25/01/2026
Even with unprecedented investment, the dementia drug pipeline continues to deliver modest and uncertain gains at best. Despite the media fanfare, recent agents largely target late-stage amyloid pathology, offering small statistical benefits that translate into limited real-world clinical impact, while carrying substantial costs and safety concerns. There is little in the current pipeline that convincingly alters disease trajectory once neurodegeneration is established. This sobering reality underlines a critical truth: dementia is unlikely to be âcuredâ pharmacologically after onset. The greatest opportunity lies earlierâshifting focus toward prevention and delay through vascular health, metabolic resilience, inflammation control, and lifelong neuroprotectionâwhere the biological leverage, population impact, and cost-effectiveness are far greater.
A recent umbrella review underlines that we already know a good deal about what to do. A total of 45 reviews covering 212 meta-analyses (including around 10,000 individual studies in total) were synthesised. From this the authors identified 14 broadly defined modifiable risk factors that were significantly associated with dementia disorders.
They were: alcohol consumption, body weight, depression, diabetes mellitus, diet, hypertension, less education, physical inactivity, sensory loss, sleep disturbance, smoking, social isolation, traumatic brain injury and vitamin D deficiency. All 14 factors were associated with the risk of major neurocognitive disorders (NCD), and five were associated with mild NCD. Of note, the scientists found considerably less research for vascular dementia and mild NCD.
The study highlighted the role of a key nutrient in prevention, namely vitamin D. Beyond vitamin D, several B vitamins and selected herbs may contribute meaningfully to dementia prevention. Folate and vitamin B12 are central to homocysteine metabolism; elevated homocysteine is strongly linked to brain atrophy, white-matter damage and faster cognitive decline, with trials suggesting benefit when deficiencies or low-normal levels are corrected. Among herbs, Ginkgo biloba has the most consistent human evidence, supporting cerebral microcirculation and endothelial function and mitochondrial activity. Turmeric (particularly bioavailable curcumin) targets neuroinflammation, oxidative stress and amyloid pathology. Low-dose lithium, even at trace nutritional levels, has emerging epidemiological and clinical support for neuroprotection, possibly reduced tau phosphorylation and enhanced neuronal resilience.
For more information see: https://pubmed.ncbi.nlm.nih.gov/38346414/