Published 28 October 2026 · Last updated 28 October 2026
The Lancet · 2024 standing Commission on dementia
The 14 things the Lancet says affect your dementia risk — and the one thing that is not on the list
In 2024 a standing commission of 27 international dementia experts published the most complete picture yet of what raises and lowers dementia risk across a whole lifetime. Their conclusion: 45% of cases could in principle be prevented or delayed.
Not one of their fourteen risk factors is a supplement. We sell supplements, and we are going to tell you that anyway.
The short version
- 45% of dementia cases worldwide are linked to fourteen modifiable risk factors — things that can in principle be changed.
- That is up from 40% and twelve factors in the Commission's previous report in 2020.
- Two factors are new in 2024: high LDL cholesterol in midlife, and untreated vision loss in later life. Together they account for 9% of cases.
- The single largest factors are hearing impairment and high LDL cholesterol, at roughly 7% of cases each.
- The risks start in childhood and run to old age. The Commission's phrase is that it is never too early or too late to act.
- No supplement, vitamin or nutrient appears anywhere among the fourteen.
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45% of cases potentially preventable or delayed |
14 modifiable risk factors identified |
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2 new factors added since 2020 |
0 supplements among the fourteen |
On this page
- What is the Lancet Commission, and why does this report carry weight?
- What are the fourteen risk factors?
- What changed in 2024?
- Why is hearing loss the biggest single factor?
- What does "45%" actually mean?
- What does the Commission actually recommend?
- Why this article recommends no supplements
- What the Commission says it cannot tell you
- So what can you actually do about it?
- What a supplement is allowed to tell you in Great Britain
- Frequently asked questions
- How this article was written
- Sources — read it yourself
What is the Lancet Commission, and why does this report carry weight?
A Lancet Commission is not an ordinary research paper. It is a standing group of international specialists assembled to review the whole evidence base on a single question and publish a consensus position, then revisit it as new evidence arrives. The dementia Commission has reported in 2017, 2020 and now 2024. The 2024 report runs to 57 pages of The Lancet, and everything below is taken from it.
Two things make it unusually useful for a general reader:
- It quantifies. Rather than listing things that are "associated with" dementia, it estimates what proportion of cases each factor accounts for at a population level — the population attributable fraction, or PAF.
- It states its own limits. The 2024 report is explicit about which associations may be only partly causal, and about what the figures do and do not mean for any individual person. That is rarer than it should be.
What are the fourteen risk factors?
The Commission groups them by the stage of life at which they matter most. Where a reliable individual percentage has been published, it is given.
Early life · under 18
One factor, and it is education
- Not completing secondary education — around 5% of cases. The Commission's reading is that education builds cognitive reserve, the brain's capacity to tolerate damage before symptoms appear.
Midlife · 18 to 65
Ten factors, and the bulk of the total
- Hearing loss — around 7% of cases. The largest single factor in the list, alongside cholesterol.
- High LDL cholesterol — around 7% of cases. New in 2024, and relevant from roughly age 40.
- Depression. The Commission notes the direction of causation here is genuinely uncertain.
- Traumatic brain injury. Hence the recommendation on helmets in contact sports and on bikes.
- Physical inactivity.
- Diabetes.
- Smoking.
- Hypertension — raised blood pressure.
- Obesity.
- Excessive alcohol consumption.
Later life · over 65
Three factors, two of them environmental
- Social isolation — around 5% of cases.
- Air pollution. One of the factors an individual has least control over, which is why the Commission's recommendation is about clean air policy rather than personal choice.
- Untreated visual loss — around 2% of cases. New in 2024. Note the word untreated.
On the missing numbers: the Commission publishes a percentage for all fourteen factors in its summary figure, and they sum to the 45% headline. Individual figures have been widely reported for five of them. For the rest, the published summaries we can verify do not pair each number to its factor unambiguously, so we have left them out rather than attach a figure to the wrong thing.
What changed in 2024?
Two factors joined the list, and between them they explain the jump from 40% to 45%.
High LDL cholesterol in midlife — the bigger addition
- Estimated at 7% of cases, which makes it joint-largest in the whole list on its first appearance.
- Relevant from around age 40 rather than in old age, which is the point most coverage misses. The Commission's recommendation is to detect and treat it from midlife.
