What My Father’s Vascular Dementia Diagnosis Taught Me About What We Can Control

Written by: Meredith Paci

My father was diagnosed with vascular dementia February 14th 2026. I watched risk factors go unaddressed for years and it changed how I think about everything I do in this practice, how I educate, how I show up for every person I support, and why the work we do at Fortify matters as much as it does. I wrote this for our community. For every person quietly watching a parent decline, or wondering what they can still do now for themselves. The conversation here is not about fear. It is about information. If you want the full story of why I wrote this, the newsletter that goes with it lives [HERE]. The newsletter is deeply personal.... this blog is deeply personal. If you are ready to get into the research and what is actually in your hands, keep reading.

Let’s Start at the Beginning: What Is Dementia?

Dementia is not a single disease. It is an umbrella term for a group of symptoms affecting memory, cognitive function, and the ability to perform everyday tasks. The key word is progressive, meaning it worsens over time, and it is caused by the death or damage of brain cells and the deterioration of the connections between them. How that cell death or damage occurs depends on the type of dementia, but the loss is cumulative and, with our current understanding, extraordinarily difficult to reverse. The frustrating thing about “over time” is that the speed is entirely individual. There is no universal timeline. That is part of what makes it so easy to miss.

Alzheimer’s disease is the most commonly known form, accounting for roughly 60 to 80 percent of cases. But it is not the only one. Lewy body dementia, frontotemporal dementia, mixed dementia, and the one I want to spend the most time on today: vascular dementia.

Here is the thing that stopped me cold when I started digging into this: a landmark report published by the Lancet Commission in 2020 identified 12 modifiable risk factors that together accounted for approximately 40 percent of all dementia cases worldwide. In 2024 they updated that report, adding two new risk factors, bringing the total to 14, and raising that figure to approximately 45 percent. Nearly half of all dementia cases. That is not a small number. That is not genetic fate. That is lifestyle. That is information. That is something we can actually work with.

Vascular Dementia: What It Is and What It Isn’t

Vascular dementia is the second most common form of dementia, and it develops when the blood supply to the brain is reduced or interrupted, most often due to strokes, mini-strokes (TIAs), or chronic damage to the small blood vessels in the brain over time. And here is where it gets important: the conditions that damage those blood vessels do not appear overnight. They are built slowly, quietly, over decades, through unmanaged blood pressure, chronically elevated blood sugar, sedentary living, smoking, poor sleep, and a metabolic environment that was never given the tools it needed to thrive. Vascular dementia is, in many ways, a cardiovascular disease that lives in the brain. Which means that everything we know about protecting the heart. We need to be applying to the brain too, and we needed to start yesterday.

Unlike Alzheimer’s, which tends to have a gradual, continuous decline, vascular dementia often has a more stepped pattern, with periods of stability, then noticeable drops after vascular events. Symptoms depend on which parts of the brain are affected, but commonly include confusion, difficulty concentrating and planning, slower thinking, and mood changes alongside memory problems.

My father also has a delirium component, which is an acute confusional state often layered on top of an underlying condition like dementia. Delirium can be triggered by illness, hospitalization, medication, or the trauma of an event, and it can make the cognitive picture look more severe in the short term than the dementia baseline alone.

Now let’s talk about the misconception that I want to dismantle right now.

Most people hear “vascular dementia” and think: genetics. Family history. Fate.

That is not the full picture. Not even close.

Genetics Loads the Gun. Lifestyle Pulls the Trigger.

Yes, genetics play a role. There are rare inherited forms of vascular dementia, most notably CADASIL, caused by a mutation in the NOTCH3 gene, and genetic variants like APOE ε4 modestly increase risk. If you have a strong family history, your risk is elevated. Full stop, I won’t pretend otherwise.

But here is what the research actually says about how much genetics versus lifestyle determines your health outcomes: current epigenetic science suggests that while genes account for roughly 20 to 30 percent of your risk for most chronic diseases, the remaining 70 to 80 percent is influenced by lifestyle, environment, and modifiable factors. Your DNA is not a sentence. It is a predisposition, and predispositions are not destinies.

