Long-Term Lifestyle Changes Best Shield Against Cognitive Decline

 Enduring lifestyle modifications appear most effective in combating cognitive decline.

Positive routines, such as engaging in physical activity and maintaining a nutritious diet, genuinely seem to enhance cognitive function, especially when pursued with commitment.

Consistent physical activity might aid in maintaining our mental sharpness.

A well-organized combination of exercise, nutrition, mental challenges, and social interaction appears particularly potent in combating cognitive deterioration, in contrast to more relaxed, self-directed strategies.

The mind’s ability to retain information, communicate, and solve problems generally diminishes with age, often resulting in dementia. However, studies indicate that up to 45 percent of global dementia cases could potentially be avoided through modifications to 14 risk factors, including insufficient education, social isolation, and traumatic brain injuries.

To explore methods of preventing this decline, Laura Baker at Wake Forest University School of Medicine in North Carolina and her team have been conducting a study known as the US POINTER initiative.

They selected over 2,100 individuals identified as high risk for cognitive decline due to their age (between 60 and 79 years), sedentary lifestyles, poor dietary habits, and at least two other dementia-associated factors, such as a family history of memory issues.

Participants were randomly divided into one of two programs, both designed to promote physical and mental activity, nutritious eating, and social engagement, but implemented in different manners.

One approach was highly structured, involving 38 group sessions across two years, led by trained facilitators who provided plans. This regimen also included regular workouts at a community center, guidelines for adhering to an anti-dementia diet, and weekly online sessions featuring brain-training software.

The other group adopted a more self-directed approach, with only six group meetings over the two years. These participants received publicly available educational materials along with $75 gift cards designed to incentivize behavior changes, such as joining gym classes.

After two years, both groups exhibited improvements on a cognitive assessment system evaluating memory, executive function, and processing speed. The structured cohort improved by 0.24 standard deviations annually, compared to their baseline scores at the start of the trial, while the self-guided group marked a 0.21 standard deviation improvement per year—a small yet statistically significant advantage.

“It’s remarkable that the structured care group outperformed,” says Gill Livingston at University College London. However, she notes the study lacked a control group receiving no interventions for a direct comparison against the structured and self-guided groups.

Baker mentions her team has modeled the potential decline in cognitive scores that could occur without either regimen, estimating the benefits to be substantial. “The two-year structured intervention is effectively slowing the cognitive aging clock by one to almost two years,” she explains.

It is plausible that both groups made progress due to the expectation of improvement, a phenomenon akin to the placebo effect, Baker suggests, noting that all participants believed they had been allocated to the group anticipated to yield the best outcomes.

Claudia Suemoto at the University of São Paulo in Brazil contends that the modest difference in cognitive scores between the groups likely wouldn’t be perceptible to either the participants or their families. Moreover, dementia typically progresses slowly, hence it would require more than two years to observe significant effects, she states.

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Baker indicates that the US POINTER study includes a four-year extension, enabling the team to track some participants for a total of six years. She says, "We are only slowing down a progressive decrease over time, and we are noticing very minor changes, as these are cognitively normal individuals. "“We are truly optimistic about the prospect that we can empower individuals at risk of dementia to take charge of their health.”

She also believes that the highly structured model could be applied pragmatically beyond trial settings. It’s not primarily about substantial public investment to instill these positive habits, but rather about caregivers and medical professionals inspiring people to adopt them, she observes.

“In general, dementia care is exceedingly costly, so alleviating its impact would yield significant savings,” Livingston emphasizes. “This study is crucial as it demonstrates that lifestyle enhancements are beneficial and that individuals fared slightly better with guided support, but this doesn’t imply that it is the sole method to achieve these improvements.”