- It is a reminder that dementia risk and cardiovascular risk overlap heavily. Several of the fourteen — cholesterol, blood pressure, diabetes, obesity, smoking, inactivity — are the standard cardiovascular cluster.
- LDL is the only one of the fourteen where the Commission's dietary comment is specific, and it is about adherence to ordinary dietary guidelines.
Untreated vision loss in later life — the smaller one, with the sharper lesson
- Estimated at 2% of cases.
- The operative word is untreated. The Commission's recommendation is that screening and treatment for vision impairment should be accessible to everyone — which implies the risk attaches to vision loss left uncorrected, not to needing glasses.
- It pairs naturally with hearing loss, the largest factor. Both are sensory, both are routinely under-treated in older people, and both are correctable with equipment rather than medicine.
Why is hearing loss the biggest single factor?
At roughly 7% of cases it is joint-top of the list, and it surprises most people. The Commission's recommendations around it are among the most concrete in the whole report:
- Make hearing aids available to everyone who needs them.
- Reduce harmful noise exposure — a prevention measure aimed decades earlier than the diagnosis.
- Note that this is a factor addressed with a device, free at the point of use in the UK, rather than with anything you swallow.
What does "45%" actually mean?
This is the part worth reading twice, because it is the part most often reported badly.
The Commission's own words: "this risk modification affects the population, and does not guarantee that any individual will avoid dementia."
- It is a population figure, not a personal one. It describes what might happen to total case numbers if everyone's risk factors were addressed. It does not mean any one person cuts their own risk by 45%.
- "Prevented or delayed" are not the same thing. Delay matters enormously — the Commission notes that healthier lifestyles may push back the age of onset, so people who do develop dementia may live fewer years with it. But delay is not prevention.
- Some associations may be only partly causal. The report gives its own example: late-life depression may be an early effect of dementia rather than a cause of it.
- "In principle" is doing real work in that sentence. Addressing fourteen risk factors across an entire population, from childhood, is a public-health programme rather than a personal to-do list. That is why most of the Commission's thirteen recommendations are aimed at governments.
What does the Commission actually recommend?
Thirteen recommendations, and the striking thing about them is how few are things an individual buys. Among them:
- Provide all children with good-quality education, and keep people cognitively active in midlife.
- Make hearing aids available to all who need them, and reduce harmful noise exposure.
- Detect and treat high LDL cholesterol from around age 40.
- Make screening and treatment for vision impairment accessible to all.
- Treat depression effectively.
- Wear helmets and head protection in contact sports and on bikes.
- Prioritise supportive community environments and housing that increase social contact.
- Reduce air pollution through strict clean air policies.
- Expand smoking measures — price controls, a higher minimum purchase age, smoking bans.
- Reduce sugar and salt in foods sold in shops and restaurants.
The Commission also modelled the economics for England. Population-level action on excess alcohol, brain injury, air pollution, smoking, obesity and high blood pressure could save over £4 billion and gain more than 70,000 quality-adjusted life years.
Why this article recommends no supplements
We sell supplements. You are reading this on the website of a supplement company. So this section matters more than the rest.
No supplement, vitamin, mineral or nutrient appears anywhere among the fourteen risk factors.
- Diet is not one of the fourteen. It appears in the report only in passing — as part of diabetes management, and in relation to dietary guidelines for cholesterol.
- The Commission's food recommendations are population measures about sugar and salt in shop and restaurant food. They are aimed at manufacturers and regulators, not at shoppers choosing a capsule.
- So the Commission does not support any supplement for dementia risk, and nobody can honestly cite it as though it does.
There is a separate, vocal argument that the Commission was wrong to omit nutrition — particularly B vitamins, homocysteine and omega-3. You will find that material easily, and it reads persuasively. We are not going to lean on it, because it is a campaign position rather than the Commission's finding, and presenting a contested reading of a major report as settled is exactly the behaviour that makes this industry hard to trust.
Separately: to state a health benefit for a food supplement in Great Britain, the claim has to appear on the GB Nutrition and Health Claims Register in the register's exact words. There is no authorised claim relating to dementia or cognitive decline for any ingredient, from anyone. If you see one made, it is not lawful — whoever is making it.
