Two lifestyle interventions tested in a newly publicized study improved cognition in older adults who were at risk of cognitive decline, and one of them protected cognition from normal age-related decline for up to two years.
Results of the Alzheimer’s Association’s US Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk, or US POINTER study, were reported for the first time today at the Alzheimer’s Association International Conference 2025 in Toronto and online in the Journal of the American Medical Association.
The cognitive benefits were consistent across age, sex, ethnicity, heart health status and apolipoprotein E-e4 genotype.
“As the burden of dementia grows world-wide, US POINTER affirms a vital public health message: healthy behavior has a powerful impact on brain health,” said Alzheimer’s Association President and CEO Joanne Pike, DrPH. The study results, she added, “encourage us to look at the potential for a combination of a lifestyle program and drug treatment as the next frontier in our fight against cognitive decline and possibly dementia.”
Both of the interventions tested focused on multiple risk factors and included physical exercise, nutrition, cognitive challenge and social engagement, and heart health monitoring. They differed in intensity, structure, accountability and support provided, however.
- Study participants randomly assigned to the structured lifestyle intervention attended 38 facilitated peer team meetings over two years and were provided with a prescribed activity program with measurable goals for aerobic, resistance and stretching exercise; adherence to the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet; cognitive challenge through BrainHQ training and other intellectual and social activities; and regular review of health metrics and goal-setting with a study clinician.
- Study participants randomly assigned to the self-guided lifestyle intervention attended six peer team meetings to encourage self-selected lifestyle changes that best fit their needs and schedules. Study staff provided general encouragement without goal-directed coaching.
Both approaches improved cognition in older adults at risk of cognitive decline, but trial participants in the structured intervention showed greater improvement on global cognition compared with those who participated in the self-guided intervention, seeing protection of cognition from normal age-related decline for up to two years.
The US POINTER study is the first large-scale, randomized controlled clinical trial to demonstrate that an accessible and sustainable healthy lifestyle intervention can protect cognitive function in diverse populations in communities across the United States, according to the researchers.
“The potential to improve cognition with fewer resources and lower participant burden is compelling. It highlights that while not everyone has the same access or ability to adhere to more intensive behavior interventions, even modest changes may protect the brain,” said Laura D. Baker, PhD, a professor of gerontology and geriatrics, and internal medicine, at the Wake Forest University School of Medicine and Advocate Health, and the US POINTER principal investigator.
The researchers plan to explore and share more data from the study “to paint an even more comprehensive picture of the US POINTER intervention effects on brain health,” Baker said.
Effective treatments for dementia, just like effective treatments for diseases such as heart disease and cancer, likely will require a multi-pronged or combination strategy, including drug and nondrug approaches, to address multiple disease mechanisms, the authors said.
“While these results are fascinating and extremely hopeful, how they are rolled out to the public — especially those at risk for Alzheimer’s and other diseases that cause dementia — needs to be handled with care and individual attention to tailor to the local environment,” said Heather M. Snyder, PhD, study primary investigator and senior vice president of medical and scientific relations for the Alzheimer’s Association.
To date, the association has invested almost $50 million to lead the study, with additional support from the National Institute on Aging of the National Institutes of Health. The association expects to invest an additional $40 million and more over the next four years to continue following study participants and to bring US POINTER interventions to communities across the United States.
The five-site, two-year US POINTER study was developed to assess whether the results of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability study, or FINGER study, could be generalized to a larger, more diverse US population at risk for cognitive decline and dementia. The 2,111 participants were aged 60 to 79 years, were cognitively healthy but led sedentary lifestyles, had suboptimal diets and cardiometabolic health, and had a family history of memory impairment. Eighty-nine percent of participants completed all assessments in the 24-month period that these results cover.
Looking ahead, the Alzheimer’s Association plans to build on the momentum of US POINTER study by launching several programs and initiatives:
- A personal brain health assessment tool.
- A virtual brain health training program for healthcare providers.
- A community recognition program for organizations championing brain health.
- A brain health roundtable that will unite leaders across healthcare, public health, community and corporate sectors to accelerate impact.
“From a pragmatic clinical and public health perspective, the key message of US POINTER may be that even relatively modest lifestyle changes can support cognitive health in aging populations. The challenge ahead will be to determine how best to implement such programs widely, equitably, and effectively — and whether their benefits are maintained over time and translate into clinically meaningful end points,” Jonathan M. Schott, MD, of the Dementia Research Center of the University College London Institute of Neurology, wrote in a JAMA editorial.
Schott pointed out that previous research “suggests that up to 45% of all-cause dementia may be preventable worldwide through modification of 14 risk factors (education, traumatic brain injury, hearing loss, depression, hypertension, diabetes, obesity, physical inactivity, smoking, excess alcohol intake, high low-density lipoprotein cholesterol, social isolation, exposure to air pollution, and visual loss) exerting influence at various stages throughout life.”
Forty-four percent of assisted living residents had a diagnosis of Alzheimer’s disease or a related dementia in 2022, according to a 2024 report from the Centers for Disease Control and Prevention’s National Center for Health Statistics.