The 2024 Lancet Commission added high LDL cholesterol to the list of modifiable dementia risk factors. First time ever. Here's what happens: High cholesterol in midlife (40s-50s) damages small blood vessels feeding your brain. Creates atherosclerosis in cerebral arteries. Reduces blood flow to brain tissue. Causes microinfarcts - tiny strokes you never feel. White matter disease - visible on MRI but silent. All accumulating over 20-30 years. By age 70: brain riddled with vascular damage. Memory problems start. Cognitive decline accelerates. Diagnosed with "mixed dementia" - Alzheimer's plus vascular disease. But the vascular part started at 45. The vascular-inflammation connection: Damaged blood vessels trigger chronic inflammation. Brain's immune cells stay activated. This inflammation accelerates amyloid and tau accumulation. Vascular damage + inflammation = faster cognitive decline. What counts as high: - LDL >130 mg/dL (optimal <100, ideally even lower). - Total cholesterol >200 mg/dL. Many people in their 40s have these levels. No symptoms. Feel fine. Doctor says "borderline high, let's watch it." Meanwhile: 20 years of silent damage starting. The numbers: Vascular dementia: 15-20% of all dementia. Mixed dementia (vascular + Alzheimer's): another 20-30%. Nearly half of all dementia has vascular component. Much of it preventable. What works: - Statins lower cholesterol 30-50%. - Mediterranean diet reduces cholesterol naturally (lots of nutritional and non-prescription options). - Exercise improves vascular health. - Blood pressure control critical. The timing: Starting treatment at 45: prevents decades of damage. Starting at 70: damage already done. Can slow progression but can't undo past harm. The missed opportunity: Millions in their 40s-50s with untreated high cholesterol. Thinking: "I'm too young for this." Not realizing dementia risk starts in midlife. What I tell patients: Your brain has tiny blood vessels everywhere.

Don't forget to join tonight's Poolside Chat! We’ll be sharing a little holiday fun with an ugly Christmas sweater or hat contest. The winner will receive a copy of Laura's book, A Loving Approach to Dementia Care. 🗓 Tuesday, December 23 ⏰ 5:30 PM MST (AZ) / 7:30 PM EST 🔗 Register here: https://us02web.zoom.us/meeting/register/PRzPtXKIRf-NNdHzhSToUg#/

A 62-year-old engineer came to my clinic terrified. Six months of worsening memory. Forgetting meetings. Losing his car in parking lots. "My father had Alzheimer's at 65," he told me. "This is it." His wife confirmed everything. Progressive decline. Personality changes. More irritable than usual. I ordered the standard workup. Cognitive testing: impaired attention and working memory. Executive function problems. MRI: normal for age. No focal atrophy. Blood work: normal. But then I asked about sleep. "I snore," he said. "My wife makes me sleep in the guest room." His wife jumped in: "He gasps and makes noises. I can't sleep in the same room." Sleep study confirmed severe obstructive sleep apnea. Oxygen saturation dropping to 78% (normal is 95%+). Waking up 47 times per hour without knowing it. Brain getting starved of oxygen all night. Every night. For years. We started CPAP therapy. Three months later, he was back. Different person. "I can think again," he said. "It's like someone turned the lights back on." Repeat cognitive testing: completely normal. Memory fixed. Attention restored. Back to his baseline. Not Alzheimer's. Never was. Sleep apnea mimics dementia perfectly. Attention problems. Memory impairment. Executive dysfunction. Mood changes. Affects 1 billion people worldwide. Most don't know they have it. The clues I look for: - Loud snoring. Witnessed apneas. Excessive daytime sleepiness. - Morning headaches. Difficult-to-control hypertension. - Cognitive complaints that seem too fast (months, not years). - Normal brain imaging. The good news: Sleep apnea is treatable. CPAP. Oral appliances. Weight loss. Sometimes surgery. And when you treat it, cognition often improves. Not always completely. Chronic severe apnea can cause permanent damage. But many patients, like this engineer, recover fully. The lesson: Not all memory loss is dementia. Before diagnosing Alzheimer's, rule out reversible causes. Sleep disorders. B12 deficiency. Thyroid problems. Medication side effects. Depression.

When we hear the word "dementia," most of us immediately think "memory loss." But dementia is so much more complex than that. And that’s where the connection begins. processes information. How a person thinks, understands, and responds to the world around them. When we shift our understanding, we shift our care. And that’s where the connection begins. Not by correcting… but by adapting. If your team would benefit from deeper dementia awareness training, I’d love to support you in becoming a dementia-aware community. WATCH Laura's full training in the CLASSROOM tab today!