Cassandra's Compass
Dementia Prevention — Reducing Your Risk
Based on the second edition of the WHO guidelines on risk reduction of cognitive decline and dementia (published 15 July 2026) and the 2024 Lancet Commission. Every recommendation below carries WHO's own strength and certainty labels.
All content in Cassandra’s Compass is based on Australian legislation, Aged Care Quality Standards, and evidence-based clinical guidelines. However, each employer’s policies and procedures can differ significantly — even when all organisations follow the same law.
Your specific workplace documentation, facility protocols, and individual care plans always take precedence. Before performing any care task, administering medications, or responding to a clinical situation — always refer to your employer’s specific policies and consult the person’s individual care plan.
Clinical note: The information provided here reflects Australian legislation and evidence-based guidelines. Your facility’s specific clinical protocols, formularies, and care plans take legal and operational precedence. Always follow your employer’s policies first.
When in doubt — ask your supervisor. That is never a weakness. It is professionalism.
How to read WHO's labels
Every WHO recommendation carries two separate labels. The page repeats both, in words, on each card.
Strength of recommendation — either strong or conditional. A strong recommendation means WHO is confident that the desirable effects of the intervention outweigh the undesirable effects, so it applies to most people in that group. A conditional recommendation means the balance of benefits and harms depends on the person and their circumstances, values and preferences — it is a decision to make with a clinician rather than a fixed instruction for everyone.
Certainty of evidence — runs from high to moderate to low to very low. It describes how confident WHO is in the body of evidence behind the recommendation, not how important the recommendation is. A strong recommendation can rest on low certainty evidence, and a conditional recommendation can rest on moderate certainty evidence — which is why the two labels are always read together.
WHO also issues recommendations against an intervention, and for some risk factors it states that the evidence is currently insufficient to make any recommendation. This page shows both, rather than leaving them out.
In July 2026 the World Health Organization released the second edition of its guidelines on the risk reduction of cognitive decline and dementia. WHO states that up to 45% of dementia risk can be attributed to modifiable risk factors, many of which are shared with other noncommunicable diseases [1]. WHO's news release describes this as risk that could be prevented or delayed [2]. The guidelines apply to adults living without dementia, including adults with normal cognition and adults with mild cognitive impairment [1].
This figure is a population estimate: it describes the share of dementia cases that could, in theory, be prevented or delayed if modifiable risk factors were addressed across a whole population. It is not a guarantee for any one person, and it does not mean dementia is always avoidable. Age and genetics remain major non-modifiable influences. The message is one of encouragement, not blame — every positive change helps, and it is never too early or too late to start.
The 2024 Lancet Commission on dementia reports a similar figure: up to 45% of dementia risk attributable to 14 modifiable risk factors (Livingston et al., 2024) [3]. WHO's figure and the Commission's are consistent with each other, and both point to the same practical message. The WHO guidelines are the international standard for translating that evidence into recommendations.
WHO also sets out the limits of what prevention can promise. Because there is no widely accessible disease-modifying treatment or cure for dementia, WHO describes prevention across the life course as its central public-health strategy for reducing future incidence [1] — a strategy for populations, not a guarantee for any individual.
WHO groups its dementia-specific recommendations into interventions that promote healthy behaviours and lifestyles. Each card below shows WHO's own strength of recommendation and certainty of evidence, and quotes WHO's wording, so you can see how firm each one actually is.
Physical activity — adults with normal cognition
WHO: strong recommendation, moderate certainty of evidence
WHO: a strong recommendation, moderate certainty of evidence — physical activity should be recommended to adults with normal cognition.
WHO's wording: “physical activity should be recommended to adults with normal cognition”
WHO makes a **strong** recommendation here, which is the strongest form of advice it issues: it is confident the benefits outweigh the harms, and that this applies to most people in this group.
The Australian 24-hour movement guidelines set the practical dose for adults: 150–300 minutes of moderate-intensity activity across the week, plus muscle-strengthening activity on at least two days [7]. Both aerobic and strength activity count, and anything is better than nothing.
For people already living with dementia or with limited mobility, movement still supports wellbeing and function — chair-based exercise, walking, hydrotherapy and dancing all count. The app's Physical Fitness page covers aged-care-appropriate options.
Physical activity — adults with mild cognitive impairment
WHO: conditional recommendation, low certainty of evidence
WHO: a conditional recommendation, low certainty of evidence — physical activity may be recommended to adults with mild cognitive impairment.
