WHO broadens dementia prevention guidance with new targets for clinicians

Clinical takeaway: Assess dementia risk across the life course and address multiple modifiable factors together—especially physical inactivity, smoking, harmful alcohol use, unhealthy diet, obesity, hypertension, diabetes, dyslipidemia, hearing loss, and social or cognitive inactivity—while avoiding drugs or supplements solely for dementia prevention when evidence is insufficient.

The World Health Organization’s second-edition guideline updates its 2019 recommendations for adults without dementia, including those with mild cognitive impairment. WHO emphasizes individualized, multidomain interventions that address at least 3 relevant risk factors, such as physical activity, diet, cognitive training, social engagement, and vascular or metabolic risk management. This new conditional recommendation is supported by moderate- to high-certainty evidence, although observed cognitive benefits were generally small.

WHO continues to strongly recommend physical activity for cognitively normal adults and tobacco-cessation interventions for all tobacco users. Healthy, balanced dietary patterns may be recommended, but vitamins B and E, omega-3 fatty acids, and multivitamin/mineral supplements should not be used specifically to prevent cognitive decline or dementia in people without diagnosed deficiencies.

Clinicians may offer management of hypertension and diabetes for potential cognitive benefit, while following established disease-specific guidance. However, intensive glucose or blood-pressure control has not shown clear additional dementia-prevention benefit. Dyslipidemia should be managed in midlife; statins should not be started solely to prevent dementia but remain appropriate for cardiovascular indications.

Menopausal hormone therapy should not be initiated specifically to reduce cognitive decline or dementia risk in women aged 65 years or older. Evidence is insufficient for this purpose in younger women. For depression, treatment remains important, but dementia-prevention evidence is inadequate; in older adults, WHO advises minimizing anticholinergic burden by generally avoiding tricyclic antidepressants and paroxetine when alternatives are available.

“What these guidelines send is a clear signal…There are concrete, evidence-based steps people can take to support their brain health, and we have an obligation to reach more of them sooner,” said Heather M. Snyder, PhD, of the Alzheimer’s Association.

What’s changed

• New recommendations address sleep, stroke, traumatic brain injury, vision impairment, HIV, air pollution, menopausal hormone therapy, and multidomain interventions.
• Hearing aids may now be offered to adults with hearing loss for possible dementia-risk reduction.
• Cognitive stimulation and social-activity interventions may be encouraged.
• Dietary guidance now favors any healthy, balanced pattern rather than emphasizing a Mediterranean-style diet alone.
• Evidence remains insufficient to recommend specific sleep treatments, post-stroke drugs, post-TBI interventions, vision treatments, antidepressants, or particular antiretroviral regimens solely to prevent dementia.

Source: World Health Organization. (2026 Jul 15) Risk reduction of cognitive decline and dementia: WHO guidelines, second edition