Education & cognitive reserve
Context & backgroundTrue Mind weight: Context only · not directly scored in v1
Evidence snapshot
Lower formal education is consistently linked with higher dementia risk at the population level, likely via lower cognitive reserve. Lifelong learning and mentally effortful activities appear protective even later in life.
Anchor study: Livingston et al., Lancet Commission 2024 – dementia prevention, intervention, and care.
Example tiny habit
After breakfast on weekdays, spend 10 focused minutes on a mentally effortful activity (language app, structured course, or serious reading) before opening email or social media.
Air pollution (fine particles & traffic-related)
Context & backgroundTrue Mind weight: Context only · not directly scored in v1
Evidence snapshot
Chronic exposure to fine particulate air pollution (PM2.5) and traffic-related pollutants is associated with modestly higher dementia risk, probably via vascular injury and neuroinflammation.
Anchor study: Recent meta-analyses of PM2.5 and dementia (e.g., large multicohort studies summarized in the Lancet Commission 2024).
Example tiny habit
Pick one high-traffic route you use regularly and replace it with a cleaner alternative (side street, park path, or indoor walking) on two days per week to start.
Blood pressure (hypertension)
Body & cardiovascularTrue Mind weight: 2 · Moderate weight in True Mind
Evidence snapshot
Mid- and late-life hypertension is robustly associated with higher dementia risk; trials like SPRINT-MIND suggest that tighter BP control reduces cognitive decline risk in higher-risk adults.
Anchor study: SPRINT-MIND (Williamson et al., JAMA 2019) – intensive BP control reduced combined MCI/dementia outcomes.
Example tiny habit
After brushing your teeth at night, sit down, put your feet on the floor, and take one home BP reading, writing it in the same small notebook or phone note every time.
High LDL cholesterol
Body & cardiovascularTrue Mind weight: 7 · One of the heavier weights in True Mind
Evidence snapshot
Newer analyses link elevated LDL and atherosclerosis with higher risk of vascular and mixed dementias; lipid-lowering and overall vascular risk management appear protective.
Anchor study: Livingston et al., Lancet Commission 2024 – high LDL added as a new, higher-impact late-life risk factor.
Example tiny habit
On the same day each week (e.g., Monday lunch), open your patient portal and glance at your last lipid panel; if >12 months old, send yourself a one-line note to ask your clinician about repeat testing.
Diabetes and glycaemia
Body & cardiovascularTrue Mind weight: 2 · Moderate weight in True Mind
Evidence snapshot
Type 2 diabetes and poor glycaemic control are associated with substantially higher dementia risk, possibly via microvascular injury, inflammation, and hypoglycaemia-related insults.
Anchor study: Cao et al., meta-analysis 2024 – diabetes accounts for ~5% of dementia PAF in pooled cohorts.
Example tiny habit
After your main evening meal, take 60 seconds to log what you ate and any glucose reading in the same place every day; use that log at your next visit to adjust meds or diet.
Obesity & central adiposity
Body & cardiovascularTrue Mind weight: 1 · Lighter but still meaningful weight
Evidence snapshot
Midlife obesity and central adiposity are associated with higher dementia risk, likely via vascular, inflammatory, and metabolic pathways; the relationship is more complex in late life.
Anchor study: Brenowitz et al., 2021 – midlife obesity associated with higher later dementia risk; late-life underweight patterns differ.
Example tiny habit
Attach one tiny food swap to a fixed cue: for example, after you plate dinner, automatically add a fist-sized portion of vegetables before anything else goes on the plate.
Physical inactivity
Body & cardiovascularTrue Mind weight: 2 · Moderate weight in True Mind
Evidence snapshot
Higher regular physical activity is associated with lower incidence of all-cause dementia and Alzheimer’s disease, with benefits seen even at moderate doses.
Anchor study: Meta-analyses of physical activity and dementia (e.g., Iso-Markku et al., Br J Sports Med 2022).
Example tiny habit
Pick one daily cue you already have (e.g., after morning coffee) and add a 5-minute brisk walk to it; only increase duration once that 5-minute loop feels automatic for 2–3 weeks.
