Brain changes that can eventually lead to dementia may begin many years before anyone notices symptoms such as memory problems, missed appointments or difficulty finding words.

This is where blood biomarkers are becoming important. Biomarkers are measurable signs of biological activity in the body. In dementia research, some blood biomarkers can give clues about biological processes related to brain changes. These can include Alzheimer’s-related protein alterations, damage to nerve cells or changes in cells that support and protect nerve cells.

But these cannot predict with certainty whether an individual will develop dementia. Higher levels may suggest increased risk, but some people with biological signs never develop dementia, while others do. That raises an important question: once early brain-related changes have begun, can lifestyle still influence dementia risk?

Our research suggests diet may still be relevant. We followed nearly 1,900 adults aged 60 and older in Sweden for up to 15 years. None had dementia at the start. During that time, 240 developed dementia.

Participants’ diets were assessed several times. We then looked at whether healthier eating patterns were linked to lower dementia risk among people with different levels of blood markers related to Alzheimer’s disease, nerve cell damage and biological stress in the brain.

We found that people with........

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