Avoiding high blood pressure, diabetes, and smoking in midlife was associated with substantially more years lived without dementia.
Three common health factors in middle age may be linked to how many years a person lives without dementia. Adults with normal blood pressure, no diabetes, and no history of smoking lived nearly 13 years longer without dementia than people who had all three vascular risk factors.
The findings, published August 5, 2026, in Neurology Open Access, an official journal of the American Academy of Neurology, show an association rather than proving that avoiding these risk factors directly delays dementia.
“Our findings support prevention of risk factors developing in midlife as a strategy for delaying the onset of dementia and maintaining brain health,” said study author Josef Coresh, MD, PhD, of NYU Grossman School of Medicine in New York. “Finding ways to prevent or delay dementia is crucial as the population ages, as treatments remain limited.”
Researchers followed 12,409 people who were free of dementia when the study began and had an average age of 56. They assessed three vascular risk factors: high blood pressure, diabetes, and smoking. High blood pressure was defined as a reading above 140/90 mmHg or the use of blood pressure-lowering medication.
Participants were tracked for an average of 26 years. Over that period, 3,008 developed dementia, while 5,238 died without developing the condition.
No risk factors meant nearly 13 more years
People without any of the three risk factors lived an average of 30.1 years after the study began without developing dementia. Those who had high blood pressure, diabetes, and smoked remained dementia free for an average of 17.5 years, a difference of nearly 13 years.
The pattern differed by sex and race
Women lived longer without dementia than men regardless of the number of risk factors they had. Among participants with all three risk factors, women lived an average of 18.1 years without dementia, compared with 16.6 years for men.
Coresh noted, “Women more often reach older ages and therefore experience many cases of late-onset dementia.”
White participants also lived longer without dementia than Black participants at every level of vascular risk. Among those with all three risk factors, White participants averaged 19.6 dementia free years, compared with 16.0 years among Black participants.
Midlife prevention remains the practical message
“People with all three risk factors were more likely to develop dementia or die at earlier ages from other causes, leading to shorter overall survival and fewer years with their thinking and memory abilities intact,” Coresh said. “Hopefully these results will help encourage people to stop smoking, manage their blood sugar and manage their blood pressure in midlife. Of course, other healthy habits such as eating better and being more active are also important.”
One important limitation is that researchers measured the risk factors only once. The analysis therefore examined long-term outcomes following that single assessment rather than tracking how blood pressure, diabetes, or smoking status changed over time.
Reference: “Midlife Vascular Risk Burden and Dementia-Free Survival Years: The Atherosclerosis Risk in Communities Neurocognitive Study” by Jiaqi Hu, Josef Coresh, Jason R. Smith, A. Richey Sharrett, Rebecca F. Gottesman, Pamela L. Lutsey, Thomas H. Mosley, Elizabeth Selvin, Michael Fang and Jordan Weiss, 5 August 2026, Neurology Open Access.
DOI: 10.1212/WN9.0000000000000152
The ARIC study is carried out as a collaborative study supported by NHLBI contracts 75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004 and 75N92022D00005. The ARIC Neurocognitive Study is supported by U01HL096812, U01HL096814, U01HL096899, U01HL096902 and U01HL096917 from the NIH.
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