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We’re not as helpless against dementia as we think

The shingles vaccine may protect your brain. The bigger story is even more hopeful.

I turned 48 this week, which meant it was time for my annual physical. After the usual battery of questions from my doctor — How much did I drink? Was I exercising? How was I sleeping? — it was my turn to ask a question. I had one prepared: Should I get the shingles vaccine?

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Dementia cases will keep climbing as the population ages — a projected million new US cases annually by 2060 — but your odds of getting it at any given age have been falling for decades. An 80-year-old today is meaningfully less likely to have dementia than one a generation ago.

Across wealthy countries, age-specific dementia rates have dropped roughly 13 percent per decade since the late 1980s, and most of that decline tracks with things we can influence: better-controlled blood pressure and cholesterol, less smoking, more years of school. The brain lives downstream of the heart.

A 2024 Lancet commission estimated that up to 45 percent of dementia could be prevented or delayed by addressing 14 risk factors — and the highest-leverage window is midlife, not old age.

The anti-dementia to-do list: treat your blood pressure and LDL cholesterol, don’t smoke, stay physically active, get your hearing and vision checked, keep learning, and go easy on alcohol. Unglamorous, but it buys time for your brain.

A growing run of studies links the shingles vaccine to lower dementia risk. The evidence isn’t conclusive and the shot is only recommended at 50, but it’s worth a conversation with your doctor.

There is no drug that reverses dementia today. That’s not the same as being helpless.

According to standard medical guidance, the answer would be no. The shingles vaccine is only recommended by the government for people 50 years or older; the only exceptions are adults whose immune systems are weakened by disease or treatment. And despite the way my back feels when I get out of bed each morning, I wasn’t there quite yet. Our immune systems weaken as we age, but at 48, I was probably still capable of beating back the varicella-zoster virus that causes shingles (and chickenpox).

And yet my doctor was open to the idea for the same reason that I was asking about it: because there is early but growing evidence that the shingles vaccine may be protective against neurodegenerative diseases like dementia. For someone my age, with more time behind me than in front of me, the possibility of developing those diseases — and the desire to do anything to prevent them — is suddenly looming large.

I’m far from alone. Dementia already afflicts more than 6 million Americans today, and a 2025 study in Nature Medicine estimated that the lifetime risk of developing dementia after age 55 is 42 percent, with higher figures for women, Black adults, and those who carry the APOE ε4 allele genetic variant, which is known to increase the risk for Alzheimer’s. That same study projected new US cases of dementia would double by 2060, from 514,000 a year in 2020 to more than 1 million annually, due largely to population aging.

Behind those figures is a universe of suffering. Nearly everyone reading this has watched, or will........

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