Two Years of a Structured Lifestyle Program Raise Older Adults' Cognitive Scores More Than a Self-Guided One

The results of US POINTER, a large clinical trial that tested how a multidomain lifestyle intervention, which changes exercise, diet, brain activity and social engagement together, affects the cognitive function of older Americans, were published in JAMA. The study was led by Wake Forest University School of Medicine in the United States.

2,111 older adults at risk of cognitive decline, two approaches compared

At five sites across the United States, the researchers recruited 2,111 people aged 60 to 79 who were sedentary, had poor eating habits and had additional risk factors such as family history or cardiometabolic risk. Participants were randomly assigned to a structured program (1,056 people) or a self-guided program (1,055 people). Both groups were encouraged to increase physical and cognitive activity, eat healthily, socialize and manage cardiovascular health, but the structured group had a set schedule, higher intensity and a system of check-ins.

After two years, the cognitive score, which combines executive function, episodic memory and processing speed, rose in both groups. The annual improvement was 0.243 standard deviations in the structured group and 0.213 standard deviations in the self-guided group, so the structured group improved by 0.029 standard deviations more. This difference did not depend on whether people carried APOE ε4, a gene linked to Alzheimer's risk, and appeared larger in people whose cognitive scores were lower at the start. Serious adverse events were fewer in the structured group.

Limitations

The difference between the two groups was statistically significant but small, and whether it translates into better daily function or fewer cases of dementia must be confirmed in long-term follow-up.