A recent publication in in the Journal of the American Medi-cal Association reported results from the US POINTER clinical trial. The trial aimed to test and compare the effects of a comprehensive lifestyle intervention versus a self-guided lifestyle intervention on the cognitive trajectory of older adults at risk of cognitive decline and dementia. Partic-ipants in the comprehensive arm of the trial were asked to: 1) join physical exercise sessions in a community centre; 2) follow nutritional advice focussed on the MIND diet [Mediter-ranean-DASH Intervention for Neurodegenerative Delay, (DASH stands for Dietary Approaches to Stop Hyperten-sion)], 3) participate in computer based cognitive training and social events designed to stimulate the brain and 4) attend medical advisor appointments for health coaching. They attended 38 face-to-face meetings with the study team over a two-year period.
Participants in the self-guided group were provided education, help to make health plans (focus on cardiovascular disease) and publicly available advice on being active, eating healthily and staying cognitively en-gaged. They attended six face-to-face meetings with the study team over the same period. Over four years the trial enrolled 2,111 participants across five centres in the United States and followed them up for a two-year period. The main outcome measure (tools used to assess the effectiveness of the intervention) was the change in global cognitive function, a combined measure that included multiple different tests such as story recall and word fluency. They also measured quality of life and other measures that they will report later. Over the study period, 43 people stopped taking part in the structured intervention, and 39 stopped taking part in the self-guided intervention. The investigators also measured adherence, the extent to which someone sticks to a recommendation, which they reported to be high (over 80% in both groups) and adverse events, which were found to be very low.
Almost all of the adverse events reported were not thought to be due to the study (COVID-19 infections for example). At the end of the study, there was a greater improvement in brain function in the structured group compared to the self-guided group across many of the measures in the combined score. The authors concluded that the intervention was safe, as indicated by the low number of adverse events; well tolerated, based on adherence data; and effective, according to improvements in the cognitive composite score. More information on this study is available here: https://pubmed.ncbi.nlm.nih.gov/40720610/