The document discusses risk and protective factors for brain health. It identifies several modifiable risk factors like alcohol consumption, poor sleep, diabetes, obesity, and hearing loss that are associated with higher risks of dementia. Protective factors discussed include a healthy diet high in Mediterranean foods, regular physical activity, social engagement, and mentally stimulating activities. Maintaining these protective factors and managing risk factors may help reduce risks to brain health and cognitive decline.

1. Brain Health
Image credits. Sleep, lightbulb in head: Unknown author licensed by CC BY-NC-ND; Scales: Unknown author licensed by CC BY-SA; Brain, diet: Unknown author licensed by CC BY-NC. Diabetes, beer, group and exercise: no image credits.
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

2. Brain
Health
Image credits. Sleep, lightbulb in head: Unknown author licensed by CC BY-NC-ND; Scales: Unknown author licensed by CC BY-SA; Brain, diet: Unknown author licensed by CC BY-NC. Diabetes, beer, group and exercise: no image credits.
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).
Notes on this presentation
This presentation was developed
by Sarah Gregory. It is intended to
be used as an open educational
resource for anyone with an
interest in risk and protective
factors for brain health. Slides can
be adapted for the purpose
needed.
Some suggested tasks are given
on the final slide that may be
helpful to those using these slides.

3. Risk Factors
Here we present some of the
modifiable risk factors for poor brain
health:
- Alcohol
- Poor sleep
- Diabetes
- Obesity
- Hearing loss
Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

4. Alcohol
• Excessive alcohol
consumption is >21
units/week1
• In midlife this has a 1.2 (95%
CI: 1.1-1.3) relative risk for
dementia1
• Some studies find
>14units/week are harmful to
brain health2
• Abstinence may also be
harmful to brain health2
1Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6; 2Sabia et al, 2018,
BMJ, DOI: https://doi.org/10.1136/bmj.k2927
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

5. Sleep
• Higher risks of dementia
associated with:
• Low sleep duration (< 5 hours)
• High sleep duration (> 10
hours)
• Better sleep is associated with
better cognitive functioning2
• Sleep quality is as important as
sleep duration, with longer sleep
latency associated with poorer
brain health3
1Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6; 2Mantua & Simonelli, 2019,
Sleep, DOI: https://doi.org/10.1093/sleep/zsz010; 3Brown et al, 2016, Sleep, DOI: https://doi.org/10.5665/sleep.5756
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

6. Diabetes
• Older adults with type 2
diabetes experience:
• Global cognitive
decline twice the rate
of those without
diabetes1
• 1.5 times increased
risk of AD2,3
• Increasing to 5.5
times increased risk
of AD when
combined with
APOE4 gene4
1Tilvis et al, 2004, Journals of Gerontology, DOI: 10.1093/gerona/59.3.m268; 2Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6;
3Biessels et al, 2006, Lancet Neurology, DOI: 10.1016/S1474-4422(05)70284-2; 4Peila et al, 2002, Diabetes, DOI: 10.2337/diabetes.51.4.1256
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

7. Obesity
• Being obese in midlife has a 1.6
(95% CI: 1.3-1.9) relative risk for
dementia1
• Being overweight (i.e. BMI 25-30)
is not associated with dementia1
• Weight loss of 2kg or more was
associated with significant
improvements in attention and
memory in obese participants1
1Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

8. Hearing loss
• Hearing loss is defined by the
threshold of 25dB (WHO)
• Having hearing loss in midlife has a
1.9 (95% CI: 1.4-2.7) relative risk
for dementia1
• Hearing aids appear to negate the
risk imparted by hearing loss1
1Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

9. Protective Factors
Here we present some of the
modifiable protective factors for
poor brain health:
- Healthy diet
- Physical activity
- Social activity
- Mentally stimulating activity
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

10. Healthy diet
• The Mediterranean diet is the most
commonly studied ‘healthy’ eating
pattern
• Eating the Mediterranean diet is
associated with:
• Better cognitive function1
• Lower cognitive decline1
• Reduced risk for Alzheimer’s
disease1
• More favourable Alzheimer’s
disease biomarker profile2
1Lourida et al, 2013, Epidemiology, DOI:10.1097/EDE.0b013e3182944410; 2Hill et al, 2019, Neurobiol Aging,
DOI:10.1016/j.neurobiolaging.2018.12.008
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

11. Physical activity
• Exercise is associated with reduced risk of
dementia1
• Specifically physical activity is associated
with reduced risk of Alzheimer’s disease2
• There appears to be a dose dependent
relationship, with more vigorous exercise
leading to more benefit3
• Physical inactivity in later life has a 1.4
(95% CI: 1.2-1.7) relative risk for
dementia3
1Hersi et al, 2017, NeuroToxicology, DOI:https://doi.org/10.1016/j.neuro.2017.03.006; 2Livingston et al, 2017, Lancet, DOI:
https://doi.org/10.1016/S0140-6736(17)31363-6; 3Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

12. Social activity
• Higher rates of dementia are seen
in people in the following marital
status categories1:
• Lifelong single
• Widowed
• High social contact is associated
with better late life cognitive
functioning2
• Social isolation in later life has a
1.6 (95% CI: 1.3-1.9) relative risk
for dementia3
1Sommerlad et al, 2017, JNNP, DOI:http://dx.doi.org/10.1136/jnnp-2017-316274; 2Evans et al, 2019, Journal of Alzheimer’s Disease, DOI:
10.3233/JAD-180501; 3Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

13. Mentally stimulating
activity
• Staying cognitively active in
later life may1:
• Reduce dementia risk
• Promote cognitive
functioning
• Reduce cognitive decline
• Low education in early life has
a 1.6 (95% CI: 1.3-2.0)
relative risk for dementia1
1Livingston et al, 2020, The Lancet, DOI: https://doi.org/10.1016/S0140-6736(20)30367-6
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).

14. Brain
Health
Image credits. Sleep, lightbulb in head: Unknown author licensed by CC BY-NC-ND; Scales: Unknown author licensed by CC BY-SA; Brain, diet: Unknown author licensed by CC BY-NC. Diabetes, beer, group and exercise: no image credits.
© Sarah Gregory, University of Edinburgh , 2022, CC BY (unless otherwise stated).
Interested in finding out more?
• Take the ‘My Brain Health’ quiz
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and build your own Brain Health
Plan.
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Research to find out about study
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• Continue your learning with the
free online course from Brain
Health Scotland ‘Understanding
Brain Health and Preventing
Dementia’