Healthy lifestyle changes improve cognitive function in people at risk for dementia

A recent clinical trial in the US found that multiple lifestyle changes made for a period of two years improved cognitive function in older adults at risk of cognitive decline and dementia.

Findings come from the US Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk, also known as the US POINTER study [1]. The US POINTER was a large randomized controlled trial conducted across five sites in the US to represent its diverse population. Over 2,100 older people (60-79 years old) with a sedentary lifestyle, suboptimal diet, and two or more additional risk factors for dementia were randomly assigned to a group that made ‘structured’ lifestyle changes or the control group that made ‘self-guided’ lifestyle changes. Both the ‘structured’ and ‘self-guided’ lifestyle interventions targeted physical exercise, nutrition, cognitive and social activities, and cardiovascular/metabolic health monitoring. 

• The structured intervention included a total of 38 team meetings, 26 phone contacts, and seven health monitoring visits across the two-year intervention. The physical activity intervention included aerobic exercise (four days/week, 120 minutes/week, 90 ‘Very Active Minutes’ on Fitbit), resistance training (two days/week, 15-20 minutes/session), and balance exercise (two days/week, 10-15 minutes/session). The nutrition intervention followed the MIND diet, which emphasizes leafy greens, other vegetables, berries, nuts, whole grains, beans, fish, poultry, and olive oil. The cognitive intervention included computerized training (three times/week, 15-20 minutes/session). Health monitoring involved a medical advisor appointment every six months to review cardiovascular disease risk factors and blood pressure taken once a month. 
• The self-guided control intervention involved six team meetings and four phone contacts across the two-year intervention that targeted physical exercise, nutrition, cognitive and social activities, and cardiovascular/metabolic health monitoring.

Global cognitive function, which was the primary outcome, improved over time for both the ‘self-guided’ control and ‘structured’ intervention groups, but the ‘structured’ intervention group showed a significantly greater benefit compared to the ‘self-guided’ control. The global cognitive function included measures of executive function (e.g., planning and decision-making), memory, and processing speed. At the end of the two-year intervention, the ‘structured’ group had cognitive functions comparable to adults who are one to two years younger compared to the ‘self-guided’ group. These lifestyle interventions were beneficial regardless of age, sex, ethnicity, heart health status, or whether or not participants had the APOE4 genetic risk factor for Alzheimer’s disease. It is also worth highlighting that the lifestyle interventions were safe, with fewer adverse events in the ‘structured’ group compared to the control group.

These positive cognitive findings with lifestyle interventions are aligned with results from the original FINGER study (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability), as well as other studies under the World-Wide FINGERS network, including the J-MINT trial in Japan [2; 3; 4].

Results from the US POINTER are encouraging. It is great news for everyone that there are concrete steps to slow or prevent cognitive decline. Get ample physical activity; eat a healthy diet rich in leafy greens, berries, whole grains, legumes, nuts, and fish; challenge your brain to learn new things; and address cardiovascular and metabolic risk factors regularly with your healthcare provider, including high blood pressure, cholesterol, and blood sugar.

1. Baker LD, Espeland MA, Whitmer RA et al. (2025) Structured vs Self-Guided Multidomain Lifestyle Interventions for Global Cognitive Function: The US POINTER Randomized Clinical Trial. Jama.
2. Ngandu T, Lehtisalo J, Solomon A et al. (2015) A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet  385, 2255-2263.
3. Oki Y, Osaki T, Kumagai R et al. (2024) An 18-month multimodal intervention trial for preventing dementia: J-MINT PRIME Tamba. Alzheimers Dement  20, 6972-6983.
4. Solomon A, Turunen H, Ngandu T et al. (2018) Effect of the Apolipoprotein E Genotype on Cognitive Change During a Multidomain Lifestyle Intervention: A Subgroup Analysis of a Randomized Clinical Trial. JAMA Neurol.

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