Up to 45% of dementia cases are linked to 14 factors you can influence. Plus a podcast conversation with Aeon’s Chief Medical Officer, Dr Manuel Puntschuh.

In episode 013 of the podcast “die gesunde unterhaltung”, host Tom talks for almost three hours with Dr Manuel Puntschuh, Aeon’s Chief Medical Officer. They cover the heart, metabolism and dementia, and with them the question of how we want to grow old. The episode is in German. You can find it on Apple Podcasts and Spotify.

This article gives you an overview before you listen: what does the research say about dementia risk factors, and how do the heart, metabolism and brain fit together? If you’ve already heard the episode, the background article on the episode puts the content in order and sets the studies next to it.

What the episode is about

Three topics run through the conversation:

  • The heart and blood vessels. Why a heart attack is the late event in a process that begins decades earlier.
  • Metabolism. What insulin resistance is, and why it can go unnoticed for a long time.
  • Dementia. How blood vessels and metabolism might be connected to the brain.

Dr Puntschuh is a specialist in general internal medicine and used to work as a senior physician in an emergency department. Today he’s Chief Medical Officer at Aeon. That’s part of the context: he speaks as a doctor and as part of our team.

The episode is a conversation, not a study. It also touches on cancer screening, hormone therapy and medication. We don’t assess those topics here, because they involve treatment decisions that belong in a conversation with your doctor.

Dementia risk factors: what the research says

When a family member develops dementia, the same question comes up sooner or later: what about me? According to Alzheimer Schweiz, around 166,300 people in Switzerland are currently living with dementia. So it’s not a niche question.

Part of the answer comes from research. In its 2024 report, the Lancet Commission on dementia (Livingston et al.) names 14 factors that can be influenced over the course of a life. The calculation behind it: up to 45% of dementia cases could in theory be prevented or delayed if all 14 were eliminated.

That’s a figure for the population, not a forecast for you. But it shows how much room there is overall.

The room to act, according to the Lancet Commission

Calculated share, not a forecast for any one person.

up to 45% of dementia cases could in theory be prevented or delayed if all 14 factors were eliminated. Share linked to the 14 factors Other cases
Schematic illustration of the estimate by Livingston et al. (2024), not patient data.

/The factors range from less schooling, through hearing loss and smoking, to untreated vision loss in later life. Several of them concern blood vessels and metabolism, which also matter for the heart: high blood pressure, high LDL cholesterol, excess weight, physical inactivity and diabetes.

How this connects to the heart and metabolism

Behind these factors, processes often start very early. A US autopsy study (Strong et al., 1999) found changes in the artery wall in people as young as 15 to 19. That doesn’t mean a 15-year-old has a heart problem. It shows that the process starts long before any symptoms.

Sugar and insulin metabolism change quietly too. In the British Whitehall II cohort (Tabák et al., 2009), blood sugar, insulin sensitivity and insulin production changed up to six years before type 2 diabetes was diagnosed. Diabetes is one of the Lancet Commission’s 14 factors, and a review in Nature Reviews Neurology (Arnold et al., 2018) describes how type 2 diabetes and Alzheimer’s disease overlap in risk factors, comorbidities and possible mechanisms.

Blood vessels, metabolism and the brain share many risk factors.

Whether metabolism helps cause dementia or simply runs alongside it is still partly open. The background article looks more closely at how far the evidence goes.

What you can take from this

The studies describe risk factors, not recipes. Still, they point to three questions you can ask at your GP practice:

  • How are my blood pressure and cholesterol? Both are among the Lancet Commission’s 14 factors. Get both measured, even if you feel well.
  • Where does my blood sugar stand? Ask about fasting blood sugar and HbA1c. For fasting values, you’ll come to the blood draw after several hours without eating. The practice will tell you exactly how long.
  • How are my values developing over the years? A single value is a snapshot. The trend tells you more.

Measuring more isn’t automatically better. What helps is what means something and what you can act on.

Conclusion

Dementia can’t be predicted, and it can’t be reliably avoided. But part of the risk sits in areas that can be measured and discussed: blood pressure, blood fats, weight, blood sugar. You don’t have to do everything perfectly. Knowing where you stand is enough for a start. And if you’d like to hear a doctor talk about all this, episode 013 is a good way in.

Listen to the episode Runtime: 2 hours 53 minutes, in German. You can also find it on Spotify.

Frequently asked questions

What exactly is episode 013 about?

The heart and blood vessels, metabolism and dementia across a lifetime. The conversation also touches on other topics such as cancer screening, hormone therapy and medication. We don’t assess these here because they involve treatment decisions that belong in a conversation with your doctor.

Who is Dr Manuel Puntschuh?

He’s a specialist in general internal medicine, used to be a senior physician in an emergency department and is now Chief Medical Officer at Aeon. His role at Aeon is part of the context: the episode isn’t an independent view from outside.

What does the 45% mean exactly?

The Lancet Commission calculated what share of dementia cases is linked to the 14 factors. If all of them were eliminated, up to 45% of cases could in theory be prevented or delayed. That applies to the population, not to any one person.

Does that mean I can avoid dementia?

No. The figure describes an association across the population. It doesn’t say that a healthy lifestyle means you won’t get dementia, or that having one of these factors means you will.

Does the episode replace a conversation with my GP?

No. A podcast episode and a blog article help you make sense of things. Neither is a diagnosis or a treatment recommendation. If you have questions about your health, your GP practice is the first port of call.

Sources