Multidomain Lifestyle Interventions Improve Older Adult Brain Health

A 2-year randomized controlled trial designed to define means of protecting the brain health of older adults at risk for dementia provided 2 promising lifestyle intervention strategies for clinicians to consider.¹

The 2000-patient U.S. POINTER study, led by Laura D. Baker, PhD, of the department of gerontology and geriatric medicine at Wake Forest University, was designed to expand on the results of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) in American patients.

FINGER took place in Finland and Sweden and included 1260 participants aged 60-77 years. After 2 years, cognition improved about 25% more in an observed multidomain intervention group.² Many other lifestyle interventions branched off from FINGER, creating a collaborative international network. U.S. POINTER is a part of the network, funded by the Alzheimer’s Association.¹

“U.S. POINTER differs from other studies most notably in its ‘high touch’ approach during recruitment…and intervention delivery to engage and retain underserved communities and provide essential support of a cohort at high risk for cognitive decline,” the team wrote.

Baker and colleagues said FINGER’s results were promising, but the studies must be “replicated and confirmed in heterogenous cohorts in other countries with regard to culture, race, ethnicity, and socioeconomic (factors).”

Because FINGER needed more diverse data, U.S. POINTER included an improved representation of older Americans at risk for cognitive decline and dementia. To do this, the team for U.S. POINTER searched for key partners in their grassroot recruitment, including leaders of Black church communities, community health clinic providers, the Alpha Kappa Alpha Sorority, the Mexican Consulate, and the AARP across multiple sites.

Eligible participants were at risk for a decline in cognitive ability, aged 60-79 years, not a regular exerciser, and had a MIND diet screener score of <9.5, indicating a poor diet. They also needed to include ≥2 of the following conditions: family history of memory impairment; a part of the African American/Black of Native American race or Hispanic ethnicity; older age (> 70 years); mild elevation in systolic blood, pressure (BP >125 mmHg); low-density lipoprotein (LDL >115 mg/dL); high cholesterol; or glycated hemoglobin (BbA1 c > 6.0%).

The study excluded people with a history of neurological or psychiatric disorders, as well as alcohol and substance abuse. They also could not be on medications like narcotics, antipsychotics, nor medicine for Parkinson’s or Alzheimer’s disease. Participants could not be residences of an assistant living facility, nor have a significant cardiovascular, lung, or organ disease.

The team conducted their trial at 5 clinical sites, and interventions focused on exercise, diet, cognitive/social, stimulation, and cardiovascular health.

According to a Lancet Commission report, treating risk factors may prevent or delay up to 40% of dementia case, although multidomain interventions targeting several risk factors could be the more effective.3

U.S. POINTER followed FINGER with a multidomain intervention of physical activity, nutritional guidance, cognitive training, and social activities. The 2000 older Americans in the trial were broken into 2 intervention groups: the Self-Guided (SG) Intervention and the Structured Intervention (STR).¹

The SG group met 3 times in the first year and 2 times in the second year to educate, support, and encourage healthy lifestyle practices. Their intervention was more intensive, with regular facilitated group meetings and structured program of aerobic exercise. Such exercises included resistance training and stretching. This group also received dietary counseling, computer-based training, cognitively and socially stimulating challenges, guideline-based coaching, and goal setting to help self-management of cardiometabolic health.

Investigators observed a statistical power of 89.7% for the targeted intervention. The team projected an 83.7% power for an intervention effect of 0.02375 per year and a 93.9% power for an intervention effect of 0.325 per year. FINGER had similar results, with an intervention effect of 0.03 statistical difference (SD) per year.

The preliminary findings suggest that U.S. POINTER may have fared well as retention rates remained high (98%) even after pausing for 4 months, and an intervention adherence stayed high (>80%).

Ultimately, the diverse participant sample was what made the U.S. POINTER stand out.

“Although a more diverse cohort may yield different results than in other trials, AD risk is higher for racially and ethnically minoritized communities and therefore these groups critically need to be included in these and other studies to better understand the impact,” investigators wrote.

References

1. ^{Baker LD, Snyder HM, Espeland MA, et al. Study design and methods: U.S. study to protect brain health through lifestyle intervention to reduce risk (U.S. POINTER) [published online ahead of print, 2023 Sep 30]. Alzheimers Dement. 2023;10.1002/alz.13365. doi:10.1002/alz.13365}
2. ^{Alzheimer Organization. A Global Collaboration for Future Generations. World Wide Fingers. Accessed October 4, 2023. https://www.alz.org/wwfingers/overview.asp.}
3. ^{Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the lancet commission. Lancet. 2020;396(10248):413-446.}