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New Landmark Study Reports Diet+Exercise+Brain Training+Social Challenge/Engagement Cognitive Function in Older Adults at Risk for Dementia & Cognitive Decline
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Download the PDF here
Download the PDF here
Download the PDF here
Scientists have unveiled the strongest evidence yet that a combination of diet, exercise and brain training can improve thinking and memory in older Americans.
"Doctors should be treating lifestyle interventions as they would a drug," she says. That would mean prescribing regimens like the one in POINTER and getting insurance companies to cover those prescriptions.
A study of more than 2,100 sedentary people in their 60s and 70s found that those who spent two years on the intensive regimen not only improved their mental abilities but appeared to reduce the usual declines associated with aging. You had to be sedentary, not a regular exerciser, and you had to be consuming a suboptimal diet.
US POINTER demonstrated that multidomain lifestyle interventions can be safely and effectively delivered to older adults. Although global cognitive function improved for both intervention groups, greater benefit was observed with the structured multidomain intervention, which promoted regular physical exercise, adherence to the MIND diet (Mediterranean Diet), cognitive and social challenge, and health monitoring. Further research is needed to understand the clinical significance of this difference and assess longer-term clinical outcomes of both interventions.
Structured vs Self-Guided Multidomain Lifestyle Interventions for Global Cognitive FunctionThe US POINTER Randomized Clinical Trial
Key Points
Question Can multidomain lifestyle interventions improve or protect cognitive function in older adults at risk of cognitive decline and dementia?
Findings In this randomized clinical trial of 2111 older adults at risk of cognitive decline and dementia, a structured lifestyle intervention of regular moderate- to high-intensity physical exercise, adherence to the MIND diet, cognitive challenge and social engagement, and cardiovascular health monitoring led to a statistically significant greater improvement in global cognition over 2 years relative to a lower-intensity self-guided intervention (mean composite z-score increase of 0.243 SD per year vs 0.213 SD per year, respectively).
Meaning The structured, higher-intensity intervention had a greater benefit on global cognition than the self-guided, low-intensity intervention. Further research is needed to understand clinical significance and longer-term cognitive effects of both interventions.
Interventions Participants were randomly assigned with equal probability to structured (n = 1056) or self-guided (n = 1055) interventions. Both interventions encouraged increased physical and cognitive activity, healthy diet, social engagement, and cardiovascular health monitoring, but differed in structure, intensity, and accountability.
Main Outcomes and Measures The primary comparison was difference between intervention groups in annual rate of change in global cognitive function, assessed by a composite measure of executive function, episodic memory, and processing speed, over 2 years.
Results Among the 2111 individuals enrolled (mean age, 68.2 [SD, 5.2] years; 1455 [68.9%] female), 89% completed the year 2 assessment. The mean global cognitive composite z score increased from baseline over time in both groups, with a mean rate of increase per year of 0.243 SD (95% CI, 0.227-0.258) for the structured intervention and 0.213 SD (95% CI, 0.198-0.229) for the self-guided intervention. The mean rate of increase per year was statistically significantly greater for the structured group than the self-guided group by 0.029 SD (95% CI, 0.008-0.050; P = .008). Based on prespecified secondary subgroup comparisons, the structured intervention benefit was consistent for APOE ε4 carriers and noncarriers (P = .95 for interaction) but appeared greater for adults with lower vs higher baseline cognition (P = .02 for interaction). Fewer ascertained adverse events were reported in the structured group (serious: 151; nonserious: 1091) vs the self-guided group (serious: 190; nonserious: 1225), with a positive COVID-19 test result being the most common adverse event overall and more frequent in the structured group.
Conclusions and Relevance Among older adults at risk of cognitive decline and dementia, a structured, higher-intensity intervention had a statistically significant greater benefit on global cognition compared with an unstructured, self-guided intervention. Further investigation of functional outcomes, biomarkers, and ongoing extended follow-up will help address clinical relevance and sustainability of the observed cognitive benefits.
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