Study details

For the study, called the POINTER study, researchers recruited 2,111 people ages 60 to 79 from a variety of racial and ethnic backgrounds. None of the participants were cognitively impaired and all had sedentary lifestyles, suboptimal diets, and two other dementia risk factors, like a family history of cognitive decline and high blood pressure.

Half of the participants were given a structured program that prescribed them a healthy diet, socially engaging activities, and a weekly regimen of eight exercise sessions and three sessions of online cognitive training.

Meanwhile, the other half followed a self-guided program. These participants were given educational materials and resources and were regularly encouraged to engage in healthy behaviors.

Both participant groups saw improvements on tests of memory and cognition, but the researchers found the structured group did significantly better.

"The structured intervention had an extra benefit over and above the self-guided," said Laura Baker, a professor of gerontology, geriatrics, and internal medicine at Wake Forest University School of Medicine and principal investigator on the study.

While the structured program was difficult, it was "life-changing" for many of the participants, Baker said, adding that most were able to make substantial and lasting changes.

Discussion

According to Kristine Yaffe, an expert in cognitive aging at the University of California, San Francisco, the study "confirms that paying attention to things like physical activity and vascular risk factors and diet are all really important ways to maintain brain health."

However, the study also leaves a number of questions unanswered.

It also wasn't clear how much of the cognitive improvement was a result of the "practice effect," a phenomenon in which participants learn to do better on assessments simply by taking them several times.

"Even though we use different stimuli within tests, the act of taking a test over and over makes you more familiar with the situation — you know where the clinic is, where to park, you're more comfortable with your examiner," Baker said.

"One of the big questions is how much do you need to do, and what's cost-effective," Anstey said. "If we only have very intensive interventions only a few people can afford, that's not actually going to address the bigger issue of population aging and lots of people developing cognitive impairment."

The Alzheimer's Association, which spent nearly $50 million conducting the POINTER study, is planning to invest another $40 million over four years to implement what they've learned and figure out next steps.

"The translation from the POINTER prescription to how we then deliver that into the community is absolutely the next step," said Heather Snyder, an SVP at the Alzheimer's Association and coauthor on the study.

To do that, Snyder said the group will be asking a variety of questions. "What's somebody going to respond to? Is it going to be something from their health care provider? Is it some sort of app, a motivation using technology? Is it something in their technology that they go do?"

An important step will be getting buy-in from healthcare providers, according to Jessica Langbaum of the Banner Alzheimer's Institute in Arizona.

"Doctors should be treating lifestyle interventions as they would a drug," she said, which would mean prescribing regimens like the one in the study and getting insurance companies to cover those prescriptions.