Lifestyle Changes Improved Cognition in Older Adults at Risk for Dementia

About 30 percent of the study volunteers have a genetic variant, APOE-e4, which raises the risk of dementia. These participants also improved their cognitive scores with lifestyle changes.

In terms of cognitive scores, POINTER participants “improved by almost an equal amount to the amount that we expected them to decline,” says Dr. Josef Coresh, founding director of the Optimal Aging Institute at NYU Langone Health, who was not involved in the study.

What we know about reducing dementia risk 

Last year, a Lancet Commission concluded that about 45 percent of all cases of dementia are potentially preventable if people and policymakers address 14 modifiable risk factors throughout life. Those risk factors include:

• Hypertension (high blood pressure)
• High LDL (bad) cholesterol
• Diabetes
• Vision loss
• Hearing loss
• Smoking
• Obesity
• Depression
• Physical inactivity
• Excessive alcohol consumption
• Traumatic brain injury
• Air pollution
• Lack of education
• Social isolation

Of course, individuals can’t control all of their risks for dementia, such as genetics, family history or early life education. But experts note that there are still many things people can do. “People should pursue as many of these strategies as they can,” Coresh says.

Strategies to reduce the risk of dementia also help protect against heart disease and depression, Coresh adds. “If people do them, they may benefit in multiple ways.”

One of the study participants, Phyllis Jones, said she was unhealthy and deeply depressed before joining the two-year trial. A panic attack related to work stress had sent her to the emergency room.

“Looking back on that time of my life, I hardly recognize myself,” said Jones, 66, at a July 28 press conference.

She said she rarely exercised before joining the clinical trial and that the structured lifestyle changes helped her lose 30 pounds, reverse her prediabetes, lower her cholesterol and improve her knee pain.

Her mental functioning also improved over the two-year study. When Jones began a new job during the trial, she initially found it difficult to keep up with frequent emails and group chats.

“I didn’t think fast,” she said. “Now, I’m right up there with the young people. I’m able to follow the conversation. I’m able to respond as quickly as I need to.”

More than 7 million Americans have Alzheimer’s disease, the most common form of dementia, according to the Alzheimer’s Association. By 2050, that figure is projected to rise to nearly 13 million.

Although many people assume their dementia risk is set in stone, the trial shows “it is not too late to do things when you are 60 to 79,” Coresh says.

How the study was performed

The study participants came from five communities around the United States. More than two-thirds of them were women, and about 30 percent identified as racial or ethnic minorities.

In the self-guided group, trained navigators encouraged healthy habits during six group meetings over two years. Participants received $75 gift cards to encourage them to make lifestyle changes. They also got annual checkups to monitor blood pressure and lab test results.

One of the self-guided group members, Peter Gijsbers van Wijk of Houston, said the trial inspired him to make lasting changes. Van Wijk, 72, now walks five miles a day, he said at the July 28 press conference.

Participants assigned to the structured regimen received a much more intensive intervention. Over the two years, they attended 38 team meetings and received telephone support. They exercised at least three hours a week, with aerobic exercise four days a week and resistance and flexibility training twice a week.

They were taught how to follow the MIND diet, which combines elements of the Mediterranean and DASH diets, which are associated with slower rates of cognitive decline. Participants performed web-based cognitive training three times a week for 15 to 20 minutes per session, and health professionals reviewed their lab results twice a year, monitoring their blood pressure, cholesterol and hemoglobin A1C levels, which are used to diagnose diabetes. Lastly, people in this group received monthly rebates of up to $10 to buy blueberries, provided by the blueberry industry group.

Some questions remain unanswered

Because participants were encouraged to make several lifestyle changes, the trial doesn’t pinpoint which strategies — such as diet or brain training — were the most important, Coresh says. What’s more, judging by attendance at meetings and willingness to volunteer for a clinical trial, the participants appear to have been highly motivated to improve their health. Researchers don’t know if people in the general population would benefit as much, Coresh says.

Volunteer participants in both arms of the study also had above-average levels of education. About one-third had earned a college degree, and another third had earned a postgraduate degree. Research has shown that formal education may reduce dementia risk, so it’s possible that people without college degrees might not benefit as much from the same lifestyle interventions. Some of the improvement in participants’ test scores could be due to practice, says Dr. Hugo Aparicio, an associate professor of neurology at Boston University’s Chobanian and Avedisian School of Medicine, who was not involved in the POINTER study.

Volunteers “may have improved their performance due to familiarity with and repetition of the testing,” he says. Researchers also don’t know if the cognitive boost volunteers received will last beyond two years (the length of the study) and if those benefits will translate into lower rates of cognitive decline or dementia, wrote Dr. Jonathan Schott, a professor at University College London’s Queen Square Institute of Neurology, in an accompanying editorial, also published in JAMA.

Future publications could answer some of these questions, says Maria Carrillo, chief science officer and medical affairs lead for the Alzheimer’s Association.

The Alzheimer’s Association will continue the study for four more years and work with 10 communities to bring interventions from the POINTER trial to older adults. Researchers plan to study participants’ gut microbiome, as well as analyze their brain imaging studies and blood samples, Carrillo said.

Given that the structured intervention was more expensive to provide, encouraging people at high risk of dementia to follow the self-guided approach “may offer a better balance of feasibility, reach and cost in many real-world settings, particularly if these can be delivered remotely,” Schott wrote.

The $150 million trial was funded by the Alzheimer’s Association and the National Institute on Aging, part of the National Institutes of Health.

Jones said she has shared what she learned through the trial with family members.

“Once I learned that dementia affects the Black community at twice the rate of my white counterparts, I knew this could no longer be just my story,” Jones said.

“When you learn something this powerful, you have to share it,” she added. “I’m energized. I’m living with purpose. I’m doing everything I can to reach out to those who may be feeling the way that I once felt — hopeless, afraid or alone. Because there is hope.”