Routine primary care is where dementia prevention actually happens: blood pressure checks, cholesterol panels, hearing checks, and the Medicare Annual Wellness Visit all target the modifiable risk factors research has linked to dementia risk. The 2024 Lancet Commission on dementia prevention identified 14 such factors and estimated that eliminating them could prevent or delay about 45% of dementia cases worldwide, according to the Lancet Commission's findings.
That 45% figure describes what primary care visits are built to address, not a guaranteed outcome. It is a modeled estimate assuming the 14 factors are causal and fully eliminated, not a measured result from any single treatment or trial, a distinction the Commission's own framing makes explicit. What follows covers which checks matter, what the trial evidence actually shows, and how to use a routine visit to act on it.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- The 14 risk factors a checkup can catch
- What blood pressure control actually does to dementia risk
- Does treating hearing loss actually protect cognition?
- Should you ask for a cognitive screening test?
- Turning this into a checklist for your next visit
- Frequently Asked Questions
The 14 risk factors a checkup can catch
The Lancet Commission's list covers less education, hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol, social isolation, air pollution, and untreated vision loss. Most of these surface routinely in a primary care visit: blood pressure readings, lipid panels, diabetes screening, a weight check, and questions about mood, drinking, smoking, and social contact are standard parts of adult care, per the 2024 Commission report.
Hearing and vision loss are easy to overlook because they don't feel like brain health issues. A primary care clinician who asks about hearing difficulty or flags an overdue vision check is addressing two of the 14 factors directly, even though neither shows up on a blood test.
- Ask your clinician to check: blood pressure, LDL cholesterol, blood sugar, weight, hearing, and vision at your next visit.
- Mention mood changes, heavy drinking, smoking, or feeling isolated — these count as risk factors too, even without a specific test.
- Bring up any past head injury; traumatic brain injury is on the list and often goes unmentioned in a routine visit.
What blood pressure control actually does to dementia risk
Hypertension is one of the better-studied factors on the list, and the evidence is more specific than "lower is better." In the NIH-funded SPRINT MIND trial, 9,361 adults aged 50 and older with hypertension were assigned to a systolic blood pressure target below 120 mmHg or the standard target below 140 mmHg. Intensive treatment did not significantly reduce probable dementia on its own — 149 cases versus 176 — but it did significantly lower mild cognitive impairment, 14.6 cases per 1,000 person-years versus 18.3, according to the NIH's 2019 report on the trial.
When the trial combined MCI and dementia into one outcome, intensive treatment showed a clear benefit: 20.2 cases per 1,000 person-years versus 24.1, a 15% relative reduction, per the same NIH analysis. That gives primary care a concrete, actionable target rather than a vague directive. Asking a clinician where your blood pressure goal sits, and whether a tighter target below 120 mmHg systolic is appropriate for you, is a direct way to act on this evidence.
Does treating hearing loss actually protect cognition?
The answer depends on who is being treated. The ACHIEVE trial gave hearing aids to 977 adults aged 70 to 84 with untreated hearing loss and compared them to a health-education control group over three years. Across the full study group, hearing aid use did not significantly slow cognitive decline, per the ACHIEVE trial results.
The result changed in a specific subgroup. Among 238 older, already-cognitively-vulnerable participants drawn from the ARIC cohort, hearing aids plus counseling slowed cognitive decline by about 48%, according to the same ACHIEVE findings. That pattern suggests hearing correction matters most for patients who already show early risk signs, not as a blanket intervention for every older adult with hearing loss. A primary care hearing check is still useful groundwork — it identifies who falls into that higher-risk group — but it is not a guarantee that a hearing aid alone will change cognitive trajectory for everyone who gets one.
Should you ask for a cognitive screening test?
Not automatically, and that is worth knowing before you ask. The U.S. Preventive Services Task Force's standing recommendation, in effect since February 2020 and still under review as of a June 2025 update to its topic page, concludes that evidence remains insufficient to recommend for or against routine cognitive-impairment screening in adults 65 and older who have no symptoms, according to the USPSTF recommendation. The Task Force does advise clinicians to stay alert to early symptoms as they arise.
Because blanket screening isn't recommended, the practical opportunity is the Medicare Annual Wellness Visit, which the Alzheimer's Association directs primary care toward for patients 55 and older. The visit allows for brief structured cognitive tools that take under five minutes to administer. Those tools detected more than 80% of patients later diagnosed with mild cognitive impairment or dementia, compared with 59% detected through physician observation alone, per the Alzheimer's Association's guidance for clinicians. If you're 55 or older, confirming that your Annual Wellness Visit includes one of these brief tools is a more targeted ask than requesting a general cognitive screening.
Turning this into a checklist for your next visit
A single visit won't cover all 14 risk factors at once, but a short list makes it manageable to work through over a year of routine care.
- Confirm your blood pressure target, and ask whether a systolic goal below 120 mmHg applies to you, per the SPRINT MIND findings.
- Get LDL cholesterol and blood sugar checked if it's been more than a year.
- Report any hearing difficulty — age, cognitive risk factors, and symptom severity determine whether a hearing aid trial is worth discussing.
- Don't skip a vision check; untreated vision loss is on the Lancet Commission's list alongside hearing loss.
- If you're 55 or older, ask whether your Annual Wellness Visit includes a brief structured cognitive tool rather than relying on general conversation to catch early changes.
Frequently Asked Questions
Does lowering blood pressure prevent dementia?
SPRINT MIND found intensive blood pressure treatment significantly reduced mild cognitive impairment and the combined MCI-or-dementia outcome, but did not significantly reduce probable dementia alone when measured by itself.
Will a hearing aid protect my memory?
The ACHIEVE trial found no significant benefit across the full study group, but a roughly 48% slower cognitive decline in a higher-risk subgroup of older, already-vulnerable participants.
Should every older adult get a cognitive screening test at checkups?
The USPSTF says evidence is insufficient to recommend routine screening for adults 65 and older without symptoms; the more established path is a brief cognitive tool during the Medicare Annual Wellness Visit for those 55 and older.