WHO's wording: “physical activity may be recommended to adults with mild cognitive impairment”
WHO gives this group a **conditional** recommendation rather than a strong one: the balance of benefits and harms depends on the person and their circumstances, so it is a decision to make with a clinician. The certainty of the evidence behind it is **low**.
WHO states that when a recommendation applies only to a specific group, it says so explicitly, and that if no group is specified a recommendation applies to all adults [1].
Sources: [1]
Tobacco cessation
WHO: strong recommendation, low certainty of evidence
WHO: a strong recommendation, low certainty of evidence — interventions for tobacco cessation should be offered to adults who use tobacco.
WHO's wording: “interventions for tobacco cessation should be offered to adults who use tobacco”
WHO makes a **strong** recommendation that cessation support should be offered to adults who use tobacco. It is never too late to benefit from quitting, and support makes quitting more likely to succeed.
In Australia, Quitline is a free confidential service on 13 78 48, and your GP can discuss subsidised nicotine-replacement therapy and other options [9].
Reducing harmful use of alcohol
WHO: conditional recommendation, moderate certainty of evidence
WHO: a conditional recommendation, moderate certainty of evidence — interventions aimed at reducing or ceasing hazardous and harmful drinking may be offered.
WHO's wording: “reducing or ceasing hazardous and harmful drinking … may be offered”
WHO gives this a **conditional** recommendation with **moderate** certainty of evidence. The recommendation covers interventions aimed at reducing or ceasing hazardous and harmful drinking, including support for people with alcohol dependence.
The Australian limits below come from the National Health and Medical Research Council, not from WHO: to reduce the risk of harm from alcohol-related disease or injury, healthy adults should drink no more than 10 standard drinks a week and no more than 4 on any single day [8].
A healthy, balanced dietary pattern
WHO: conditional recommendation, moderate certainty of evidence
WHO: a conditional recommendation, moderate certainty of evidence — a healthy, balanced dietary pattern may be recommended to adults with normal cognition or mild cognitive impairment.
WHO's wording: “a healthy, balanced dietary pattern may be recommended”
WHO gives this a **conditional** recommendation with **moderate** certainty of evidence. The pattern WHO describes is built from beliefs, cultural context, locally available foods and dietary customs — a Mediterranean-style pattern fits it well: vegetables, fruit, legumes, whole grains, olive oil as the primary fat, fish, nuts, and limited red meat and ultra-processed food.
The benefit comes from the overall pattern rather than any single food or supplement — see "What WHO does NOT recommend" below.
Sources: [1]
Cognitive training
WHO: conditional recommendation, low certainty of evidence
WHO: a conditional recommendation, low certainty of evidence — cognitive training may be offered to older adults with normal cognition or mild cognitive impairment.
WHO's wording: “cognitive training may be offered to older adults with normal cognition or mild cognitive impairment”
Cognitive training means a targeted, repetitive exercise or task that stimulates a specific cognitive domain [1]. WHO gives it a **conditional** recommendation with **low** certainty of evidence.
WHO notes that cognitive training may produce a small improvement in cognitive function, but that the evidence shows little to no effect on dementia incidence after five years of follow-up, and that the optimal type, frequency, intensity and duration are not yet established [1].
Sources: [1]
Cognitive stimulation
WHO: conditional recommendation, very low certainty of evidence
WHO: a conditional recommendation, very low certainty of evidence — engagement in cognitive stimulation may be encouraged.
WHO's wording: “engagement in cognitive stimulation may be encouraged”
This is a **new** recommendation in the 2026 second edition. Cognitive stimulation means structured activities or programmes in a group or social setting within a set time, as well as everyday activities such as reading, storytelling and playing games [1].
WHO gives it a **conditional** recommendation with **very low** certainty of evidence. WHO explains that it made this recommendation because it allows for both structured and everyday activities that are culturally appropriate, publicly acceptable and low-cost [1].
Sources: [1]
Social activity
WHO: conditional recommendation, very low certainty of evidence
WHO: a conditional recommendation, very low certainty of evidence — engagement in social activity interventions may be recommended to adults with normal cognition or mild cognitive impairment.
WHO's wording: “engagement in social activity interventions may be recommended”
This is an **updated** recommendation in the 2026 edition. WHO explains that in the 2019 guidelines no recommendation was made because of insufficient evidence, and that the broader evidence base now indicates social activity interventions may confer small cognitive benefits, particularly in executive function and memory [1].
The certainty of evidence remains **very low**, so the recommendation is **conditional**. In aged care, meaningful social programmes are a practical way to act on it — intergenerational programmes, music and movement groups, pet therapy, and volunteer visitor schemes all count.
