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Preventing dementia is a key goal for many midlife and older adults.

Medications and supplements have shown limited success.

A groundbreaking study identifies the lifestyle changes that could dramatically reduce your risk of dementia.

We might all make changes based on the low-cost approaches they developed.

My prior blog posts addressed whether you have dementia, how lifelong factors may protect against dementia, and the role of genetics in dementia. But everyone wants to know, “What can I do to prevent dementia right now?”

A caveat: Check with a healthcare provider before you make lifestyle changes. An online blog educates the public about new research but not what is right for you.

Researchers have long known that poor health behaviors and environmental factors put people at risk of dementia: low education, chemical toxins, lack of sleep, stress, social isolation, being sedentary, and poor diet (put those potato chips down and get off the couch when you finish reading this).

But does a combination of positive health behaviors prevent dementia?

Recent research suggests that a full-life makeover might help prevent dementia, and even reverse some of the cognitive declines of late life.

The Alzheimer’s Association and the National Institute on Aging completed an ambitious research endeavor: the US POINTER Trial (U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk). The goal: To find a constellation of effective lifestyle changes to combat cognitive impairment and dementia.

It involved a herculean effort. Scholars at five research sites recruited over 2,000 adults aged 60 to 79 who were at risk of cognitive impairments. Participants engaged in the study interventions for two years.

Before they started, these people spent most of their time sedentary and ate a poor diet. And they had at least two of these factors: family history of memory impairment, high blood pressure, cholesterol was off, borderline diabetic, or were from a high-risk demographic group. You probably know people over 60 who fit the bill.

This was a gold standard clinical trial. The researchers compared two intervention groups, one expected to benefit and the other a “control”. They used random assignment, basically a coin flip, until an even number of participants were in each group. If they had compared people who received an intervention with those who received no intervention, any positive effect might reflect general activity, not the specific intervention.

The study was “blinded.” The people in the study didn’t know if they were assigned to the group expected to benefit. People might try harder if they knew they were expected to benefit from the intervention or change their behavior in ways unrelated to the intervention.

What Were the Intervention Groups?

The two intervention programs included similar content but differed in their structure, check-ins, and personal support.

Self-Guided Lifestyle Intervention

This group had access to publicly available educational materials and medical test results every 6 months. The researchers encouraged them to make lifestyle changes that were convenient. They also met with other study participants in a peer group five times across the two years.

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Structured Lifestyle Intervention

A betting person would stake their money on this intervention. This group participated in 38 peer group meetings over the two years. They received a tailored program that included physical activity, a carefully designed diet, phone call check-ins, cognitive training, and regular health and goal reviews. It was a lot!

So What Did the Researchers Find?

The good news: The POINTER study produced positive results - it was a big step forward!

Both interventions maintained their cognitive skills, and even showed modest improvements. This held true regardless of the person’s sex, ethnicity, heart health, or genetic risk for the APoE4 allele (see my prior post).

But the structured intervention group outperformed the other group in important ways. Their cognitive performance improved more; some estimates say that they slowed their cognitive aging by one to two years.

Several factors boosted the effects of the structured intervention. Greater personal support (e.g., check-ins), in-person contact, and accountability may have contributed to the differences. Personally, I’m terrible at asynchronous online programs. I log on and end up going down rabbit holes, reading irrelevant news, and sending emails.

Before you shout, “Hurray! Easy peasy!,” let’s think about the array of lifestyle changes (and think about whether adults should be using the phrase “easy peasy”).

Moderate to high intensity group exercise classes 4 times a week for 30 minutes.

Strength training (e.g., weights) and flexibility exercises 2 times a week.

Adherence to the MIND diet, similar to the Mediterranean and DASH diets, with leafy greens, berries, nuts, whole grains, olive oil, and fish, and very limited sugar and unhealthy fats.

Meetings with a dietary interventionist.

Online cognitive training that was demanding and a little tedious at least three times a week. (Not just Sudoku or crossword puzzles. The Spelling Bee from the New York Times doesn’t count either.)

Regular engagement in cognitively stimulating peer group activities.

Medical check-ups, lab tests, and advisor appointments every 6 months.

Analogous to physical fitness, you have to go faster and lift more weight to build capacity; it won't be easy. Cognition is complex, drawing on multiple skills, including socializing and using language. Together, this means you must engage in intense activity across multiple domains simultaneously to prevent declines.

But if you have a full-time job, children, aging parents, a plumbing leak, a pet that needs to go to the vet, and other responsibilities, it might be challenging to accomplish this combination of lifestyle changes. And of course, stress is bad for the brain. So, it won’t help to add to your “to-do” list.

The news is truly good, though, even for the busiest among us. The POINTER study is among the first to show that declines can be reversed. And the findings lend hope that if you do end up on the precipice of cognitive impairment, there are things you can do to improve your cognitive health. And each of these components has benefits. I’ve already covered what you get out of socializing at the holidays and beyond. And I’ll cover some of the benefits of other behaviors in my next posts.

Meanwhile, be excited about the possibilities for avoiding cognitive decline.

Alzheimer’s Association.news and U.S. POINTER: A lifestyle intervention trial to support brain health and improve cognition. https://www.alz.org/us-pointer

Baker, L. D., Espeland, M. A., Whitmer, R. A., Snyder, H. M., Leng, X., Lovato, L., Papp, K. V., Yu, M., Kivipelto, M., Alexander, A. S., Antkowiak, S., Cleveland, M., Day, C., Elbein, R., Farias, S. T., Felton, D., Garcia, , 334(8), 681–691. https://doi.org/10.1001/jama K. R., Gitelman, D. R., Graef, S., … Carrillo, M. C. (2025). Structured vs self-guided multidomain lifestyle interventions for global cognitive function: The US POINTER randomized clinical trial. JAMA.2025.12923

Baker, L. D., Snyder, H. M., Espeland, M. A., Whitmer, R. A., Kivipelto, M., Woolard, N., Katula, J., Papp, K. V., Ventrelle, J., Graef, S., Hill, M. A., Rushing, S., Spell, J., Lovato, L., Felton, D., Williams, B. J., Ghadimi Nouran, M., Raman, R., Ngandu, T., Solomon, A., … Carrillo, M. C. (2024). Study design and methods: U.S. study to protect brain health through lifestyle intervention to reduce risk (U.S. POINTER). Alzheimer’s & Dementia, 20(2), 769–782. https://doi.org/10.1002/alz.13365

Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet Standing Commission.  Lancet. 2024;404(10452):572-628. doi:10.1016/S0140-6736(24)01296-0

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