Hearing loss
Senses & headTrue Mind weight: 7 · One of the heaviest weights in True Mind
Evidence snapshot
Hearing loss is one of the largest modifiable contributors to dementia risk; treating hearing loss with hearing aids or other interventions appears to slow cognitive decline in older adults at elevated risk.
Anchor study: ACHIEVE trial (Lin et al., Lancet 2023) – hearing intervention slowed cognitive decline over 3 years in higher-risk adults.
Example tiny habit
Within the next month, set one specific cue to act: for example, when you finish this assessment, write down a date in your calendar titled “Book hearing test” and treat it like any other medical appointment.
Vision loss
Senses & headTrue Mind weight: 2 · Moderate weight in True Mind
Evidence snapshot
Emerging data suggest untreated visual impairment is linked to higher dementia risk, plausibly via reduced stimulation, social withdrawal, and shared vascular pathways; cataract surgery and vision correction may be protective.
Anchor study: Summarized in the Lancet Commission 2024 – recent cohorts link untreated visual impairment with higher dementia risk.
Example tiny habit
Tie your eye care to a date you’ll remember: each year in your birthday month, schedule or confirm a comprehensive eye exam and add it as a repeating calendar event.
Traumatic brain injury (TBI)
Senses & headTrue Mind weight: 3 · Mid-range weight in True Mind
Evidence snapshot
Moderate–severe TBI and repeated head injuries are consistently linked with higher dementia risk; prevention and avoiding further injuries are key, especially for people with prior TBI.
Anchor study: Meta-analyses of TBI and dementia (e.g., Kuring et al. 2020) – prior TBI, especially multiple or severe, increases dementia risk.
Example tiny habit
Create a “helmet first” rule: whenever you touch your bike/scooter or step onto a ladder, the very next action is to put on your helmet or check your footing before anything else.
Smoking
Mind & lifestyleTrue Mind weight: 2 · Moderate weight in True Mind
Evidence snapshot
Current smoking is associated with substantially higher dementia risk; large cohorts show that quitting, especially in midlife, meaningfully reduces that excess risk over time.
Anchor study: Jeong et al., JAMA Netw Open 2023 – smoking cessation was associated with lower dementia risk vs continued smoking.
Example tiny habit
Choose one high-risk time of day (e.g., after lunch) and pre-decide a replacement routine: when the urge hits, you automatically walk for 3 minutes or drink a glass of water before making any decision about smoking.
Harmful alcohol use
Mind & lifestyleTrue Mind weight: 1 · Lighter weight but still relevant
Evidence snapshot
Heavy or binge-pattern alcohol use is associated with increased risk of dementia and other brain outcomes; there is no clear ‘safe’ threshold for brain health.
Anchor study: Summarized in the Lancet Commission 2024 – heavy and binge drinking are associated with higher dementia risk.
Example tiny habit
Pick two “automatic no-alcohol nights” each week (for example, Sunday and Monday) and decide in advance what you’ll drink instead (tea, sparkling water) so the decision is made before the craving.
Depression & persistent low mood
Mind & lifestyleTrue Mind weight: 3 · Mid-range weight in True Mind
Evidence snapshot
Depression is associated with about a doubling of dementia risk in many cohorts; it may partly be prodromal, but treating depression and supporting mental health is important for quality of life and may reduce risk.
Anchor study: Elser et al., JAMA Neurol 2023 & subsequent meta-analyses – depression across the life course is linked with higher dementia risk.
Example tiny habit
Set a simple daily check-in: at the same time each evening, write one sentence about how your mood was that day and one small thing that helped, then bring that log to your next clinician visit.
Low social contact & isolation
Mind & lifestyleTrue Mind weight: 5 · Relatively heavy weight in True Mind
Evidence snapshot
Low social contact and persistent loneliness are consistently associated with higher dementia risk; regular, meaningful social engagement appears protective.
Anchor study: Recent systematic reviews on loneliness/social isolation and dementia, summarised in the Lancet Commission 2024.
Example tiny habit
Choose one weekly social cue: for example, every Sunday after breakfast, send a short message or make a 5-minute call to one person you’d like to keep in your life.