Sources: [1]
WHO also makes dementia-specific recommendations on managing health conditions and biological states associated with an increased risk of dementia. Most of these are conditional recommendations on very low certainty evidence — worth acting on with your GP, but not fixed instructions.
Hypertension (high blood pressure)
WHO: conditional recommendation, very low certainty of evidence
WHO: a conditional recommendation, very low certainty of evidence — management of hypertension may be offered to adults with hypertension.
WHO's wording: “management of hypertension may be offered to adults with hypertension”
WHO gives this a **conditional** recommendation with **very low** certainty of evidence.
Separately, the SPRINT MIND trial found that intensive blood-pressure control reduced the risk of mild cognitive impairment; it did not find a statistically significant effect on probable dementia [4].
Diabetes
WHO: conditional recommendation, very low certainty of evidence
WHO: a conditional recommendation, very low certainty of evidence — management of diabetes may be offered to adults with diabetes.
WHO's wording: “management of diabetes may be offered to adults with diabetes”
WHO includes the management of diabetes among the health conditions it addresses for dementia risk reduction, as a **conditional** recommendation with **very low** certainty of evidence [1].
Because the certainty is very low, this is framed as a decision to make with your GP rather than a fixed instruction. Managing diabetes is worthwhile for many reasons beyond dementia risk.
Sources: [1]
High cholesterol and dyslipidaemia
WHO: conditional recommendation, low certainty of evidence
WHO: a conditional recommendation, low certainty of evidence — management of dyslipidaemia at midlife may be offered.
WHO's wording: “management of dyslipidaemia at midlife may be offered”
WHO's recommendation applies specifically **at midlife**, with **low** certainty of evidence and **conditional** strength [1]. WHO states that when a recommendation applies only to a specific age group it says so explicitly.
Lifestyle measures and lipid-lowering medication where clinically indicated support both cardiovascular and brain health.
Sources: [1]
Obesity and healthy weight
WHO: conditional recommendation, low certainty of evidence
WHO: a conditional recommendation, low certainty of evidence — interventions for reducing midlife overweight or obesity may be offered.
WHO's wording: “interventions for reducing midlife overweight or obesity may be offered”
WHO's recommendation applies specifically **at midlife**, with **low** certainty of evidence and **conditional** strength [1].
Sources: [1]
Dietary restriction for adults who are overweight or obese
WHO: conditional recommendation, low to moderate certainty of evidence
WHO: a conditional recommendation, low to moderate certainty of evidence — dietary restriction interventions may be offered to adults who are overweight or obese.
WHO's wording: “dietary restriction interventions may be offered to adults who are overweight or obese”
This is a **new** recommendation in the 2026 second edition, given **conditional** strength with **low to moderate** certainty of evidence [1].
Sources: [1]
Hearing loss
WHO: conditional recommendation, low certainty of evidence
WHO: a conditional recommendation, low certainty of evidence — hearing aids may be offered to adults with hearing loss.
WHO's wording: “hearing aids may be offered to adults with hearing loss”
WHO gives this a **conditional** recommendation with **low** certainty of evidence. WHO notes that evidence was identified for hearing aids specifically, and that there is currently insufficient evidence to draw conclusions about cochlear implants for dementia risk [1].
The ACHIEVE trial found that a hearing intervention reduced cognitive decline in a subgroup of older adults at increased risk; its primary analysis across the whole cohort did not show a significant effect [5]. WHO's own advice is that hearing aids should not be used solely for the purpose of preventing dementia [1].
In aged care, ensuring residents' hearing aids are in, charged, clean and working every shift is a concrete action.
The 2026 second edition adds a new group of recommendations on environmental risk factors — the first time WHO has addressed these for dementia risk.
Reducing exposure to ambient air pollution (including PM2.5)
WHO: conditional recommendation, very low certainty of evidence
WHO: a conditional recommendation, very low certainty of evidence — reducing exposure to ambient air pollution, especially PM2.5, may reduce the risk or incidence of cognitive decline and/or dementia.
WHO's wording: “Reducing exposure to ambient air pollution (especially PM2.5) may reduce the risk or incidence of cognitive decline and/or dementia”
This is a **new** recommendation in the 2026 second edition, given **conditional** strength with **very low** certainty of evidence [1].
WHO notes that population-level policy is an important enabler of brain health across the life course, and that air pollution interventions are the one area where high-quality evidence directly links population-level policy to reduced dementia incidence [1].
