1: Risk and protective factors for dementia
There are 2 main activities proposed to improve available data on dementia risk and protective factors. These include activities to:
- 1a: Investigate known and emerging risk and protective factors for dementia and their impacts
- 1b: Expand dementia risk factors included in Australian Burden of Disease Study analysis.
These activities may involve single projects, or multiple projects aimed at improving data on dementia risk and protective factors. Each activity provides information on the intended outcome, level of investment required, timeframe for completion of the activity and who is responsible for undertaking the activity.
Activity 1a: Investigate known and emerging risk and protective factors for dementia and their impacts
This activity involves projects aimed at investigating and analysing dementia risk and protective factors using existing national data, and work to develop new data if required. For example, this could include an activity that uses linked data (such as the National Health Survey and 2021 Census within the Person Level Integrated Data Asset (PLIDA) and the ADAPTOR study that capture risk factors that contribute to dementia), existing epidemiological studies and data-sharing platforms (such as Dementias Platform Australia). Risk and protective factors for dementia incidence and progression would be analysed for different population groups and compared to those from large/pooled international studies to appreciate variability across population groups within (and across) countries. Relative risks would be calculated, and prevalence of risk factor exposure estimated. The overall contribution of each risk factor on dementia prevalence and mortality (if applicable) in Australia could be estimated. Where no data are available to assess dementia risks among priority population groups, further development work to augment existing data collections may be needed.
| Outcome | More comprehensive estimates of the contribution of each risk factor on dementia prevalence and mortality in Australia and how this may change over time, and enable monitoring of risk factors following preventive health initiatives |
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| Level of investment | Low–Medium: Low investment is needed for activities that plan to use existing data. More investment is needed for activities that aim to augment existing data collections, analyse more complex risk factors (such as social determinants of health and diseases-as-risks), or explore risks in priority population groups where greater data development is required. |
| Timeframe | Short: Activities could commence now |
| Responsible stakeholder | Academic researchers; organisations holding potential sources for reporting dementia risk and protective factors at a national level |
| Progress | Not started |
Activity 1b: Expand dementia risk factors included in Australian Burden of Disease Study analysis
The ABDS 2024 estimated the dementia burden attributable to 6 modifiable risk factors (overweight and obesity, physical inactivity, impaired kidney function, high blood plasma glucose, high blood pressure in midlife and tobacco use). This is not an exhaustive list of risk factors linked to dementia and only includes risk factors that were measured in the ABDS 2024.
To include additional risk factors in the study, risk factor exposure data are required at the Australian population level (or which could be applied to the Australian population), as well as estimates of the additional risk of developing or dying from dementia (relative risks). Only risk factors that have these data available will be able to be included in this study. Where possible, new data and information developed from the previous activity addressing this data gap would be incorporated into this activity.
Undertaking a specific dementia risk factor burden analysis that includes a broader range of established risk factors for dementia (such as air pollution, depression, hearing loss and traumatic brain injury), would allow the contribution of modifiable risk factors to dementia burden in Australia to be better understood. This information can be used to prioritise public health efforts to reduce the incidence of dementia. It should be noted that burden of disease analysis has stringent evidence requirements, which means that evidence accepted in other scientific disciplines may not be included in the ABDS.
Further, additional work would be required to assess whether the risk factors and available data used for estimating dementia burden due to risk factors in the general population are applicable for estimating this among First Nations people.
| Outcome | Greater inclusion of dementia risk and protective factors data in burden of disease studies allowing greater appreciation of burden and avoidable burden to inform policy and prevention programs |
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| Level of investment | Low: This activity requires relatively low investment as it largely utilises existing data and methods developed by the ABDS. However, some method development work is required to include diseases as risk factors linked to dementia. |
| Timeframe | Short |
| Responsible stakeholder | AIHW |
| Progress | The AIHW are reviewing evidence and generating risk factor inputs to be used in the ABDS 2026 to ensure a broader range of established risk factors for dementia are included. This work will be published on the AIHW website in late 2026. |
Risk factors are attributes or exposures that increase the likelihood of a person developing a health condition. Diseases and injuries can also act as risk factors. Conversely, protective factors decrease the chance of a person developing a health condition or may help slow its progression. Protective factors for dementia include higher levels of education and maintaining a socially and cognitively active lifestyle (Jackson and Martin 2009; Seeher et al. 2011). Actions to address modifiable risk factors include reducing high blood pressure and high cholesterol, eating a Mediterranean style diet, ceasing smoking, limiting alcohol, ensuring sufficient physical activity, healthy sleep patterns and taking protective actions to minimise head injury (Dementia Australia 2024a).
Risk and protective factors can be grouped into two broad categories: non-modifiable (meaning they cannot be modified in any way) and modifiable (meaning they can be altered or treated with changes in behaviour).
Risk and protective factors for dementia include:
- non-modifiable: advancing age, sex, genes associated with dementia (for example, apolipoprotein Eɛ4), family history (AIHW 2025)
- modifiable: low levels of education in early life, obesity in midlife, high blood pressure in midlife, tobacco smoking, excessive alcohol consumption, physical inactivity, high cholesterol, high homocysteine, depression, social isolation, air pollution and post-traumatic stress disorder (PTSD) (AIHW 2025; Desmarais et al. 2020; Dintica and Yaffe 2022; Günak et al. 2020)
- diseases and injuries: cardiovascular disease (including coronary heart disease, stroke, and atrial fibrillation), chronic kidney disease, diabetes, depression, traumatic brain injury (AIHW 2025, Dintica and Yaffe 2022). Several of these diseases are modifiable with treatment.
