Doctors reveal the simple lifestyle changes that could prevent dementia in largest study of its kind
Researchers at the world's largest dementia conference this week unveiled the findings of the US POINTER Study, the country's most comprehensive study on lifestyle interventions on Alzheimer's disease.
The team of nearly three dozen US researchers looked at more than 2,000 older Americans, all of whom had a family history of dementia or known risk factors like high blood pressure and obesity.
They were divided into two groups and asked to either follow a strict diet or exercise regimen, establish a support group or social circle for two years or pick their own habits to change.
Measures included implementing aerobic exercise like walking and biking, following a Mediterranean-style diet and doing brain-training exercises on their computers.
Researchers found both groups improved their ability to balance tasks, process information and recall personal experiences. However, people who followed a more regimented routine had nine percent better scores than those who followed a self-guided approach, which researchers called a 'significant' shift.
In fact, participants in the structured group performed at a cognitive level one to two years younger than their actual age, suggesting the interventions 'slowed the cognitive aging clock.'
The study comes after a recent Lancet Commission study identified 14 modifiable risk factors for dementia, which include physical inactivity, smoking, diet, pollution and lack of social contact, among others.
The researchers, speaking Monday at the Alzheimer's Association International Conference in Toronto, said this is the 'first large-scale randomized trial that is demonstrating accessible and sustainable health and lifestyle interventions that can protect cognitive function in diverse populations and communities across the country.'
Dr Laura Baker, principal investigator and professor of gerontology and geriatrics at Wake Forest University, said during a press conference ahead of the reveal: 'This test of the POINTER lifestyle prescription provides a new recipe for Americans to improve cognitive function and increase resilience to cognitive decline and that structured lifestyle intervention is feasible.
'I am happy to have a positive clinical trial. We now know that healthy behaviors matter for brain health. Though our rigorous trial we know that.'
Trial participants speaking at AAIC also called the study their 'lifeline' and that it helped them reverse key dementia risk factors like prediabetes, obesity and depression.
The team is planning to observe participants for another four years and roll the study out to additional sites across the US, many of which are underserved by dementia prevention resources.
The study, unveiled today at the Alzheimer's Association International Conference in Toronto, looked at 2,111 adults from five sites in the US for two years.
The report was also published today in the journal JAMA.
Participants were ages 60 to 79, with an average age of 68. About 69 percent of participants were female.
Adults included in the study tended to live a sedentary lifestyle and follow a typical Western diet.
They all also met at least two of the following criteria: had an immediate family history of memory impairment; had cardiovascular issues like high blood pressure or cholesterol cardiometabolic risk; were American Indian or Alaska Native, Black, Middle Eastern or North African race; were Hispanic, Latinx or Spanish; were 70 to 79 years old; or were men.
Over two-thirds of participants were white. About one in three were APOE-ε4carriers, making them genetically susceptible to Alzheimer's disease. And eight in 10 had a family history of memory issues.
The participants were assigned to two equally sized groups: structured or self-guided lifestyle interventions.
Structured interventions included exercise, nutrition, cognitive and social challenges and health coaching.
Types of exercise included in the structured group were aerobic (such as running or biking), resistance (weightlifting), and stretching and balance exercise, all mostly done at facilities like a gym or YMCA.
Aerobic exercise was done four days per week for 30 to 35 minutes at a time. Resistance training was 15 to 20 minutes for two days per week, while flexibility training was scheduled for 10 to 15 minutes two days per week.
Structured participants were also encouraged to follow the MIND diet, which combines tenets of the Mediterranean and DASH (Dietary Approaches to Stopping Hypertension). It's been shown to lower dementia risk by emphasizing brain-healthy foods like leafy green vegetables, berries, nuts, olive oil, lean fish and whole grains.
They were also given cognitive training exercises on their home computers three times per week for 15 to 20 minutes at a time and attended support group sessions with peers.
Meanwhile, participants in the self-guided group were encouraged to follow all of these interventions based on provided educational materials but were not given specific guidelines.
Peter Gijsbers van Wijk of Houston was assigned to the self-guided group. He said during AAIC that he focused on working out more, purchasing a smart watch to track his steps and parking further away during trips to the grocery store.
He also tried to swap out salty snacks for granola bars and implement more fruits and vegetables in his diet. When his wife passed away during the study, he dedicated his free time to volunteering and 'giving back to the community.'
Both groups underwent blood tests and memory assessments every six months.
The researchers found both groups improved their cognitive scores after two years of lifestyle interventions, though the structured group had nine percent better scores than those following a self-guided protocol.
The structured participants also scored better than self-intervention participants in executive function and processing speed. These are things like switching between tasks and taking in new information.
Both groups had similar improvements in episodic memory, the ability to recall specific personal experiences.
But the team emphasized strict, structured approach was the most impactful overall.
Dr Baker said: 'What we've learned is it's the structure and the support that's needed for success change and endurable change.'
There were also fewer adverse effects like illness and death in the structured group than the self-guided group, with 151 serious and 1,095 non-serious events compared to 190 and 1,225.
The researchers noted because 35 percent of older adults don't meet physical activity guidelines and 81 percent consume suboptimal diets, according to national data, the findings could have sweeping implications.
Phyllis Jones of Chicago said during AAIC that getting the call to participate in POINTER was her 'lifeline,' as she was 'circling the drain' with prediabetes, obesity and depression.
Now, she no longer has depression, joint pain and high cholesterol and has lost 30 pounds.
She said: 'I lost the belief that pain and decline are just normal parts of aging. I'm energized. I'm living with purpose.'
There were several limitations to the study, including only studying participants from five sites and not looking at overall dementia outcomes.
However, the team is planning to observe the participants for another four years to look at long-term impacts and roll the program out to other sites.
Gijsbers van Wijk also suggested providing smart watches to participants who can't afford them so they can better keep track of their health metrics.
Dr Baker said: 'We are so proud to be part of this study. It's been a most magnificent journey.'
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