Sources: [1]
Reducing exposure to household air pollution
WHO: conditional recommendation, very low certainty of evidence
WHO: a conditional recommendation, very low certainty of evidence — reducing exposure to household air pollution may reduce the risk or incidence of cognitive decline and/or dementia.
WHO's wording: “Reducing exposure to household air pollution may reduce the risk or incidence of cognitive decline and/or dementia”
WHO issues this as a **new** recommendation alongside the ambient air pollution one, with **conditional** strength and **very low** certainty of evidence [1].
Sources: [1]
Multidomain interventions
WHO: conditional recommendation, moderate certainty of evidence
WHO: a conditional recommendation, moderate certainty of evidence — tailored, multidomain interventions may be offered.
WHO's wording: “tailored, multidomain interventions may be offered”
This is a **new** recommendation in the 2026 second edition: programmes that target several risk factors together, tailored to the individual. WHO gives it **conditional** strength with **moderate** certainty of evidence [1].
The FINGER trial found that a combined programme of diet, exercise, cognitive training and vascular risk monitoring improved cognition in at-risk older adults [6]. The practical message is that no single action is a silver bullet — the greatest benefit comes from addressing several modifiable factors at once, tailored to the person.
WHO addresses these factors but states that the evidence is currently insufficient to make a recommendation for dementia risk reduction, or — in the case of menopausal hormone therapy — makes a recommendation against. Saying so is part of being honest about what the evidence does and does not support.
Depression
WHO: Insufficient evidence for a recommendation
For the specific purpose of reducing the risk of cognitive decline and/or dementia, WHO states there is currently insufficient evidence to recommend the management of depression [1]. WHO notes the bidirectional relationship between depression, cognitive function and dementia, and the potential for reverse causality. Depression itself should still be treated in line with WHO guidance — the point is only that it is not established as a dementia risk-reduction intervention.
Stroke
WHO: Insufficient evidence for a recommendation
For the specific purpose of reducing the risk of cognitive decline and/or dementia, WHO states there is currently insufficient evidence to recommend pharmacological interventions typically used to reduce the risk of recurrent stroke [1]. Stroke care should follow WHO guidance on its own merits.
Traumatic brain injury
WHO: Insufficient evidence for a recommendation
For the specific purpose of reducing the risk of cognitive decline and/or dementia, WHO states there is currently insufficient evidence to recommend specific interventions after traumatic brain injury [1]. WHO does advise that measures to prevent head injuries and traumatic brain injury should be consistently implemented and enforced across all populations.
Vision impairment
WHO: Insufficient evidence for a recommendation
For the specific purpose of reducing the risk of cognitive decline and/or dementia, WHO states there is currently insufficient evidence to recommend vision impairment interventions [1]. WHO does advise that screening for suspected vision impairment should be offered to all adults, and management to those diagnosed, in line with its own eye-care guidance.
Sleep
WHO: Insufficient evidence for a recommendation
For the specific purpose of reducing the risk of cognitive decline and/or dementia, WHO states there is currently insufficient evidence to recommend interventions to treat sleep–wake disorders, and insufficient evidence to recommend interventions to improve sleep quality or duration [1]. WHO adds a general clinical remark that sleep is important for overall health and wellbeing, and that maintaining good sleep is advised throughout life. Sleep treatment should not be offered or taken as a way to prevent dementia; sleep care remains important for comfort, safety, daytime functioning and carer wellbeing.
Sleep & DementiaHIV
WHO: Insufficient evidence for a recommendation
For the specific purpose of reducing the risk of cognitive decline and/or dementia, WHO states there is currently insufficient evidence to recommend one antiretroviral therapy (ART) combination over another; ART regimens should therefore be used according to disease control needs and patient preferences [1]. WHO does advise that antiretroviral therapy should be initiated for all people living with HIV, in line with its own guidance.
Menopausal hormone therapy
WHO: conditional recommendation recommendation against, very low certainty of evidence
For postmenopausal women aged 65 years and older, WHO recommends against menopausal hormone therapy for the specific purpose of reducing the risk of cognitive decline and/or dementia, with very low certainty of evidence. For women aged under 65, WHO makes no recommendation because there is currently insufficient evidence to advise for or against its use for this purpose [1]. This concerns dementia risk reduction only — it is not advice about hormone therapy for other indications, which is a matter for a woman and her clinician.
WHO issues recommendations against the following for dementia risk reduction. This helps people avoid unnecessary cost and potential harm, and shifts focus toward the behaviours and conditions that do have supporting evidence.
