What modifiable risk factors for dementia can I address now?

The Lancet Commission on dementia has identified factors accounting for approximately 45% of dementia cases globally, including physical inactivity, hypertension, obesity, smoking, excessive alcohol, depression, social isolation, diabetes, air pollution, and sensory impairment (hearing and vision). The Maintain Your Brain trial specifically targeted physical activity, nutrition, cognitive training, and mental health. MYB+ also adds cardiovascular health and social connection. All of these can be discussed with your GP and most can be addressed with supported lifestyle change.

How do I participate in the MYB+ trial?

The MYB+ trial is recruiting Australians aged 45–79 nationally, with particular interest in rural and regional participants. Details are available through the UNSW Centre for Healthy Brain Ageing (CHeBA) at https://www.unsw.edu.au/cheba. You do not need to have memory concerns to participate — the trial targets people before symptoms appear, which is the entire point of the intervention window.

Dementia prevention works. Australia's landmark trial is going national

What just happened

Australia’s landmark dementia prevention trial has secured $3 million in Federal Government funding to expand nationally — and this time, it is recruiting from age 45.

The Maintain Your Brain (MYB) trial, co-developed by Professor Henry Brodaty at UNSW, enrolled 6,000 New South Wales participants aged 55–77 between 2018 and 2021. Half received information about dementia risk factors. The other half received personalised online coaching across four domains — physical activity, nutrition, cognitive activity, and mental health — sustained over three years. The result, published in Nature Medicine, was a significant improvement in cognition in the coaching group compared with the information-only group.

That is a randomised controlled trial, not an observational study. Not a correlation. Not a surrogate endpoint chosen for statistical convenience. It is robust evidence that lifestyle intervention at scale can measurably slow cognitive decline in the domain we actually care about: cognition itself.

The expanded programme, MYB+, will recruit approximately 5,000 Australians aged 45–79 nationally over five years, with particular emphasis on rural and regional communities and the addition of several new risk-factor targets.

The both-and

The evidence that dementia risk is substantially modifiable is now strong enough to act on. The complication is that this is harder than taking a tablet — it requires sustained, coached behaviour change across multiple domains over years, and the health system is not yet built to deliver it at scale.

What the original trial actually showed

MYB was not a supplement study or a single-component dietary intervention reporting blood markers. It was a three-year randomised controlled trial with cognition as the primary outcome — the outcome that matters for people, not for research papers. The coaching group had significantly better cognition at three years. This result is what justified the $3 million national expansion it just received.

The four domains in the original trial — physical activity, nutrition, cognitive training, and mental health — map directly onto modifiable risk factors identified by Lancet Commission modelling as accountable for approximately 45% of dementia cases globally. MYB+ extends the target list to social isolation, cardiovascular health, hearing and vision impairment, and diabetes — each with its own evidence for dementia risk modification.

This accumulation of evidence is important: it tells us that dementia is not an inevitable consequence of ageing that arrives regardless of what you do in the decades before. It is substantially shaped by how you live, starting well before the first symptom appears.

Why the expanded trial starts at age 45

MYB+ targets participants from age 45 — a decade younger than the original trial. This reflects growing understanding that the pathological processes underlying Alzheimer’s disease, the most common cause of dementia, begin 15–20 years before symptoms are clinically apparent. The amyloid burden, the neuroinflammation, the vascular compromise — these processes are already underway in the decade before diagnosis, often in the decade before that.

By the time a person is 65 and concerned about memory, the window for maximum intervention impact has narrowed. The MYB evidence suggests the ideal intervention window is in midlife — and MYB+ has been designed to test that hypothesis at scale.

This is an uncomfortable reframe for most people. The woman in her mid-forties managing perimenopause, work, and compounding responsibilities may reasonably feel that dementia is a problem for future-her. The trial is designed on the premise that future-her would prefer that present-her pays attention now.

What the intervention looks like in practice

The MYB model used personalised online coaching rather than in-person clinic visits, enabling reach into regional and rural communities that face persistent barriers to specialist-level preventive care. The expansion to rural and regional Australia is deliberate: dementia risk is compounded by limited access to preventive services, social isolation, and lower detection rates for manageable conditions like hypertension and hearing loss.

There is no medication in this trial. No pharmaceutical intervention. The active ingredients are structured coaching, accountability, and behavioural change — harder to sustain than a tablet, and harder for the health system to fund than a prescription pad. Dr Marita Long, a GP and representative of Dementia Australia, captured the core issue in commentary on the expansion: “Prevention is better than cure and there is no cure at the moment, so prevention is really our best shot.”

2 cents

Two concrete steps this week.

First: if you are between 45 and 79 and interested in participating in MYB+, the trial is now recruiting nationally. The UNSW Centre for Healthy Brain Ageing has details. You do not need existing memory concerns to participate — the whole point of the trial is to intervene before symptoms appear.

Second: if trial participation is not for you, the modifiable risk factors identified in MYB are not waiting for the trial to finish. Physical activity, blood pressure management, treating depression, protecting your hearing, staying socially connected — these are decisions you can make with your GP today, not a decade from now when the question becomes more urgent.

This is general health information and does not constitute individual clinical advice.

Verdict

Verdict: yes — worth knowing about.

Australia’s most robust dementia prevention trial has shown that personalised lifestyle coaching over three years significantly improves cognition, and is now expanding nationally to recruit from age 45. For anyone in midlife thinking about long-term cognitive health, the science is clear enough to act on, and MYB+ offers a direct pathway to participate in the evidence that will shape how Australian general practice approaches this challenge.