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Healthy Lifestyle Changes May Benefit Cognition in Older People with APOE4

Healthy Lifestyle Changes May Benefit Cognition in Older People with APOE4

Researchers have found that a group of lifestyle changes improved cognitive function and memory in older people with APOE4, a genetic risk factor for Alzheimer's disease [1].

The findings come from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a randomized controlled trial conducted at several sites in Finland. Over 1,100 older adults (average age 69.3 years) were randomly assigned to a group that made lifestyle changes or a control that just received general health advice. Of this large group, 362 participants had at least one copy of the APOE4 allele.

The lifestyle changes included four components: nutritional guidance, physical exercise, cognitive training, and management of metabolic and vascular risk factors [2]. After two years, APOE4 carriers who made the lifestyle changes improved overall cognitive function and memory when compared to carriers in the control group. (For non-carriers, people making the lifestyle changes appeared to improve on cognitive functions too, though this effect was not statistically different when compared to those in the control group.)

The nutritional intervention included diet counseling based on the Finnish Nutrition Recommendations. Participants were advised to consume a diet with 10-20% of daily calories from proteins, 25-35% from fat (less than 10% from saturated or trans-fat), and 45-55% from carbohydrates (less than 10% from refined sugars). They were also given limits on saturated fat, salt, alcohol, and refined sugars and told to eat 25-35 grams of dietary fiber per day [2]. Recommended foods included high amounts of fruits and vegetables, whole grain products, low-fat options in milk and meat products, vegetable margarine or rapeseed oil instead of butter, and at least two servings of fish per week.

The physical exercise component was based on international guidelines and included strength training, balance exercises, and aerobic exercises guided by physiotherapists [2]. Strength training involved exercising eight main muscle groups. Participants chose the aerobic exercises they enjoyed most, such as Nordic walking, aqua gym, jogging, and gymnastics. The frequency and duration of exercise increased over the two year study to 60-minute sessions of strength and balance training 2-3 times per week and 45-60 minutes of aerobic exercise 3-5 times per week.

The cognitive training included 10 psychologist-led group sessions lasting 60-90 minutes each and individual computer-based training of executive functions three times a week for 10-15 minutes [2]. The computer-based training was specially developed for these studies and focused on updating information on memory. Social activities were encouraged in all group sessions.

Management of metabolic and vascular conditions began with a risk factor assessment; a study nurse met with participants and measured their weight, blood pressure, and hip and waist circumferences. Study participants also met with the study doctor, who ran lab tests for conditions such as diabetes or high cholesterol. They were given information on the importance of reducing risk factors and, when test results showed increased risks, were told to see their primary care physicians for treatment.

Findings from this randomized clinical trial are largely consistent with the seven steps we recommend for brain health. Future data from the extended 7-year follow up of this FINGER trial will provide additional information on whether lifestyle changes are effective in preventing dementia. This follow-up study will also investigate whether benefits are more pronounced in APOE4 carriers compared to non-carriers.


  1. 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.
  2. Kivipelto M, Solomon A, Ahtiluoto S et al. (2013) The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): study design and progress. Alzheimers Dement 9, 657-665.

Yuko Hara, PhD, is Director of Aging and Alzheimer's Prevention at the Alzheimer's Drug Discovery Foundation. Dr. Hara was previously an Assistant Professor in Neuroscience at the Icahn School of Medicine at Mount Sinai, where she remains an adjunct faculty member. Her research focused on brain aging, specifically how estrogens and reproductive aging influence the aging brain's synapses and mitochondria. She earned a doctorate in neurology and neuroscience at Weill Graduate School of Medical Sciences of Cornell University and a bachelor's degree in biology from Cornell University, with additional study at Keio University in Japan. Dr. Hara has authored numerous peer-reviewed publications, including articles in PNAS and Journal of Neuroscience.

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