Studies show that crossword puzzles and other brain exercises are a fine way to help prevent dementia, but the best way to avoid the disease when you’re older may be to protect your cardiovascular health now.

You may feel too young to be worried about dementia, but David Cantor, Ph.D., says subtle cognitive abnormalities can show up surprisingly early. Using quantitative electroencephalography, he can screen the brain for early signs of dementia by checking for signs of abnormal brain function.

“If someone even in their late 20s or early 30s already has blood pressure problems, elevated cholesterol or smokes, they’re running the risk of potentially restricting blood flow or reducing oxygen availability to the brain,” says Dr. Cantor, a neuropsychologist and director of the Psychological Sciences Institute in Duluth, GA. Blood pressure spikes can cause small bleeds or mini-strokes in anybody, at any age, if they have poorly regulated high blood pressure compounded by elevated cholesterol, he says. “If you have enough of those, after a while you will begin to suffer dementia.”

Even moderately elevated cholesterol levels in your 40s puts you at greater risk for Alzheimer’s disease and vascular dementia decades later, says Rachel Whitmer, Ph.D., a research scientist with Kaiser Permanente Division of Research in Oakland, CA.

Her recent study found that the risk of late-life cognitive problems increased by 66 percent in people whose midlife cholesterol was high (240 milligrams per deciliter [mg/dl] or more), and even those with borderline cholesterol levels had a 52 percent greater risk of dementia. “This study underscores the importance of addressing dementia risk factors in midlife, before an underlying disease or symptoms appear,” she says. (A healthy cholesterol level is below 200 mg/dl.)

High midlife blood pressure, smoking and diabetes are also bad news for the brain in later years. Another new study found that among people aged 47 to 70, smokers were 70 percent more likely to be hospitalized for dementia within the following 12 years, while those with hypertension had a 60 percent increased risk, and those with diabetes had double the risk.

“We can infer from our observations that individuals who keep their blood pressure at normal levels during their midlife will have a lower risk of developing dementia later in life," says study author Alvaro Alonso, M.D., Ph.D., from the University of Minnesota.

In his study, high blood pressure was defined as a systolic pressure of 140 millimeters of mercury (mmHg) or higher and a diastolic pressure of 90 mmHg or higher, so even a person who is not considered hypertensive, with a blood pressure of, say, 135/85 mmHg, may have a higher risk of dementia compared to a person with blood pressure of 120/70 mmHg.

Lifestyle changes to help control both high blood pressure and high cholesterol include losing excess weight, decreasing fat and salt, and emphasizing fruits, vegetables and whole-grain foods. Exercise, smoking cessation and limiting alcohol consumption can also help.

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