Cognitive Decline Can Be Slowed Down with Lifestyle Changes

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A 2,100-participant clinical trial found that structured and self-guided lifestyle changes can improve cognitive capabilities in older, at-risk adults

Sara Hashemi

Sara Hashemi - Daily Correspondent

August 6, 2025 1:01 p.m.

A new study of more than 2,000 people offers further evidence that lifestyle changes can improve cognition and health in older adults. The results were published in the journal JAMA and presented at the Alzheimer’s Association International Conference in July.

The $50 million U.S. POINTER study, funded by the Alzheimer’s Association, is the largest randomized clinical trial in the country to look at how lifestyle can impact thinking and memory. Researchers compared two methods of combating cognitive decline across 2,100 people at risk of dementia. Nearly 70 percent of the participants were female, and 31 percent were from racial or ethnic minority groups. Participants lived in five locations: North Carolina, Rhode Island, Northern California, Houston and Chicago.

“These are cognitively healthy people between the ages of 60 and 79 who, to be in the study, had to be completely sedentary and at risk for dementia due to health issues such as prediabetes and borderline high blood pressure,” explains principal investigator Laura Baker, a researcher of gerontology and geriatrics at Wake Forest University, to Sandee LaMotte at CNN.

From that sedentary baseline, the participants then made changes to their lifestyles. Half of the participants were prescribed an activity schedule with aerobic exercise four times per week, cognitive training sessions and adherence to the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. They also attended 38 structured meetings in their neighborhoods over two years, at which a facilitator taught them the importance of socialization and spread information about brain health. The participants also received 26 additional phone calls to assess their diet over the course of the study.

The other half of the participants followed a self-guided program where they chose their own diet and brain health regimen. They attended six meetings over the course of the study, in which the research staff offered general encouragement without specific directions. While this group received education on health, exercise and diet, they were not prescribed any standardized plan. Both groups were given physical and cognitive tests every six months.

Ultimately, both programs improved the participants’ cognitive scores, but those in the structured group had slightly better results. “The structured intervention had an extra benefit over and above the self-guided,” Baker says to Pam Belluck at the New York Times.

Researchers estimate that, compared to the self-guided group, participants in the intensive program seemed to delay cognitive aging by an extra one to almost two years, reports CNN.

“It confirms that paying attention to things like physical activity and vascular risk factors and diet are all really important ways to maintain brain health,” Kristine Yaffe, an expert in cognitive aging at the University of California, San Francisco, who was not involved in the study, tells the New York Times.

Need to know: What causes Alzheimer’s disease?

While scientists don’t completely understand the exact causes of Alzheimer’s disease, a combination of genetic, environmental and lifestyle factors are thought to be at play. Two proteins—clumps of beta-amyloid and misshapen tangles of tau proteins—are seen in the brains of people with Alzheimer’s and dementia.

Still, given that the two groups scored similarly, the work suggests more research is needed. In an editorial for JAMA, Jonathan M. Schott, a dementia researcher at University College London, writes that “the more striking finding is perhaps the similarity of the cognitive benefits across both groups, despite the self-guided group requiring only a fraction of the engagement and interventions.”

Schott also notes that the clinical trial didn’t include a control group of participants who got no guidance and made no lifestyle changes. This makes it hard for researchers to pinpoint which aspect of the program might have been responsible for the positive effect. However, Heather M. Snyder, senior vice president for medical and scientific relations at the Alzheimer’s Association, tells the New York Times that the organization thought neglecting to offer an intervention to one group would be unethical.

The results do suggest that supervision and encouragement can make a big difference in helping people commit to lifestyle changes, Baker tells NPR’s Jon Hamilton. “There is no way to form a new habit or change behavior without intentional work on a regular basis,” she says.

Next, the team will analyze brain scans and blood samples taken over the course of the study to determine whether participants’ cognitive improvement was correlated with biological changes. Those results will be published later this year, per NPR.

The Alzheimer’s Association will also be looking at ways to implement what they learned from this study. The organization is investing $40 million for a four-year follow-up with participants, and around 80 percent of the study’s participants have joined, reports CNN.

“We now need to translate this and to turn brain health interventions into public health outcomes and solutions,” Snyder says to the New York Times.