Modifiable factors related to lifestyle have been extensively studied in terms of their effects on the vascular system, particularly the risk of heart disease. In recent years, however, it has become increasingly evident that many of these coronary risk factors also account for a large proportion of strokes, as well as cognitive impairment, dementia, and even Alzheimer's disease occurring in the absence of a clinically recognized vascular "event." Observational studies support a role for hypertension, dyslipidemia, and diabetes mellitus as risk factors for cognitive decline in late life, although there are conflicting results from some studies. Available evidence, although limited, also supports a role for some medical therapies targeting risk factors as a means to reduce the risk of subsequent cognitive decline. In many instances, however, basic lifestyle interventions show great promise for ameliorating the risk of cognitive decline. Such interventions include regular physical exercise or moderate alcohol consumption.