Dementia Prevention
Dementia – Is It Really Inevitable?
When you go to medical school, you learn about three kinds of diseases:
the ones you can cure (like pneumonia),
the ones you can manage (like arthritis or asthma),
and the ones you can do nothing about.
For decades, dementia has sat firmly in that last category.
We wait until people are severely affected before we act. The medications for Alzheimer’s disease — though heavily marketed — offer, at best, small and short-lived benefits. In twenty years of practice, I’ve rarely seen meaningful improvement. It often feels like we’re “doing something,” but the truth is, those treatments don’t change the course of the disease.
The Shift in Thinking
Before the pandemic, I came across research on a new blood test measuring p-tau217, a protein produced in the brain during the earliest stages of Alzheimer’s disease. It struck me — if we can see the changes decades before symptoms appear, why are we still waiting until it’s too late?
I wasn’t the only one asking that question.
Dr Dale Bredesen, a neurologist and researcher at UCLA and the Buck Institute for Research on Aging, had already been exploring how to reverse cognitive decline by treating the many drivers of brain dysfunction, not just one.
The Bucket Analogy
Bredesen uses a simple but powerful analogy: imagine your brain as a bucket with 36 holes. Each hole represents a factor that contributes to cognitive decline — inflammation, insulin resistance, nutrient deficiencies, toxins, infections, lack of sleep, stress, or hormonal imbalance.
If you patch one hole, it doesn’t make much difference.
But patch up ten or twenty, and suddenly the bucket starts to hold water again.
That’s the idea behind his ReCODE programme (short for Reversal of Cognitive Decline): address the underlying causes in a personalised, multi-step way.
The Roots of Dementia
Dementia doesn’t appear overnight.
It develops silently over years — even decades.
Modern imaging and biomarker testing now show changes in the brain long before memory loss begins.
Think of it like fire prevention:
If you wait until the forest is in flames, it’s too late.
But if you spot the glowing cigarette butt and stamp it out, you can prevent disaster altogether.
The same logic applies to brain health.
The Three Major Drivers of Cognitive Decline
According to Dr Bredesen’s model, there are three main biological patterns (or “types”) of dementia. Most people have a mix of them:
Inflammatory (Type 1)
Caused by chronic inflammation — from infections, poor diet, gum disease, or ongoing stress.
Think of it as the brain’s immune system being constantly switched on.Atrophic or Glycotoxic (Type 2)
Driven by problems with energy and metabolism — too much sugar, insulin resistance, lack of key hormones or nutrients.
The brain isn’t getting the fuel or signals it needs to stay healthy.Toxic (Type 3)
Linked to exposure to toxins such as heavy metals, mould, air pollution, or chemical residues.
These toxins can damage nerve cells and disrupt communication in the brain.
Other factors — sleep, head trauma, infections, stress — can make any of these worse.
What Can We Do About It?
The good news is that many of these processes are modifiable.
By addressing them early, we can often slow or even reverse changes before dementia takes hold.
Some key strategies include:
Nutrition: adopt an anti-inflammatory, low-sugar, whole-food diet.
Sleep: treat sleep apnoea, establish good sleep hygiene.
Movement: exercise regularly for blood flow and insulin sensitivity.
Stress: use relaxation, mindfulness, and social connection.
Testing: measure key biomarkers such as HbA1c, fasting insulin, homocysteine, ApoB, vitamin D, and (if available) p-tau217.
Medical review: check thyroid, hormones, gut health, oral hygiene, and toxin exposure.
It’s about prevention, not reaction.
A New Way Forward
One day soon, screening for dementia risk will be as normal as checking blood pressure or cholesterol. Until then, it’s up to proactive clinicians and motivated patients to start the conversation.
I’m not waiting for the guidelines to catch up. My patients — and many others around the world — are choosing to act early. The risk of doing nothing is far greater than the “risk” of prevention.