There are several other risk factors that may be associated with an increased risk of developing dementia, but more research is needed on these. They include various lifestyle and biomedical factors (such as prolonged stress, hearing loss, diet, inadequate sleep, and various health conditions) and environmental risks such as air pollution (Anstey et al. 2019; Luo, Beam and Gatz 2023). Repeated head injuries can lead to chronic traumatic encephalopathy (CTE) which is a type of brain degeneration that is associated with the development of dementia. Investigating data sources that could help better understand CTE and its relationship with dementia in Australia would be an important first step to improve data in this area.
Addressing the data gap and improving data
Monitoring dementia risk and protective factors by demographics such as sex, age, geography and cultural background is crucial to understand a population’s risk profile and how this impacts the rate of dementia and trends over time. Having robust and up-to-date information on risk and protective factors is needed to inform primary prevention policies. While effective policies across the entire disease pathway are important, reducing risk and increasing protective factors can reduce, delay or prevent dementia (Alzheimer's Association 2018).
Improved data on dementia risk factors includes better data on the prevalence of risk factors, the strength of association between the risk factor and development of dementia, and research into new risk factors and how risk factors work together. Potential sources for reporting dementia risk and protective factors at a national level are listed below and further sources may emerge over time.
- The Australian Bureau of Statistics (ABS) National Health Survey collects data on population-level health risk factors, including some risk factors for dementia (such as level of highest educational attainment, obesity, physical inactivity, hypertension, smoking, hearing loss and diabetes). National data on other risk factors such as social isolation, head injuries and genetic risk factors are lacking.
- The ABS 2021 Census asked questions on long-term health conditions, including dementia, for the first time. The Census also includes some data relating to dementia risk factors, such as highest educational attainment and household composition (a possible indicator of social isolation).
- The Sax Institute’s Analysis of Population Traits and Risk Factors (ADAPTOR) study links longitudinal data from over 200,000 participants from the 45 and Up Study with data on their use of prescription medications, and hospital, general practitioner (GP) and other health services. It will identify people with dementia and the risk factors that may have contributed to their dementia.
- The Centre for Healthy Brain Ageing is leading the establishment of Dementias Platform Australia. This platform aims to facilitate data sharing between dementia researchers to enhance productivity and reusability of data from contributing studies to enable the development of new insights into ageing, ageing-related diseases and dementia risk.
Genetic testing is currently not a routine part of dementia diagnosis and is usually only performed in rare cases where there is a strong family history of younger onset dementia, to assess a person’s risk of developing dementia (Huq et al. 2021, Poulton et al. 2023). This may change in the future as the understanding of the association between genes and dementia increases (Dementia Australia 2024b). Genetic tests assessing a person’s risk of developing certain types of dementia are not covered under the Medicare Benefits Schedule (MBS), but de-identified data from pathology clinics offering genetic testing could be a potential future data source (subject to relevant privacy provisions) contributing to understanding genetic risk factors and their association with dementia diagnosis and outcomes.
AIHW (Australian Institute of Health and Welfare) (2025) Dementia in Australia, AIHW, Australian Government, accessed 15 October 2025.
Alzheimer's Association (2018) ‘2018 Alzheimer's disease facts and figures’, Alzheimer's & Dementia, 701, doi:10.1016/j.jalz.2018.02.001.
Anstey KJ, Ee N, Eramudugolla R, Jagger C and Peters R (2019) ‘A systematic review of meta-analyses that evaluate risk factors for dementia to evaluate the quantity, quality, and global representativeness of evidence’, Journal of Alzheimer’s Disease, 70(s1):S165–S186, doi:10.3233/JAD-190181.
Dementia Australia (2024a) Reducing your risk of dementia, Dementia Australia website, accessed 23 February 2023.
Dementia Australia (2024b) Genetics and dementia, Dementia Australia website, accessed 28 July 2023.
Desmarais P, Weidman D, Wassef A, Bruneau M-A, Friedland J, Bajsarowicz P, Thibodeau M, Herrmann and Nguyen QD (2020) ‘The interplay between post-traumatic stress disorder and dementia: a systematic review’, American Journal of Geriatric Psychiatry, 28(1):48–60, doi:10.1016/j.jagp.2019.08.006.
Dintica CS and Yaffe K (2022) ‘Epidemiology and risk factors for dementia’, Psychiatric Clinics of North America, 45(4): 677–689, doi:10.1016/j.psc.2022.07.011.
Günak M, Billings J, Carratu E, Marchant N, Favarato G and Orgeta V (2020) ‘Post-traumatic stress disorder as a risk factor for dementia: systematic review and meta-analysis’, The British Journal of Psychiatry, 217(5):600–608, doi:10.1192/bjp.2020.150.
Huq AJ, Sexton A, Lacaze P, Masters CL, Storey E, Velakoulis D, James PA and Winship IM (2021) ‘Genetic testing in dementia-A medical genetics perspective’, International Journal of Geriatric Psychiatry, 36(8):1158–1170, doi: 10.1002/gps.5535.
Jackson J and Martin P (2009) World Alzheimer report 2009, Alzheimer’s Disease International, accessed 17 May 2023.
Luo J, Beam CR and Gatz M (2023) ‘Is stress an overlooked risk factor for dementia? A systematic review from a lifespan developmental perspective’, Prevention Science, 24(5):936–949, doi:10.1007/s11121-022-01385-1.
Poulton A, Curnow L, Eratne D and Sexton A (2023) ‘Family communication about diagnostic genetic testing for younger-onset dementia’, Journal of Personalised Medicine, 13(4):621, doi:10.3390/jpm13040621.
Seeher K, Withall A and Brodaty H (eds) (2011) The dementia research mapping project, the 2010 update: final report, Dementia Collaborative Research Centre, University of New South Wales.