Epigenetics, the study of how our behaviors and environment affect which genes are expressed, has fundamentally shifted how we understand this. You can have a genetic variant that increases vascular risk and still dramatically reduce your likelihood of vascular dementia through the choices you make over decades. The reverse is also true: you can have no family history and build yourself directly toward it through cumulative, unaddressed cardiovascular damage.

When I look at my father’s life, and I am sharing this without judgment, because he did what he knew. I see a man who had high blood pressure for years, managed with a pill but never addressed at its root. Who was not overweight but was significantly undermuscled, carrying almost no meaningful lean muscle mass. Who almost certainly had micronutrient deficiencies that were never identified or addressed. I have worked collaboratively with his current provider and the deficiencies are glaring.

He lived in a world that told him what he wanted to hear and dismissed that he could do “something.” It was “just part of aging.” That is the world most of our parents lived in. But you are reading this, which means you have the tools. So let’s use them.

What Is Actually Within Your Control

I want to be honest here: there is no single intervention that functions as a guaranteed prevention strategy for vascular dementia. Anyone who tells you otherwise is selling something. What we have is a constellation of lifestyle factors that, when stacked together, create a profoundly different risk environment for your brain over time. Everything I am about to walk you through is something Sarah and I talk about inside Fortify Health, not because it is trendy, but because this is what the evidence consistently points toward.

Cardiovascular Training: Your Brain’s Best Friend

Your brain is one of the most metabolically demanding organs in your body. It requires a constant, uninterrupted supply of oxygenated blood to function. Cardiovascular training, the kind that gets your heart rate up and challenges your aerobic system, is one of the most powerful tools we have for maintaining the integrity of the blood vessels that supply your brain. It improves endothelial function, reduces systemic inflammation, lowers blood pressure, increases BDNF (essentially fertilizer for your brain cells) and supports healthy lipid profiles. A 2022 meta-analysis in the British Journal of Sports Medicine found that regular physical activity is associated with up to a 20 to 30 percent reduction in dementia risk, including vascular dementia specifically.

We are not talking about training for a marathon. We are talking about consistent, progressive cardiovascular work: walking at a pace that challenges you, cycling, swimming, zone 2 cardio done regularly over time.

And I want to be very clear about something, because the fitness culture we have been swimming in for decades has gotten this badly wrong: we are talking about well-fueled cardiovascular training. Not fasted. Not running on fumes and cortisol and a prayer. Not the undereating, overtraining model that so many people, particularly women, were handed as the blueprint and wondered why their hormones, their thyroid, and their energy eventually fell apart. Your brain and your cardiovascular system need you to show up to training resourced. Fed. Supported. The goal is to build a resilient body, not to deplete one.

Strength Training: Muscle Is a Metabolic Organ and a Protective One

This is the one I want every person reading this to hear clearly, because we have been so conditioned to view strength training as only aesthetic vanity or for 'fat loss' that we have missed its profound systemic importance.

Muscle tissue is not passive. It is metabolically active. It produces myokines, signaling molecules that communicate with the brain, the liver, and the immune system. Adequate muscle mass improves insulin sensitivity, regulates blood sugar, reduces inflammatory markers, and supports the hormonal environment that protects vascular and cognitive function. Low muscle mass (sarcopenia) is independently associated with cognitive decline. My father, who was not overweight but had minimal muscle mass throughout his life, is a real-world example of this. You can look fine and still be deeply under-resourced metabolically.

Blood Sugar Management: This Is NOT About Avoiding Carbohydrates or Fearing 'Sugar'

I want to say this slowly and clearly: blood sugar management does not mean carbohydrate elimination or fearing 'sugar'. Managing your blood sugar is not about avoiding carbs. In truth I can not express the importance of understanding that your blood sugar is affected beyond what you eat. It is about understanding how your body processes glucose, what drives dysregulation, and how to support stable blood sugar across the day in a way that is sustainable and individualized.