What the Commission says it cannot tell you
- Whether you personally will avoid dementia. The figures are population estimates and the report says so plainly.
- How much of each association is causal. Some may be partly or wholly reverse causation.
- Whether the new drug treatments work in the long run. On anti-amyloid antibody treatments the report says they are "new, without long-term data available".
- What the remaining 55% is. More than half of dementia is not accounted for by these fourteen factors at all. Age and genetics are not modifiable and are not in the list.
So what can you actually do about it?
This is the question the report is usually written up without answering, and the answer is more encouraging than the headline suggests. Ten of the fourteen factors sit in midlife, and most of them are things that get measured rather than guessed at.
Five of the fourteen can be checked in one GP appointment
- Blood pressure — measured in two minutes, free, and available in many pharmacies without an appointment at all.
- LDL cholesterol — a blood test. The Commission says from around age 40, which is earlier than most people expect to be asked.
- Blood sugar — the same blood draw covers diabetes risk.
- Weight — already on your record.
- Alcohol and smoking — the two questions nobody enjoys, attached to two of the fourteen.
In England that is broadly what the NHS Health Check covers for 40 to 74 year olds. If you are in that bracket and have not had one, it maps onto this list more closely than anything you could buy.
Two of the largest factors are corrected with equipment, not medicine
- Hearing loss is joint-largest in the entire list at around 7%, and the Commission's recommendation is simply that hearing aids should be available to everyone who needs them. On the NHS they are.
- Untreated vision loss carries the word untreated for a reason. A sight test is free on the NHS for over-60s.
Between them these two account for roughly 9% of cases — the same as both of 2024's new risk factors combined. Neither involves taking anything.
And the ones that are genuinely free
- Physical activity — one of the fourteen in its own right, and it also moves blood pressure, weight and blood sugar, which are three more.
- Staying socially connected — around 5% of cases, and the Commission's recommendation is about housing and community environments rather than willpower.
- Staying cognitively active in midlife — recommended explicitly, and it costs nothing.
- Head protection — helmets on bikes and in contact sports, for the traumatic brain injury factor.
Several of these overlap, which is the quietly good news in the report. The midlife cluster is mostly one cluster. Moving more tends to move four of the fourteen at once.
What a supplement is allowed to tell you in Great Britain
Having said all of the above, the obvious next question is what, if anything, supplements are permitted to claim at all. It is worth knowing, because the honest answer explains a great deal about why supplement labels read the way they do.
There are two kinds of authorised claim, and the difference is the whole point:
- Function claims say a nutrient contributes to something working normally in a healthy person. There are hundreds of these on the register, in fixed wording, and they are the ones you see on labels.
- Reduction-of-disease-risk claims say a nutrient reduces the risk of a named condition. These are vanishingly rare — a handful across the whole food industry — and each one had to be authorised individually, naming the disease.
There is no claim of either kind about dementia, for any ingredient, held by anybody.
To be completely clear about what that means for this article: none of the authorised claims that do exist has anything to do with the fourteen risk factors above, and we are not going to put them side by side and let you join them up. A real function claim about a nutrient and ordinary bodily function is simply a different statement from anything in this report, and treating it otherwise would be the exact behaviour that makes supplement marketing worth distrusting.
If you want to check any claim you see anywhere — ours included — the GB Nutrition and Health Claims Register is public and searchable. If a benefit is not on it in those words, it cannot lawfully be claimed.
The line we would take away from it
From the lead author, Professor Gill Livingston: "It's never too early or too late to take action."
The fourteen factors span childhood to old age, and the two added in 2024 sit at opposite ends of adult life. If there is one usable conclusion for a general reader, it is that the midlife factors — blood pressure, cholesterol, hearing, weight, activity, alcohol, smoking — are the densest cluster, and they are the ones a GP can measure in a single appointment.
Frequently asked questions
What is the 2024 Lancet Commission on dementia?
It is the 2024 report of the Lancet standing Commission on dementia prevention, intervention and care, published by an international group of dementia specialists. It identifies fourteen modifiable risk factors associated with 45% of dementia cases worldwide, updating the twelve factors and 40% figure from the Commission's 2020 report.
What are the two new risk factors added in 2024?
