KEY POINTS Older adults can improve thinking and memory with exercise, diet, brain training and social engagement.

It is never too late to make lifestyle changes that can have measurable impact on brain health.

A new study found no differences regardless of age, sex, ethnicity, heart health and the presence of an Alzheimer’s risk factor.

Older Americans in their 60s and 70s can improve thinking and memory through a combination of diet, exercise and brain training.

That’s the finding of a new study involving more than 2,100 older adults at risk of cognitive decline and dementia.

The researchers, from five U.S. academic and health institutions across the country, showed that “a structured lifestyle intervention of regular moderate- to high-intensity physical exercise, adherence to the MIND diet, cognitive challenge and social engagement and cardiovascular health monitoring was better at preserving thinking and memory than self-guided, lower-intensity efforts.”

Both interventions helped. But the structured program provided greater gains.

“Our findings have tremendous implications for older adults: It is never too late to make lifestyle changes that can have measurable impact on one’s brain health,” said Jeffrey Katula, McDonough Family Faculty Fellow in the Wake Forest Department of Health and Exercise Science, in a story from Wake Forest News. He worked with principal investigator Laura D. Baker, a professor of gerontology, geriatrics and internal medicine at Wake Forest’s medical school, to design and coordinate the study.

The findings were published this week in the Journal of the American Medical Association and presented at the Alzheimer’s Association International Conference in Toronto. The study is called the “U.S. Study to Protect Brain Health Through Intervention to Reduce Risk” (U.S. POINTER).

The findings showed no differences by age, sex, ethnicity, heart health status and APOE4 genotype. The APOE4 allele is considered a risk factor for and possibly a cause of Alzheimer’s disease.

The study is the first large-scale, randomized controlled clinical trial to show that accessible, sustainable healthy lifestyle changes can protect cognitive function among diverse U.S. populations. Alzheimer’s Association president and CEO Joanne Pike said in a news release that communities could scale it to meet needs.

“The positive results of U.S. POINTER encourage us to look at the potential for a combination of a lifestyle program and drug treatment as the next frontier in our fight against cognitive decline and possibly dementia,” she said.

About the study

While the two interventions both centered around exercise, nutrition, cognitive challenge, social engagement and heart health monitoring, they were different in terms of their intensity, structure, accountability and how much support was provided to those participating.

The group randomized into the structured intervention attended 38 facilitated peer team meetings over the course of two years and were given specific sets of activities that had measurable goals. Those included aerobic, resistance and stretching exercises; following the MIND diet; challenging themselves mentally through an online program called BrainHQ training and “other intellectual and social activities.” Their goal-setting and health metrics were regularly reviewed by a study clinician.

The MIND Diet stands for Mediterranean-DASH Intervention for Neurodegenerative Delay. It combines the Mediterranean diet with the DASH diet, which is designed to deal with hypertension and heart health. Fruits, especially berries, are key. But so are green, leafy vegetables, nonstarchy vegetables, nuts, olive oil, whole grains, fish, beans and poultry, according to Healthline. Regularly eating butter and margarine, cheese, red meat, fried food and pastries and sweets is discouraged because they contain saturated fats.

The Healthline article notes the health effects of saturated fat are “widely debated in the nutrition world.”

The self-guided intervention included six peer team meetings to “encourage self-selected lifestyle changes that best fit their needs and schedules.” Staff provided general encouragement but didn’t help set goals.

The mean age of the study participants was 68.2 years and nearly 7 in 10 participants were female. Just under a third were from ethnoracial minority groups. Almost 8 in 10 reported a first-degree relative with memory loss and 30% were APOE4 carriers. Nearly 9 in 10 stayed in the study for the full two years.

Both groups improved in terms of thinking and memory. Memory improvements were about the same overall, but executive function improved more for those in the structured arm of the study.

Future plans to target healthy cognition

The researchers called the results “initial” and said they will continue to explore all the collected data to learn even more.

Per the Alzheimer’s Association news release, “People with cognitive decline and dementia often have a variety of damaging changes in their brain. This means effective treatment will likely require a multi-pronged or combination strategy to address multiple disease mechanisms.”

The association said it has invested almost $50 million in the study so far, with other support from the National Institute on Aging for complementary studies on imaging, vascular measures and health data related to sleep and gut microbiome. The association said it plans to invest at least $40 million more over the next four years to continue to follow the study participants and to bring the study’s interventions to communities across America.

The Alzheimer’s Association also announced it will build on the study’s momentum with several programs and initiatives, including: