It's not clear exactly how dementia gets started or might be stopped, but we do know that there are many different risk factors for the condition, ranging from hearing impairments to breathing polluted air.While some risk factors like genetics can't be changed, and others, such as air pollution, reflect systemic, societal problems, a number of dementia risk factors fall within the realm of modifiable lifestyle factors – things we can potentially do something about. A new study from researchers in the US and China, published in Neurology Open Access, has identified three middle-age risk factors that are associated with a later dementia onset. In other words, more dementia-free years. Analyzing the health records of 12,409 participants spanning a median of 26 years, the team found that having normal blood pressure, not having diabetes, and not smoking were linked to almost 13 additional years without dementia, on average.The crucial years for these risk factors were from 45 to 65, emphasizing the importance of good health in middle age – and in particular vascular health, the condition of your blood vessels, which blood pressure, diabetes, and smoking can all affect.Those with more risk factors were more likely to develop dementia earlier. (Hu et al., Neurol. Open Access, 2026)"Maintaining optimal midlife vascular health was associated with up to 12.6 additional dementia-free survival years, reflecting both higher dementia hazard and markedly higher competing mortality," write the researchers in their published paper."Expressing vascular risk in time-based terms offers a clear, patient-centered framework to motivate prevention strategies that preserve both cardiovascular and cognitive health."Several other factors were accounted for in the analysis, including sex, race, age, physical activity levels, and the presence of the APOE4 gene that significantly increases the risk of Alzheimer's disease.As well as developing dementia earlier, those with all three identified risk factors were more likely to die at an earlier age.