High LDL cholesterol in midlife, from around age 40, estimated at 7% of cases; and untreated vision loss in later life, estimated at 2% of cases. Together they account for 9% of dementia cases and explain the increase from 40% to 45%.
Does the Lancet Commission recommend any supplements for dementia?
No. No supplement, vitamin, mineral or nutrient appears among the fourteen risk factors. Diet features only in passing, in relation to diabetes management and dietary guidelines for cholesterol, and the Commission's food recommendations are population measures about reducing sugar and salt in food sold in shops and restaurants.
Does 45% mean I can cut my own dementia risk by 45%?
No. It is a population attributable fraction, which estimates how total case numbers might change if these risk factors were addressed across a whole population. The Commission states directly that this risk modification affects the population and does not guarantee that any individual will avoid dementia.
Which single risk factor is the largest?
Hearing impairment and high LDL cholesterol are joint-largest, each estimated at around 7% of cases. Less education in early life and social isolation in later life follow at around 5% each.
Why is hearing loss linked to dementia?
The Commission treats it as one of the largest modifiable factors and recommends making hearing aids available to everyone who needs them, alongside reducing harmful noise exposure. The association is well established in the evidence the Commission reviewed, though the report is careful throughout about how much of any association is causal.
At what age should I start paying attention to cholesterol for this reason?
The Commission places high LDL cholesterol in midlife and recommends detecting and treating it from around age 40. That is considerably earlier than most coverage of dementia risk implies.
What about the other 55% of dementia cases?
They are not accounted for by these fourteen factors. The Commission's list covers only modifiable risks, so age and genetic factors are excluded by definition. More than half of dementia risk sits outside what the report describes as changeable.
Are there any authorised health claims about dementia for food supplements in Great Britain?
No. To state a health benefit for a food supplement in Great Britain the claim must appear on the GB Nutrition and Health Claims Register in the register's exact words, and no authorised claim relating to dementia or cognitive decline exists for any ingredient.
What can I actually do about the fourteen risk factors?
Five of them are measurable in a single GP appointment: blood pressure, LDL cholesterol, blood sugar, weight, and alcohol and smoking history. In England the NHS Health Check for 40 to 74 year olds covers broadly that ground. Two of the largest factors, hearing loss and untreated vision loss, are corrected with hearing aids and sight tests rather than medicine. Physical activity, social connection, staying cognitively active and wearing head protection are free.
What is the difference between a function claim and a reduction-of-disease-risk claim?
A function claim states that a nutrient contributes to something working normally in a healthy person, and there are hundreds of these on the GB register in fixed wording. A reduction-of-disease-risk claim states that a nutrient reduces the risk of a named condition; only a handful exist across the whole food industry, each authorised individually and naming the specific disease. Neither kind exists for dementia.
How this article was written
- Every figure comes from the report itself or from The Lancet’s own press material, not from secondary coverage. The sources are linked below so you can check any of them.
- We are not clinicians and this is not medical advice. We are a supplement company, which is exactly why the article says plainly that no supplement appears in the report — a reader is entitled to know what our interest is before weighing what we have written.
- Where a figure could not be verified we left it out rather than guessed. Nine of the fourteen individual percentages are not stated here for that reason, and the article says so where it matters.
- No claim is made for any product anywhere on this page, and there are no product links in it. That is deliberate, not an oversight.
- Last reviewed October 2026. The Lancet standing Commission reports periodically; we will update this article when it next does.
Sources — read it yourself
Everything above comes from the report itself rather than from coverage of it. The full citation:
Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. 2024;404(10452):572–628.
- The report on The Lancet — the published version of record
- The free full text at UCL Discovery — the accepted manuscript, open access. Worth knowing about, because the published version sits behind a paywall and this one does not
- The Lancet's own risk factor infographic — the published figure the percentages in this article come from
If anything here does not match what you find in the report, the report is right and we would want to know. There is a contact page on this site.
This article reports the findings of a published scientific report and is general information, not medical advice. It is not advice about any product. If you are concerned about your dementia risk, your blood pressure, your cholesterol, your hearing or your eyesight, speak to your GP — all of those can be checked. Food supplements should not be used as a substitute for a varied and balanced diet and a healthy lifestyle, and are not intended to diagnose, treat, cure or prevent any disease.
