y Chris Simms | 28 July 2025
A structured course of exercise, diet, cognitive challenges, and social engagement appears to be particularly effective at slowing cognitive decline, compared to more relaxed, self-guided efforts.
As people age, their ability to remember, use language, and solve problems tends to diminish, potentially leading to dementia. However, research suggests that up to 45% of global dementia cases may be preventable by modifying 14 risk factors, including lack of education, social isolation, and traumatic brain injury.
To explore prevention strategies, Laura Baker at Wake Forest University School of Medicine and her team conducted the US POINTER study. Over 2100 participants aged 60 to 79, considered at high risk for cognitive decline due to sedentary lifestyles, poor diets, and at least two other dementia risk factors, were selected.
Participants were randomly assigned to one of two lifestyle intervention groups. Both aimed to encourage physical and cognitive activity, healthy diets, and social engagement:
Structured Group: Attended 38 small group meetings over two years, received personalized plans from trained facilitators, participated in community exercise sessions, followed dietary guidelines, and completed weekly online brain-training sessions.
Self-Guided Group: Attended only six group meetings over the same period, received publicly available educational materials, and were given $75 gift cards intended to help them adopt healthier behaviors.
After two years, both groups showed cognitive improvements. The structured group improved by 0.24 standard deviations per year on cognitive tests (memory, executive function, and processing speed), while the self-guided group improved by 0.21 — a small but statistically significant difference.
Gill Livingston at University College London found the results promising but noted the lack of a control group with no intervention. Baker’s team estimated that without either intervention, participants would have experienced notable cognitive decline. They concluded the structured intervention may have delayed cognitive aging by one to nearly two years.
Baker acknowledged the possibility of a placebo effect, since all participants believed they were assigned to the most beneficial group. Nonetheless, she emphasized the potential of structured interventions to empower at-risk individuals to manage their own cognitive health.
The US POINTER study has been extended to six years, allowing further analysis of long-term effects. Claudia Suemoto at the University of São Paulo noted that the small differences in cognitive scores might not be noticeable to participants or families over just two years, given the slow progression of dementia.
Baker believes structured programs could be applied beyond research settings, with health professionals and caregivers promoting these lifestyle changes without excessive public spending.
Livingston added that dementia care is costly, so reducing its prevalence through lifestyle changes could ultimately save money. She emphasized that while guided programs showed slightly better results, other approaches to improving lifestyle habits could also be effective.
Journal Reference:
JAMA DOI: 10.1001/jama.2025.12923