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By Angela Hanson, MD
I had the opportunity to travel to Toronto for the Alzheimer’s Association International Conference (AAIC) in the summer of 2025. Researchers presented results from many studies, including the POINTER study, a large clinical trial on brain health interventions. This study was the US version of a 2015 Finnish study (FINGER) that showed that a 2-year intervention with diet, exercise, and medical management in older adults could help prevent cognitive decline.
Laura Baker, PhD, Associate Professor in the Department of Internal Medicine at Wake Forest University and a former faculty member in the UW ADRC, presented the POINTER study. The authors compared 2 lifestyle interventions targeting a combination of physical activity, improved nutrition, cognitive and social challenges, and health monitoring in 2,111 older adults with risk factors for cognitive decline and dementia, such as poor diet or lack of exercise. The average age of participants was 68, and 30% were from an ethnic minority group. Over 80% of participants followed the protocols assigned to them, either an intense structured intervention or a self-guided one.
The results showed that both groups showed cognitive benefit over 2 years, but the participants in the more structured intervention group improved more. The structured intervention set the brain aging clock back 1 to 2 years in terms of cognitive performance. In other words, the intervention participants showed scores on tests of memory and thinking skills that would be typical of people 1 to 2 years younger. This effect could increase resilience against cognitive decline. This benefit was consistent across subgroups, including men and women, and those with and without the Alzheimer’s risk gene APOE4.
The takeaways are that participants with greater structure and peer support, along with accountability and intervention intensity, showed greater success in protecting brain health than those provided with good information but no concrete plan for what to do with it.
We could all take action today based on the intervention's components, without being in a clinical trial.
Physical Exercise
Participants in the intervention arm of the POINTER study engaged in aerobic, resistance, stretching, and balance exercises at a community facility, with support through facilitated peer group meetings. This could be recreated through taking exercise classes at gyms or senior centers, or partnering with a friend or family member to keep each other on track with your exercise goals.
The intervention involved 30–35 minutes of moderate-to-intense aerobic activity four times a week, plus strength and flexibility exercises twice a week.
Nutrition
POINTER participants were encouraged to follow the MIND diet (a modified Mediterranean diet, with support through peer group meetings and telephone contacts with the interventionist. This approach could be recreated by asking your care provider for a referral to a nutritionist, making healthy choices at the grocery store, and regularly preparing meals with friends or family.
The MIND diet emphasizes dark leafy greens, berries, nuts, whole grains, olive oil and fish, and limits to sugar and unhealthy fats
Cognitive and social challenge
POINTER participants completed computer-based cognitive training at home and were encouraged to regularly participate in intellectually and socially engaging activities through peer group meeting support. Recreate this by setting aside time each day for cognitive activities that you enjoy, such as crossword puzzles, sudoku, or reading. We also encourage social cognitive activities such as book club, bridge, or even something like pickleball, which is physical, social, and cognitive all at once!
The intervention involved a computer-based brain training program three times a week for 30 minutes, plus regular engagement in other intellectually challenging and social activities.
Guideline-based health coaching
The study scheduled medical advisor appointments every 6 months to review monthly pressure monitoring results, blood laboratory results obtained at clinic visits, and progress toward goals. This approach could be recreated by checking in with your primary care provider about your laboratory tests and blood pressure goals. Many visits can be done through telephone or electronic messaging.
One of the last talks at AAIC that I attended reviewed multicomponent intervention trials, such as FINGER and POINTER. Overall, the research shows that when brain-healthy behaviors are combined, they can improve overall cognition. Those at greatest risk receive the greatest benefit. These findings are valuable for motivating individuals and communities to ensure we all have access to safe walking spaces, nutritious food, and health care providers. As I heard at the conference, “We can’t afford to do these things” when it comes to working on dementia prevention.
There are many things we can do to prevent cognitive decline and to keep our brains as healthy as possible for as long as possible. The POINTER study showed that working together as a community helps us stay focused on health. And it makes exercise and eating healthy more fun!
