August 6, 2025
A combination of healthy behaviors including regular exercise, a nutritious diet, mental stimulation and heart health monitoring improved cognitive health in older adults at increased risk of developing dementia, a large new study found. Adults who were enrolled in a structured program with regular check-ins showed greater improvements than those who were in a self-guided program, though both groups showed benefits for brain health.
The study looked at a racially and ethnically diverse mix of 2,111 Americans in their 60s and 70s. They lived in five geographically diverse areas: North Carolina, Rhode Island, northern California, Houston and Chicago. None had Alzheimer’s disease or other serious memory problems at the start of the study. However, all were at increased risk of Alzheimer’s because they were fairly sedentary (got less than 60 minutes a week of moderate intensity exercise), did not eat a particularly healthy diet, had family members with Alzheimer’s disease or had heart and metabolic risk factors like high blood pressure, high cholesterol or obesity.
Over the next two years, participants were randomly assigned to one of two groups: a structured lifestyle program, or a self-guided program.
In the structured program, participants attended 38 team meetings over the two-year course of the study. Trained group leaders provided guidance on the best ways to eat and exercise and discussed the importance of socialization and cognitive stimulation for brain health. The structured program focused on four main areas of behavior:
Physical exercise. Exercise sessions included aerobic activities (4 days a week, 30 to 35 minutes per session); weight and resistance training (2 days a week, 15 to 20 minutes per session); and stretching and flexibility exercises (2 days a week, 10 to 15 minutes per session). Exercise sessions were done at local Y’s or other community centers.
MIND diet. Participants were encouraged to follow the MIND diet, which combines elements of two diets that have been shown to be beneficial for heart health: the traditional Mediterranean diet, rich in fruits, vegetables, whole grains, legumes and olive oil; and the DASH (Dietary Approaches to Stop Hypertension) diet, low in salt and also rich in vegetables, fruits, low-fat dairy and nuts. Foods to be avoided or eaten less often include red meat, saturated fats like butter, sugary sweets and pastries, whole fat cheese, and fried or fast food.
Cognitive training and social engagement. Participants used a computer program called BrainHQ, which offers puzzles and other cognitive challenges designed to stimulate the brain, completing at least three 15- to 20-minute sessions a week at home. They were also encouraged to socialize and meet with peers for regular check-ins.
Heart health monitoring. Medical advisors met with participants every six months to review monthly blood pressure monitoring results and blood test results.
Participants in the self-guided group received publicly available educational materials about health, exercise and diet. They were encouraged to make lifestyle changes that best suited their personal needs and schedules. Gift cards ($75) were provided at six team meetings to support behavior changes. They also got regular medical checkups.
Most people enrolled in the study stayed in it for the full two years. Both groups showed improvements on tests of memory and thinking skills by the end, though those in the structured group tended to show the greatest benefits. People who had the lowest cognitive scores at the study’s start also tended to show greater improvements than those with higher scores. For both groups, the biggest cognitive improvement involved executive function, which involves skills like planning and organizing.
The researchers will continue to analyze brain scans and other medical data to see what additional effects the training may have had on the brain. The study, called the U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk, or U.S. Pointer, was published in JAMA, the journal of the American Medical Association. Results were presented at the international conference of the Alzheimer’s Association, which funded the study.
The findings underscore the importance of lifestyle in keeping thinking skills intact as we age. In an editorial accompanying the study, Dr. Jonathan Schott, of the University College London, writes that “the key message of U.S. POINTER may be that even relatively modest lifestyle changes can support cognitive health in aging populations.” Even if we aren’t enrolled in such a study, all of us can take steps to keep our brains in good working order and lower the risk of dementia as we age.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Eric Schmidt, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.
Sources: Laura D. Baker, PhD; Mark A. Espeland, PhD; Rachel A. Whitmer, PhD; et al: “Structured vs Self-Guided Multidomain Lifestyle Interventions for Global Cognitive Function: The US POINTER Randomized Clinical Trial.” JAMA, July 28, 2025
Jonathan M. Schott, MD: “Lifestyle Interventions to Improve Cognition in Later Life: When Is Enough Enough?” JAMA, July 28, 2025
