Modifiable Risk Factors for Alzheimer Disease and Related Dementias Among Adults Aged ≥45 Years

United States, 2019

John D. Omura, MD; Lisa C. McGuire, PhD; Roshni Patel, MPH; Matthew Baumgart; Raza Lamb; Eva M. Jeffers, MPH; Benjamin S. Olivari, MPH; Janet B. Croft, PhD; Craig W. Thomas, PhD; Karen Hacker, MD


Morbidity and Mortality Weekly Report. 2022;71(20):680-685. 

In This Article


In 2019, among adults aged ≥45 years in 31 participating states and DC, the most common potentially modifiable risk factors for ADRD were high blood pressure and not meeting the aerobic physical activity guideline; each was found in nearly one half of adults. Disparities in the prevalence of risk factors were observed by selected demographic characteristics, including race and ethnicity. Adults with SCD were more likely to report having modifiable risk factors (except binge drinking) and were more likely to report a higher number of risk factors than were those without SCD. Prevalence of SCD was highest among persons with depression, with hearing loss, and with four or more risk factors.

Consistent with previous reports,[1,3] these findings indicate the prevalence of several modifiable risk factors was higher among American Indian or Alaska Native, Black or African American, and Hispanic populations than among other races and ethnicities. These findings are consistent with known understandings of chronic disease disparities which are influenced by differences in the social determinants of health.*** In combination with known racial and ethnic differences in the prevalence of ADRD, these findings help identify opportunities to improve health equity through prioritizing and tailoring public health strategies for those at highest risk.[1,4–6] For example, CDC's National Healthy Brain Initiative††† supports culturally tailored interventions that address ADRD risk factors specifically for American Indian or Alaska Native, Black or African American, or Hispanic populations.[7]

This analysis focused on SCD, an early indicator of possible future ADRD[4] and observed that adults with SCD were more likely to report almost all assessed risk factors, as well as a larger number of risk factors, than were those without SCD. The possible mechanisms of protection from dementia in relation to addressing modifiable risk factors are complex;[2] however, early detection of SCD and associated risk factors might facilitate early intervention to slow the progression of ADRD and its symptoms. The earlier dementia is diagnosed, the sooner care can be provided, including building a care team, participating in support services and counseling, addressing other chronic conditions, and better managing medications.[8] Future research might also seek to understand the relationship between an increasing number of risk factors and related risk for ADRD and evaluate multicomponent strategies or interventions that simultaneously address multiple risk factors.

The findings in this report are subject to at least six limitations. First, causality between risk factors and SCD cannot be inferred from a cross-sectional study, and not everyone who reports SCD will develop ADRD.[9] Second, self-reported data might be subject to several biases, including recall and social desirability. Third, the low response rates could have resulted in response bias. Fourth, respondents with missing risk factor data were not excluded when calculating the total number of risk factors reported; however, findings were similar in a sensitivity analysis conducted excluding any missing values. Fifth, because data are from 31 states and DC, the findings of this report might not be nationally generalizable. Finally, although this analysis examined common modifiable risk factors for ADRD with available data in the 2019 BRFSS, they are only a subset of suggested risk factors. Major strengths of this study include the large sample size and ability to examine many risk factors and SCD.

Important milestones have been achieved in advancing a public health approach to address risk factors for ADRD in the United States. In 2021, the National Plan was updated to include a new goal to reduce risk factors for ADRD.[3] Given the prevalence of modifiable risk factors for ADRD and anticipated growth of the older adult population and those with ADRD,[1,5,10] this new goal has the potential to benefit a large proportion of U.S. adults. The findings in this report highlight opportunities to accelerate action, particularly among specific populations at high risk. Many evidence-based activities that support healthy aging and prevention and control of various chronic conditions, such as managing hypertension and promoting physical activity, can also serve as potential strategies to achieve this goal. For example, in addition to helping patients discuss concerns about memory loss, health care professionals should also screen patients for modifiable risk factors, counsel patients with risk factors, and refer them to effective programs and interventions where recommended. Public health professionals can implement policy, systems, and environmental strategies to address modifiable risk factors at the population level. Additional resources are available from the Building Our Largest Dementia Infrastructure Public Health Center of Excellence on Dementia Risk Reduction.§§§