After running a full economic evaluation on five widely used medications and comparing them against seven non-drug interventions, Robert J. Brent’s research on dementia care lands on a genuine surprise finalist: statins.

Yes, the same cholesterol medication tens of millions of people already take for heart health turns out, in this analysis, to be the single best-performing pharmaceutical intervention for people living with dementia and one of the best-performing interventions, period, drug or otherwise.

The numbers behind the win

Statins work by unblocking arteries and restoring blood flow, which matters for dementia because most people with the condition also have some degree of vascular impairment in the brain. In Brent’s data, statins reduced dementia symptoms nearly four times more than NSAIDs did, and the mortality benefits that followed were substantial: roughly $35,600 per person in total benefits, against a lifetime medication cost of less than $900. That’s a net gain of almost $34,800 per person, nearly identical to the NSAID result, but achieved even more efficiently.

The researchers didn’t just stop at the headline number, either. Worried the result might be too good to be true, they stress-tested it against worst-case assumptions, assuming everyone used the more expensive, high-intensity version of the drug, and using the most pessimistic end of the effectiveness range reported in the underlying studies. Even in that scenario, with costs raised eightfold and benefits cut by two-thirds, statins still came out solidly ahead, with benefits still seven times greater than costs. This wasn’t a fragile result propped up by one favorable assumption. It held up from every angle they tried to break it.

The full leaderboard

Here’s where the book gets genuinely useful for anyone trying to make sense of where dementia care dollars should actually go. Brent’s team ran all ten interventions five medications and five non-drug approaches from an earlier companion volume through the same cost-benefit framework, so they could be compared on equal footing using the benefit-cost ratio (how many dollars of benefit each dollar of cost produces).

Three medications came back with negative net-benefits: the FDA-approved Alzheimer’s drugs, beta-blockers, and antipsychotics. Mathematically, a losing investment produces an “infinite” benefit-cost ratio for not taking it because avoiding a loss costs nothing and saves money at the same time. In plain English: for the average patient in this data, skipping these three treatments would have been the financially and medically better move.

Among everything left standing, the ranking by return on investment looked like this:

• Statins — the top-performing medication, with benefits roughly 60 times the cost.

• Medicare eligibility — simply having access to the additional care that comes with turning 65, worth more than 20 times its cost.

• Years of education — early-life education’s protective effect against later dementia symptoms, worth nearly 19 times its cost.

• Vision correction — a simple pair of glasses, worth 9 times its cost.

• NSAIDs — the aspirin-and-ibuprofen result from earlier in this series, worth over 5 times its cost.

Avoiding a nursing home stay and hearing aids are both positive, though with more modest returns.

What this list actually tells us

Line these up and a pattern jumps out immediately: the interventions with the best returns are rarely the ones getting the most attention or the most research funding. A pair of glasses outperforms a purpose-built Alzheimer’s drug. Getting Medicare coverage at 65 outperforms most pharmaceutical interventions on the market. And the flagship medications specifically developed and FDA-approved for dementia landed at the very bottom of the list, not just underperforming, but actively subtracting value.

That’s not an argument against medicine in general; statins prove pharmaceuticals absolutely can be part of the answer. It’s an argument against assuming that “newest, most targeted, most expensive” automatically means “most effective.” In Brent’s research, some of the most cost-effective tools for reducing dementia symptoms were also some of the least dramatic: a hearing aid, a pair of glasses, an aspirin, a government health program that already exists.

For policymakers working with limited budgets, and for families trying to make sense of where to focus their energy and money, that’s a genuinely actionable finding. The highest-impact choices aren’t always hiding behind a prescription. Sometimes they’re sitting in a drawer, waiting to be used.