Your Neighborhood Could Influence Your Dementia Risk

A secluded cottage in the quiet countryside might seem better for your brain than a home in a crowded city. But a new study of dementia mortality across England found a more surprising pattern.

Researchers at Cambridge University examined data from nearly 41 million individuals in England from 2011 to 2023. Dementia-related deaths were highest not in the most densely populated cities or the most rural areas, but in the suburbs and other mid-density neighborhoods. The researchers calculated that improving access to services and the quality of outdoor spaces in the most disadvantaged communities could prevent up to 10.5 percent of dementia deaths.

The findings highlight how our understanding of neurodegenerative disease has evolved. For decades, the search for the causes of dementia focused largely on the brain and body. Now, researchers are increasingly looking outward, examining how the places where people live—and the conditions they encounter there—can shape brain health.

In 2017, the Lancet Commission identified nine modifiable risk factors for dementia—including obesity, smoking, depression, hearing loss and social isolation. Unlike age, genetics and sex, these are factors that people or governments can potentially change. The commission added air pollution and traumatic brain injury in 2020, followed by high cholesterol and vision loss in 2024.

Together, these risk factors may help explain why dementia-related deaths were higher in medium “urbanicity” areas (calculated by population density and conditions such as income, housing, service accessibility, education and employment), according to the 2026 study.

Access to health providers is a key consideration. “The time it takes to get to an audiologist, for example, in urban settings is vastly different from rural settings,” says Arman Fesharaki-Zadeh, assistant professor of psychiatry and neurology at Yale School of Medicine.

City residents may also be more likely to receive screenings for metabolic risk factors such as high cholesterol, blood pressure, blood sugar, diabetes, and obesity, says Alvaro Pascual-Leone, professor of neurology at Harvard Medical School. Air pollution also tends to be higher, and even though cities and towns are more densely populated, that doesn’t automatically mean residents have richer social lives, he adds.

“Unfortunately, the sense of loneliness and social isolation is a lot higher,” Pascual-Leone says. Researchers theorize that suburbs and other mid-density communities may experience the disadvantages of both ends of the spectrum: environmental pressures without the concentration of services available in city centers or the environmental benefits of rural areas.

(Asking for help is actually really good for you, according to science.)

However, some experts urge caution when interpreting figures shaped by so many variables. Emer MacSweeney, consultant neuroradiologist and CEO of Recognition Health, believes that the concentration of dementia-related deaths could be explained by people relocating once they have started to develop cognitive symptoms.

“They'd probably compromise on a semi-rural area, especially if they're moving into a care home, which can be very expensive in a big city,” she says. “I would find it hard to believe that just where you happen to live is more important than how you live.”

More research is needed to understand the complex correlation between environment and dementia fully, says Jordan Weiss, assistant professor at the Optimal Aging Institute at NYU Grossman School of Medicine. But a neighborhood doesn’t have to cause dementia directly to influence a resident’s risk. “Neighborhood is not a separate pathway, it's the thing that ‘sets the dose’ on all of these established risk factors,” Weiss says.

Scientists have studied dementia since the late 19th century, but the questions they ask have expanded. Rather than looking only at what happens inside the brain, researchers are increasingly examining how genetics, lifestyle and the environment interact over a lifetime.

Scientists call that lifetime collection of exposures the “exposome.” Epidemiologist Christopher Wild coined the term in a landmark 2005 paper, published shortly after the completion of the Human Genome Project. He argued that research into environmental exposures lagged behind genetics, despite their “overwhelmingly important role” in chronic diseases.

(Here’s why your neighborhood matters more for your health than you think.)

While researchers haven’t yet fully mapped which aspects most influence dementia outcomes, the Lancet estimates that 45 percent of cases could be prevented by addressing modifiable risk factors, many of which are “very much interrelated,” says Fesharaki-Zadeh.

He adds that the findings highlight how the places people already call home can support—or undermine—brain health. “I think this paper is more about where you would put a clinic or a bus route, not where you should buy a house.” Pascual-Leone agrees, saying, “We have policies for smoking and for diabetes that have made an impact. I think we need the same for brain health.”

Wherever you live and whatever your age, you can still take steps to reduce your risk of dementia. MacSweeney says that exercise is the “single most important factor in decreasing risk” because it can have a knock-on effect in terms of obesity, hypertension, and depression. She also recommends a low-sugar Mediterranean diet and adequate sleep.

Untreated hearing loss also deserves more attention, Weiss says. It can place additional strain on the brain and cause people to withdraw socially, both of which may contribute to dementia.

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“If you want to take one action, get your hearing tested,” he says. But he is less enthusiastic about brain-training games. “The evidence is kind of weak on those. You mostly just get better at the game, but it's better than no stimulation.”

And don’t underestimate the importance of friends and family, Fesharaki-Zadeh says. Loved ones can notice signs of cognitive decline and encourage people to attend screening appointments—but their importance extends beyond monitoring. Simply spending time together and having fun “can make a massive amount of difference,” he adds.