Preparing for dementia means taking action on two fronts: reducing your risk of developing it and putting legal, financial, and practical plans in place in case you or someone you love does. Up to 45% of dementia cases worldwide are linked to modifiable risk factors, according to the 2024 Lancet Commission report, which means a significant portion of cases could potentially be delayed or prevented. For the rest, the earlier you plan, the more control you retain over your care, your finances, and your quality of life.
Risk Factors You Can Actually Change
The Lancet Commission identified 14 modifiable risk factors with strong evidence behind them: lower education, hearing loss, high blood pressure, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption (more than 12 US standard drinks per week), traumatic brain injury, air pollution, social isolation, untreated vision loss, and high LDL cholesterol. You don’t need to tackle all 14 at once. Even addressing a few, like treating hearing loss with hearing aids, staying physically active, or managing blood pressure, meaningfully lowers your overall risk.
Some of these factors matter more at certain life stages. Education and head injury prevention matter most in early life. Hearing loss, high blood pressure, obesity, and excessive drinking become more important in midlife. Depression, social isolation, diabetes, physical inactivity, air pollution, and untreated vision loss carry the most weight after age 65. Knowing this helps you prioritize: if you’re in your 40s, getting your blood pressure and cholesterol checked is one of the highest-impact things you can do.
Diet and Physical Activity
The MIND diet, a hybrid of the Mediterranean and DASH diets, was designed specifically with brain health in mind. It emphasizes green leafy vegetables, other vegetables, berries (over other fruits), whole grains, beans, nuts, fish at least once a week, and olive oil as the primary cooking fat. It limits red meat, sweets, cheese, butter and margarine, and fast or fried food. You don’t need to follow it perfectly. Even moderate adherence has been associated with slower cognitive decline in observational studies.
Physical activity works through multiple pathways: it improves blood flow to the brain, helps regulate blood sugar, reduces inflammation, and lowers the risk of depression and obesity, which are themselves risk factors. The type of exercise matters less than consistency. Walking, swimming, gardening, and dancing all count. Aim for regularity rather than intensity.
Recognizing Early Cognitive Changes
Normal aging causes some memory slips, like occasionally forgetting a name or misplacing your keys. Mild cognitive impairment (MCI) is different. People with MCI notice a measurable decline in memory, planning ability, or decision-making that goes beyond what’s expected for their age and education level. The key distinction is that daily life remains largely intact. You can still manage your finances, drive, and live independently, but you or the people close to you notice that something has shifted.
If you’re concerned, a doctor can administer a brief screening test such as the Montreal Cognitive Assessment (MoCA) or the Mini-Mental State Examination (MMSE). These take about 10 to 15 minutes and test memory, attention, language, and spatial reasoning. On the MoCA, a score below 26 out of 30 is the standard threshold for mild cognitive impairment. A family member or close friend is often asked to confirm whether they’ve noticed changes, since people with early cognitive decline sometimes underestimate their own symptoms. Not everyone with MCI progresses to dementia, but catching it early gives you the most time to plan.
Legal Documents to Complete Now
Dementia eventually impairs the ability to make decisions, which means the window for legal planning closes. These are the documents to prioritize while you or your loved one still has full decision-making capacity:
- Durable power of attorney for finances: Names someone to manage bank accounts, pay bills, handle investments, and make financial decisions when you no longer can.
- Durable power of attorney for health care: Names a health care proxy, someone who can make medical decisions on your behalf if you can’t communicate your wishes. This person should understand your values and preferences deeply.
- Living will: Spells out which medical treatments you want or don’t want in emergency situations, including the specific conditions under which each choice applies.
- Will: Directs how your property, money, and other assets are distributed after death. It can also address care for dependents and pets.
- Living trust: Names a trustee to hold and distribute your property and funds on your behalf when you can no longer manage your own affairs. Unlike a will, a trust can take effect while you’re still alive.
Most states require advance directives to be witnessed by two adults, and some require notarization. Once completed, give copies to your health care proxy, your alternate proxy, and your doctors. Store originals in a safe but accessible place, and tell the people you trust where to find them. Review and update these documents at least once a year or after any major life change.
Financial Planning and Insurance
The cost of dementia care is substantial, and it escalates as the disease progresses. Long-term care insurance can help cover in-home care, assisted living, and nursing home stays, but the details of each policy vary considerably. Most policies require a defined level of physical or cognitive impairment before they start paying. They also have an elimination period, a waiting window between when you qualify and when benefits actually begin. If you’re considering long-term care insurance, buying it in your 50s or early 60s is typically more affordable and more likely to result in approval.
Beyond insurance, organize your financial records so someone else can step in if needed. This means documenting bank accounts, retirement accounts, debts, recurring bills, insurance policies, and any income sources like pensions or Social Security. A trusted family member or financial advisor should know where to find all of this. If a diagnosis has already occurred, acting quickly on these steps is critical, because legal and financial decisions made after cognitive capacity has declined can be challenged or invalidated.
Making the Home Safer
Home safety modifications can be made gradually and don’t require a major renovation. Start with the most immediate risks and build from there.
Falls are the biggest physical danger. Mark stair edges with brightly colored tape so they’re easier to see. Install nightlights and automatic light sensors in hallways, bathrooms, and bedrooms. Choose wall colors that contrast with the floor so boundaries between surfaces are clear, and avoid busy patterns on flooring or walls that can cause visual confusion. Place nonskid mats or adhesive strips in the bathtub, shower, and on uncarpeted bathroom floors. Install grab bars in the shower and beside the toilet, ideally in a color that contrasts with the wall so they’re easy to spot.
In the kitchen, add safety knobs and an automatic shut-off switch to the stove. Lock cabinets and drawers that contain knives, cleaning chemicals, or medications. Pad sharp furniture corners or remove sharp-edged furniture entirely. Place eye-level decals on sliding glass doors and large glass panels so they’re visible. Store any potentially dangerous items, including firearms, power tools, and toxic substances, in a locked area or remove them from the home altogether. Install bed rails if nighttime falls are a concern.
Planning for Future Care Needs
Dementia is progressive, and care needs will change over time. Early on, a person may only need reminders and occasional help with complex tasks like managing medications or finances. In middle stages, they may need daily assistance with cooking, bathing, and dressing. In later stages, around-the-clock supervision becomes necessary, and behaviors like wandering or aggression can make staying at home unsafe.
It helps to think through these stages before they arrive. Talk with your family about preferences: Would you want to stay at home with hired caregivers for as long as possible? Would an assisted living community be acceptable? What about a memory care unit in a nursing home? These conversations are easier and more productive when the person with the diagnosis can still participate. Write down the answers and revisit them as circumstances change.
Long-term care options range from in-home aides who visit for a few hours a day, to adult day programs that provide structured activities and supervision, to full residential facilities. Researching options in your area early, even just visiting a few places, removes some of the pressure of making these decisions during a crisis.
Building a Support Network
Caregiving for someone with dementia is physically and emotionally demanding, and isolation makes it worse. In-person and online support groups give families a space to share experiences, ask questions, and hear from people further along in the process. The Alzheimer’s Association, the NIA’s ADEAR Center (reachable at 800-438-4380), and local Area Agencies on Aging are practical starting points for finding support groups, respite care, and educational resources.
Respite care, where another caregiver temporarily takes over so the primary caregiver can rest, is one of the most important and underused resources available. It can be arranged through home health agencies, adult day programs, or short-term stays at residential facilities. Building these supports into your plan early, rather than waiting until burnout sets in, makes caregiving sustainable over the years that dementia typically spans.