The connection to vascular dementia is significant. Chronic hyperglycemia and insulin resistance damage blood vessels throughout the body, including the microvessels supplying the brain. This is so well established that some researchers have proposed the term “Type 3 diabetes” for the insulin-resistant state of the brain seen in certain neurodegenerative conditions. Prioritizing protein and fiber at meals, timing carbohydrates strategically, moving your body after meals, building muscle, and prioritizing sleep are the levers that actually move this. Understanding your own metabolic picture (fasting glucose, fasting insulin, HbA1c, HOMA-IR, lipids) is foundational. These are not just numbers for people with diabetes. They are a window into your vascular risk that most conventional medicine does not look through unless something is already badly wrong.

Thyroid Health: The System Nobody Is Watching Closely Enough

The thyroid gland governs metabolic rate, cardiovascular function, lipid metabolism, and neurological health. Every cell in your body has thyroid hormone receptors. Your brain is profoundly sensitive to thyroid status. Untreated or subclinical hypothyroidism is associated with elevated cholesterol, hypertension, endothelial dysfunction, and cognitive impairment, all of which contribute directly to vascular risk. Yet many people walk around for years with TSH levels that look “normal” on a conventional panel while their free T3, free T4, and reverse T3 tell a completely different story.

We do not run a single TSH and call it a day. We look at the full picture, including TPO and TgAb antibodies to identify autoimmune thyroid disease, which affects a significant proportion of the population and is frequently missed. If you do not know your full thyroid panel, that is where I would start.

Hormonal Health: What HRT and TRT Actually Do for Your Brain and Blood Vessels

This is the section I want to write with nuance, because the conversation around hormones and brain health has been both overpromised and underdiscussed, often in the same breath thanks to social media.

Let me be clear upfront: hormone replacement therapy isNOT a first-line prevention strategy for dementia, and I am not suggesting that it is. There is no single intervention I would put in that position: not HRT, not any supplement, not any training protocol. Everything 'matters'... everything contributes. The hierarchy of what matters most is individual to you and your life. That said, dismissing the role of hormones in vascular and cognitive health would be a significant oversight, and the evidence deserves to be taken seriously.

For decades, much of what clinicians believed about estrogen and the brain was shaped by a single study: the Women’s Health Initiative Memory Study, which concluded that 'estrogen plus progestin increased the risk of dementia in postmenopausal women aged 65 and older and offered no cognitive protection'. That conclusion sent shockwaves through medicine, effectively halting HRT prescriptions for a generation of women and leaving millions without a conversation that could have changed their trajectory.

But wait... here is what that study got wrong and what was glazed over completely. The women enrolled were aged 65 and older, meaning many were already a decade or more past menopause. The formulation used was synthetic progestin combined with conjugated equine estrogen, not bioidentical hormones. And critically, the brain does not wait. By the time estrogen therapy was introduced in that study, the window had already closed.

This is where the pioneering work of neuroscientist Dr. Lisa Mosconi at Weill Cornell Medicine has fundamentally reframed the conversation. Using PET imaging, Mosconi’s research has demonstrated that estrogen is not simply a reproductive hormone. It is a brain hormone. It supports cerebral blood flow, reduces neuroinflammation, protects against oxidative stress, and plays a central role in the synthesis of neurotransmitters including acetylcholine and serotonin. When estrogen drops, the brain loses a key neuroprotective element. The vasomotor symptoms that women are told to manage and endure, the hot flashes, the night sweats, the sleep disruption, the brain fog, the mood shifts, these are not happening in the ovaries. They are happening in the brain. They are neurological events driven by estrogen deprivation.

The timing hypothesis, now supported by a substantial and growing body of research, tells us that the window in which estrogen therapy is initiated matters enormously. Starting HRT close to the onset of perimenopause or early menopause, when the brain’s estrogen receptors are still responsive and the neurological architecture is still intact, appears to be associated with meaningful cognitive and vascular benefit. Waiting until symptoms are severe, or until a decade has passed, is a different physiological situation entirely and should not be conflated with early intervention.

