Dementia is not one single disease. It is a set of symptoms that affects memory, thinking, communication and everyday independence. It becomes more common with age, but it is not an inevitable part of growing older. In Malta, updated estimates suggest that 7,988 people were living with dementia in 2021, and that this number could rise to 21,523 by 2060. Moreover, the estimated annual cost of dementia in 2021 was around €220 to €260 million.

An international report concluded that around 45% of dementia cases could potentially be prevented or delayed by addressing modifiable risk factors across the life course. Moreover, a local study suggests that about one in three dementia cases in Malta could potentially be prevented or delayed if feasible interventions were widely adopted. In this local study, targeting risk factors such as high LDL ("bad") cholesterol, reducing loneliness, treating untreated vision loss, and tackling physical inactivity, could provide the highest public health impact and potentially reduce the number of persons with dementia in the Maltese population.

A useful way to think about dementia risk is to stop looking for a single "magic trick" and instead build a set of everyday habits that protect the brain over many years. These habits often sound familiar because the brain is closely linked to the heart and blood vessels. High blood pressure, diabetes, smoking, obesity and inactivity do not just affect the heart; they also affect blood flow and inflammation in the brain. The good news is that small improvements, repeated consistently, can add up.

There is strong evidence that blood-pressure control reduces the risk of mild cognitive impairment (a stage that can precede dementia). This is not about chasing extreme targets on your own; it is about having a proper plan with your GP, taking medicines as prescribed if needed, and treating blood pressure as a long-term brain- health investment. Moreover, cholesterol, especially LDL, is now recognised as a modifiable dementia risk factor by major international experts. In the Maltese modelling study, elevated LDL cholesterol emerged as the largest single contributor to preventable risk. Practically, that means getting a simple blood test, discussing your overall cardiovascular risk with your doctor, and taking treatment seriously if you qualify for it. Lifestyle changes (diet, weight loss, activity) matter, but for many people medication is also part of effective risk reduction.

Exercise is one of the most practical tools we have. The World Health Organisation recommends that adults aim for 150 to 300 minutes of moderate activity per week, or 75 to 150 minutes of vigorous activity, or a mix of both. For most people, brisk walking is enough. If 30 minutes feels too much, split it into 10 minutes after each meal. The goal is consistency, not perfection.

Following a Mediterranean-style diet has been associated with a reduced risk of dementia. In practice, this means building meals around vegetables, beans and lentils, fruit, wholegrains, olive oil, nuts, and fish when possible, while cutting down on ultra-processed snacks, sugary drinks, and frequent fried or fast foods. Malta is already a Mediterranean country; the challenge is keeping the healthiest parts of that tradition in a modern, busy lifestyle.

Some of the most overlooked risk factors are the ones people assume are as "just part of ageing" such as hearing and vision loss. Yet they matter because they affect how much we engage with the world and have been found to be associated with increased dementia risk. Studies have found that using hearing restorative devices (such as hearing aids or cochlear implants) among people with hearing loss was associated with better cognitive outcomes, including lower risk of long-term cognitive decline. For vision, cataract extraction is associated with a lower risk of developing dementia. So if you are struggling to follow conversations, or you have been putting off an eye check because "I can manage", consider this a gentle push: treating hearing and vision is not vanity - it is brain health.

Finally, do not underestimate the role of social connection and mood. Loneliness was one of the top modifiable contributors in the Maltese modelling study. Moreover, depression is also linked to higher dementia risk. If you feel persistently low, withdrawn, anxious, or you have lost interest in things you used to enjoy, speak to your GP early. Just as importantly, treat social contact like a health appointment: plan regular meet-ups, join a local group, volunteer, or take up a class where you will see the same people weekly. These are not "soft" interventions - they are practical prevention.

Reducing dementia risk is not about fear. It is about giving yourself the best possible chance of healthy ageing. If you were to choose only three starting points, consider the following: move more each week, check and control blood pressure and cholesterol, and stay socially connected. Over time, those choices do not only reduce dementia risk - they make life better in the present too.

Malta Dementia Society are full members of Malta Health Network www.maltahealthnetwork.org.

Dr Anthony Scerri PhD is the vice-chair, Malta Dementia Society