Cognitive Health: Dementia and Alzheimer’s Disease Risk Factors

Cognitive Health: Dementia and Alzheimer’s Disease Risk Factors

As the population ages, clients increasingly ask coaches about "brain health," memory changes in themselves or a parent, or how to reduce their risk of dementia. The NBHWC 2026-2030 Content Outline (item 5.3.1.7) expects coaches to have working literacy about dementia and Alzheimer's disease: what the conditions are, which lifestyle factors are associated with risk, and how to recognize warning signs that belong to a physician, not a coach. This is knowledge for conversation and referral, not for assessment or diagnosis.

What Dementia Is (and Is Not)

Dementia is not a single disease. It is an umbrella term describing a decline in cognitive abilities (memory, language, problem-solving, attention, or visuospatial skills) severe enough to interfere with a person's ability to perform everyday activities independently. Because it is a syndrome rather than a diagnosis, a physician must determine the underlying cause.

Alzheimer's disease is the most common cause of dementia, responsible for an estimated 60-80% of cases. It is a progressive neurodegenerative disease characterized (at the biological level) by amyloid plaques and tau tangles that disrupt neuron communication and eventually cause cell death. Other causes of dementia coaches may hear about include:

Coaches do not need to diagnose or differentiate between these types. The exam-relevant point is recognizing that "dementia" is a general category and that only a qualified clinician (typically a neurologist, geriatrician, or primary care physician working with cognitive testing) can determine the specific cause.

Normal Aging vs. Warning Signs

A coach's first job in this domain is helping clients understand the difference between typical age-related change and patterns that warrant medical attention. This distinction also protects the coach from overstepping scope in either direction — alarming a client unnecessarily, or missing a genuine red flag.

Typical aging (not a coaching red flag):

• Occasionally misplacing items but retracing steps to find them.
• Momentarily forgetting a name or word but recalling it later.
• Needing more time to process new information.
• Making an occasional decision-making error.

Possible warning signs of dementia (referral indicated):

• Memory loss that disrupts daily life, such as repeating the same questions or forgetting recently learned information.
• Difficulty completing familiar tasks (paying bills, following a known recipe, driving a familiar route).
• Getting lost in previously familiar places.
• New difficulty with words in speaking or writing.
• Poor judgment, such as falling for scams or neglecting hygiene.
• Withdrawal from social activities or hobbies.
• Noticeable, uncharacteristic changes in mood or personality.

When a coach observes or hears about these patterns — whether from the client themselves or a concerned family member — the appropriate action is a warm, non-alarming referral to the client's physician for a cognitive evaluation. Coaches never say "you may have dementia" or "this sounds like Alzheimer's"; that is a clinical determination outside the scope of coaching.

Modifiable Lifestyle-Linked Risk Factors

A substantial and growing body of research (including the Lancet Commission reports on dementia prevention) identifies lifestyle-linked factors associated with dementia risk. This is squarely within a coach's educational scope, because it overlaps directly with general wellness behaviors coaches already address: movement, nutrition, sleep, stress, and connection. Coaches should always frame this information as risk-reduction association, not guaranteed prevention or a cure, and should encourage clients to discuss personal risk with their physician.

Factors commonly discussed at the coaching-education level include:

• Physical activity: Regular aerobic exercise supports cerebral blood flow and is associated with lower dementia risk; coaches can help clients build sustainable movement routines.
• Cardiovascular health: Hypertension, high cholesterol, and diabetes in midlife are linked to higher dementia risk, especially vascular dementia. Coaching support for blood pressure and glycemic management (within the scope covered elsewhere in this guide) indirectly supports brain health.
• Nutrition patterns: Diets emphasizing vegetables, fruits, whole grains, fish, and healthy fats (such as Mediterranean-style eating patterns) are associated with better cognitive outcomes than diets high in processed foods and added sugar.
• Sleep quality: Chronic poor sleep is associated with amyloid accumulation and higher dementia risk; coaches can reinforce sleep hygiene practices.
• Social connection and cognitive engagement: Social isolation and low levels of mental stimulation are associated with higher risk; coaches can help clients build routines involving social contact, learning, and novel activities.
• Hearing health: Untreated hearing loss is associated with increased dementia risk, likely through reduced social engagement and cognitive load; coaches can encourage clients to have hearing evaluated.
• Substance use: Excessive alcohol consumption and smoking are associated with elevated risk; both fall within general coaching conversations about health behaviors.

The coach's role is to educate generally ("research links several everyday habits to brain health") and, with the client's permission, share relevant information — never to promise that a specific behavior will prevent dementia, and never to imply a client's current symptoms are or are not caused by lifestyle choices.

Coaching Scope: What Coaches Do and Do Not Do

• Do educate clients generally on lifestyle factors associated with cognitive health, when relevant and with permission.
• Do recognize red-flag symptoms and refer promptly to a physician for cognitive evaluation.
• Do support clients and family caregivers with general wellness goals, stress management, and connecting to community resources (such as the Alzheimer's Association helpline or local caregiver support groups).
• Do not administer, score, or interpret cognitive screening tools (such as the Mini-Mental State Examination or Montreal Cognitive Assessment); these require clinical training and licensure.
• Do not diagnose dementia, name a suspected type, or predict disease progression.
• Do not advise on medication management for cognitive symptoms.
• Do not coach a client who has significant, diagnosed cognitive impairment through a standard goal-setting process without first confirming (with appropriate consent and possibly involvement of a caregiver or care team) that coaching is a safe and appropriate fit.

Supporting Caregivers Within Scope

Coaches increasingly work with the family members and caregivers of people experiencing cognitive decline, rather than with the client directly. This is legitimate coaching work as long as it stays within general wellness support: helping the caregiver manage their own stress, sleep, nutrition, and boundaries, and connecting them to respite and support resources. A coach should never coach the caregiver on behalf of the person with dementia in a way that substitutes for that person's own care team, and should not offer guidance on managing specific dementia-related behaviors (such as wandering, aggression, or sundowning) beyond suggesting the caregiver consult the treating clinician or a dementia-care specialist.

NBHWC Exam Tips

• Know that Alzheimer's disease is the most common cause of dementia (60-80% of cases), but dementia itself is an umbrella term, not a diagnosis.
• Be able to distinguish normal age-related forgetfulness from red-flag symptoms that require referral.
• Expect scenario questions where a client or caregiver describes memory symptoms; the correct coach response is almost always a warm, non-alarming referral to a physician, not reassurance or diagnosis.
• Remember that lifestyle risk-factor education (exercise, nutrition, sleep, social connection, cardiovascular health) is within scope when framed as general, permission-based information — not a guarantee of prevention.