Vitamin B, vitamin E, omega-3, and multivitamin/mineral supplements
WHO: strong recommendation recommendation against, moderate certainty of evidence
WHO's wording: “supplemention of vitamins B and E, omega-3 polyunsaturated fatty acids (PUFA) and multivitamins/minerals is not recommended”
WHO recommends against supplementation with vitamins B and E, omega-3 polyunsaturated fatty acids (PUFA) and multivitamins/minerals for reducing dementia risk, in adults without a diagnosed deficiency. This is a strong recommendation with moderate certainty of evidence — one of the firmest statements in the guideline [1]. WHO notes the lack of evidence of any benefit to outweigh unexpected harmful effects. A healthy, balanced dietary pattern is recommended instead. If you have a diagnosed deficiency, treat it on medical advice.
Sources: [1]
Menopausal hormone therapy for dementia risk reduction
WHO: conditional recommendation recommendation against, very low certainty of evidence
WHO's wording: “Menopausal hormone therapy is not recommended for specifically reducing the risk of cognitive decline and/or dementia”
For postmenopausal women aged 65 years and older, WHO recommends against menopausal hormone therapy for the specific purpose of reducing the risk of cognitive decline and/or dementia [1]. For women aged under 65, WHO makes no recommendation either way because the evidence is insufficient. This is about dementia risk reduction only and is not advice about hormone therapy for other indications.
Sources: [1]
These are population and individual risk-reduction strategies, not guarantees. Acting on them improves the odds and supports overall health — but it cannot ensure dementia will not occur. The framing matters: this is about encouragement without pressure or blame.
For people already living with dementia, these same strategies still matter — they support wellbeing, function and quality of life, and they apply equally to carers and aged-care staff, whose own cognitive health is just as important.
This page is educational and does not replace personal medical advice. For an individual assessment of dementia risk, speak with your GP, who can consider your personal and family history, medications and circumstances.
Two free, self-paced online courses from the University of Tasmania's Wicking Dementia Research and Education Centre. Both are open to anyone — no entry requirements, and no cost.
Understanding Dementia
FreeOnline, self-paced — check the course page for current enrolment dates
21 hours of content; 4 modules
Free, self-paced course from the Wicking Dementia Centre covering the brain, signs and risks, person-centred care, and being and belonging with dementia.
Open the course page on UTASPreventing Dementia
FreeOnline, self-paced — check the course page for current enrolment dates
8 hours of content
Free course on dementia risk reduction — lifestyle, health and brain-protective strategies. No exams, no prerequisites.
Open the course page on UTASCourse details read from UTAS’s own pages on 9 October 2026. Check the course page for current enrolment dates.
References
- [1]World Health Organization. (2026). Risk reduction of cognitive decline and dementia: WHO guidelines (2nd ed.). Open source
- [2]World Health Organization. (2026, July 15). New WHO guidelines: up to 45% of dementia risk could be prevented or delayed [News release]. Open source
- [3]Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., … Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572–628. DOI
- [4]SPRINT MIND Investigators for the SPRINT Research Group. (2019). Effect of intensive vs standard blood pressure control on probable dementia: A randomized clinical trial. JAMA, 321(6), 553–561. DOI
- [5]Lin, F. R., Pike, J. R., Albert, M. S., Burgard, S., Chisolm, T., Couper, D., … Coresh, J. (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): A multicentre, randomised controlled trial. The Lancet, 402(10404), 786–797. DOI
- [6]Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., … Kivipelto, M. (2015). A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial. The Lancet, 385(9984), 2255–2263. DOI
- [7]Australian Government Department of Health, Disability and Ageing. (2021). Australian 24-hour movement guidelines for adults (18 to 64 years) and older adults (65 years and over). Open source
- [8]National Health and Medical Research Council. (2020). Australian guidelines to reduce health risks from drinking alcohol. Open source
- [9]Quit. (n.d.). Quitline 13 78 48. Open source
Every link above was opened and confirmed working when this page was last checked. If a link no longer opens, the citation text is still enough to find the source.
Every claim on this page is drawn from a source listed in the references above, and each reference is linked to the source itself. WHO's own strength and certainty labels are shown on every recommendation card. Where WHO says the evidence is insufficient to make a recommendation, the page says so. This does not replace medical advice. For an individual assessment of dementia risk, speak with your GP.
Knowledge is empowerment. The more you understand dementia, the more confidently — and compassionately — you can care.
— Cassandra's Compass
Verified against official sources on 12 October 2026