A Physical Therapy Playbook for Primary Prevention of Dementia and Alzheimer’s
By Dr. John Mishock, PT, DPT, DC
In the U.S., ~7.2 million older adults are living with Alzheimer’s in 2025; without breakthroughs, prevalence could approach ~13–14 million within a few decades. Total annual care costs are ~$384B in 2025, trending toward ~$1T by 2050. PMC+1 Chronic Disease Directors
The 2024 Lancet Commission estimates that ~45% of dementia cases are associated with 14 modifiable risk factors—a practical roadmap for prevention across the lifespan, including: Less education, Hearing loss,
High LDL cholesterol, Depression, Traumatic brain injury (TBI), Physical inactivity, Smoking, Diabetes, Hypertension, Obesity, Excessive alcohol consumption, Social isolation, Air pollution, and Untreated vision loss Chronic Disease Directors
Exercise: he cornerstone
Regular physical activity is linked to meaningfully lower incident dementia risk (often ~20–35% relative risk reductions) with dose-response benefits; mechanisms include improved cerebrovascular health, insulin sensitivity, and neurotrophic signaling. Walk more (work toward 3,800 → 9,800+ steps/day), train to improve aerobic conditioning, and perform resistance to improve strength and power while improving balance. The Lancet+1
Rest & recovery: sleep as brain hygiene
Aim for ~7–8 hours/night with consistent timing; screen for sleep-disordered breathing and refer. Deep sleep supports glymphatic clearance of neurotoxic proteins (e.g., amyloid-β).
Nutrition: the third pillar
MIND and Mediterranean-style dietary patterns are associated with lower dementia risk; in the Rush cohorts, high MIND adherence was linked to ~53% lower Alzheimer’s risk (moderate adherence ~35%). Emphasize plants, olive oil, fish, berries, legumes, and whole grains; set protein at ~1.6 g/lb body weight (individualize) to preserve muscle, tightly tied to mobility and late-life cognition. Limit added sugars to <10% of calories.
Where Physical Therapy adds immediate value
- Screen & refer for the big 14 during intake and progress checks (BP, glucose risk, hearing/vision, mood, sleep, social connection).
- Program exercise precisely (≥150–300 min/wk moderate or 75–150 min vigorous; 2–3 RT days/wk; balance/dual-task 2–3×/wk).
- Coach recovery & nutrition (sleep hygiene, MIND/Med plate, protein targets, hydration).
- Measure what matters (gait speed, 30-s sit-to-stand, balance, step counts; brief cognitive screen within scope) and coordinate with PCP, audiology, optometry, sleep, and mental health. The Lancet
Mishock Physical Therapy can help!
Visit our website to read more physical therapy-related articles, learn more about our treatment philosophy, our physical therapy staff, and our 5 convenient locations in Gilbertsville, Skippack, Boyertown, Phoenixville, Limerick at www.mishockpt.com.
If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call: locations in Gilbertsville (610-327-2600), Skippack (610-584-1400), Phoenixville (610-933-3371), Boyertown (610- 845-5000), Limerick (484-948-2800) at www.mishockpt.com or request your appointment by clicking here.
Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon or train2playsports.com.
