — together estimated to account for 45% of dementia cases worldwide, in a population-level, modeled sense. We are deliberately not attaching a percentage to any single factor, because we can't source those figures reliably. Sleep is not on the list, however associated it might turn out to be once more research is done. None of these factors are addressed by a supplement, and no Proco product — or anyone's — is shown to reduce dementia risk.

This article is for informational purposes only and has not been evaluated by the FDA. It is not intended to diagnose, treat, cure, or prevent any disease. Speak with a healthcare provider before starting any new supplement, especially if you take medication or have an existing health condition. Specifically: this article is not medical advice about dementia prevention or treatment, and no claim is made anywhere in it that any Proco product, or any supplement, reduces dementia risk.

References

1. Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404(10452):572-628. pubmed.ncbi.nlm.nih.gov/39096926
2. The Lancet. Risk factors for dementia (infographic summarizing the 2024 Commission report). thelancet.com/infographics-do/dementia-risk
3. Alzheimer Europe. 2024 Lancet Commission underscores the potential for dementia risk reduction, identifying 14 modifiable risk factors across the life course. alzheimer-europe.org/news/2024-lancet-commission
4. Sabia S, Fayosse A, Dumurgier J, et al. Association of sleep duration in middle and old age with incidence of dementia. Nature Communications. 2021;12:2289. nature.com/articles/s41467-021-22354-2
5. Zhang X, Li Y, Del Gobbo LC, et al. Effects of Magnesium Supplementation on Blood Pressure: A Meta-Analysis of Randomized Double-Blind Placebo-Controlled Trials. Hypertension. 2016;68(2):324-333. pubmed.ncbi.nlm.nih.gov/27402922
6. Sarris J, Murphy J, Mischoulon D, et al. Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses. American Journal of Psychiatry. 2016;173(6):575-587. pubmed.ncbi.nlm.nih.gov/27113121
7. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-446. pubmed.ncbi.nlm.nih.gov/32738937

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