Dementia Risk and Protective Factors Self-Report

This handout grew out of the OT Potential course Risk Factors for Cognitive Decline with Ganesh Babulal, PhD, OTD, MSCI, MOT, OTR/L, FAOTA. He went through the modifiable risk factors named by the 2024 Lancet Commission on dementia. (Modifiable means they can be changed.) He also covered his own research on how the places people live, such as walkability, green space, and light at night, relate to cognition.

During the course, Sarah Lyon suggested a handout that would let clients see these factors and pick one to address. This handout puts that idea into practice. It pairs the Lancet factors with the environmental factors from Dr. Babulal’s research, so clients can look at both their habits and their surroundings.

The handout supports Dr. Babulal’s point that a client’s home and neighborhood belong in the treatment plan. The Environment section brings up concrete targets that fit OT’s scope. Examples include noise and light in the bedroom, filtering indoor air, and finding a safe place to walk.

The Health History section can point to next steps outside OT. For example, a client who marks hearing loss as a concern may need a hearing test. A client who marks depression as a concern may need a depression screen, such as the PHQ-2 or PHQ-9, or a referral. In the course, Dr. Babulal described working with audiology and screening for depression as part of a therapist’s role in reducing risk.

The 2024 Lancet Commission on dementia estimates that nearly half of dementia cases could be prevented or delayed by addressing 14 modifiable risk factors across the lifespan. This handout covers 12 of them: hearing loss, high cholesterol, depression, physical inactivity, diabetes, smoking, high blood pressure, obesity, excessive alcohol, social isolation, air pollution, and vision loss. This is a population-level estimate. It does not predict any one person’s risk.

The environmental items draw on a 2025 study in Alzheimer’s & Dementia by Li and colleagues. Dr. Babulal is one of the authors. In older adults, walkability, green space, and tree canopy were linked to better cognitive performance, and light pollution was linked to worse cognitive performance. These links held whether or not participants had biomarkers of early Alzheimer’s disease. The study was cross-sectional, meaning it measured everything at one point in time. So it shows associations, not cause and effect.

The Health History section asks for actual numbers: BMI, blood pressure, A1C (average blood sugar over the past few months), and LDL cholesterol. Many clients won’t know these offhand. Before the session, ask them to look up recent results in their patient portal. Or let them skip a row and come back to it after their next medical appointment.

When you introduce the handout, make it clear that a risk factor is not a diagnosis, and that the goal is to build up protective factors. If a client is defensive or discouraged, try starting with the Environment section. In the course, Sarah Lyon noted that talking about surroundings first can feel less threatening and takes blame off the client. Keep the Action Plan to one first step. Use the question about support to plan what you, the client’s family, or another provider can help with. The handout is for educational purposes only. Send clients to their medical team for questions about lab values, medications, or memory concerns.