For perimenopausal and early postmenopausal women, the conversation about HRT is not simply about hot flashes. Although, those hot flashes are more than just annoying but that is an entire blog on its own as those hot flashes are temperature regulation that is changing in the BRAIN! It is about long-term vascular protection, brain health, bone density, metabolic function, and quality of life. That conversation deserves to happen before the crisis, not after it.

Testosterone matters too, for women and for men. In both sexes it supports muscle protein synthesis, insulin sensitivity, cardiovascular function, mood regulation, and cognitive clarity. For women, low testosterone contributes to loss of muscle mass, poor energy, low mood, and reduced cognitive edge. For men, testosterone deficiency is associated with increased cardiovascular risk, metabolic dysfunction, and cognitive decline. Hormonal optimization is one piece of a larger framework, and depending on where you are in your health journey and what your labs show, it may be a high-priority piece for you, or it may not. That is a conversation to have with a provider who understands functional medicine.

Sleep: The Underestimated Non-Negotiable

During sleep, specifically deep slow-wave sleep, the brain activates its glymphatic system, a kind of lymphatic network that clears metabolic waste products including those associated with neurodegeneration. Chronically poor sleep and lack of enough sleep does not just leave you tired. It leaves your brain’s cleaning system under-resourced, night after night, year after year. Sleep deprivation also drives cortisol dysregulation, insulin resistance, increased inflammatory markers, and blood pressure elevation, every single one of which is a vascular risk factor. Sleep is not laziness. It is the most undervalued health intervention we have access to. 

Micronutrients: The Silent Gap

Most people carry micronutrient insufficiencies that their conventional bloodwork has never identified because it was never looked for. For brain and vascular health I pay particular attention to B12 and folate, essential for homocysteine metabolism, and elevated homocysteine is an independent risk factor for vascular disease and cognitive decline. Magnesium, critical for blood pressure regulation and vascular tone. Vitamin D, where deficiency is associated with increased cardiovascular risk and cognitive decline. Omega-3 fatty acids, anti-inflammatory and supportive of cerebrovascular integrity.

And zinc, critical for thyroid conversion and neurological health when indicated. That last part is SO important, because I want to say something here that most wellness content will not say: adding micronutrients blindly, simply because they are "good for you," can be the wrong move entirely. Minerals are not innocent bystanders. They have synergistic relationships with each other, but they also have antagonistic ones. Too much zinc displaces copper. Too much calcium without adequate magnesium and vitamin K2 can work against you. Iron supplementation without confirmed deficiency creates oxidative stress. The goal is not to take everything on this list. The goal is to know your own status, identify your actual gaps, and address those specifically. A targeted approach based on real data is medicine. A supplement shopping cart based on a wellness blog is a guess.

My father was not supplementing his needs. His nutrition was 'okay' but not intentional and not 'enough'.  Nobody had taken the time to speak with him, ask him questions, PUSH BACK ON his educational bias, or lack of one. No one looked at his micronutrient status, or taken a preventive lens to his health. He is not unique in this. Most people are not.

I started writing this for our community. For every person who sent me a message in the last few weeks saying “I am in this too.” For every person sitting in something hard and quietly wondering what they could have done differently, or what they can still do now.

I have heard from so many of you: watching a parent decline, quietly terrified about your own trajectory, wondering if this is just the way it goes. I want you to hear me clearly: it does not have to be. Not entirely. Not for you.

The conversation I am having inside Fortify Health is not about fear. It is about information. It is about building a body and a brain that are as resilient and well-resourced as possible, because you deserve to be here, fully here, for a long time.

Cardiovascular training. Strength. Blood sugar stability. A thyroid that is actually functioning. Hormones that are monitored and supported appropriately. Sleep treated like the medicine it is. None of it is glamorous. All of it compounds. And unlike so many things in life, unlike what happened on February 14th, this part is yours to direct.

With love and transparency,

Mere

Co-Founder, Fortify Health

References

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