Effect of a Structured Lifestyle Intervention on Cognitive Function in Older Adults: The U.S. POINTER Randomized Clinical Trial

JAMA. 2025;334(6):513–525.

 

What Was the U.S. POINTER Trial?

 

A large U.S. study of 2,000 older adults (ages 60–79) who were at higher risk for memory problems, but did not yet have dementia.

 

The goal: see if healthy lifestyle changes can help keep memory and thinking sharp.

 

 

 

What Did They Do?

 

People were placed into two groups for 2 years: 

 

Structured Program (more hands-on)

  • Regular meetings with coaches
  • Help setting goals and staying accountable
  • Group exercise sessions, healthy meal guidance, brain games, and social activities

 

Self-Guided Program (more on your own)

  • Received health information and general advice
  • Fewer check-ins, less structured support
 

 

What Did They Find?

 

Both groups improved in memory and thinking, but…

 

  • The structured program helped people do a little better than the self-guided group.
  • People with lower starting memory scores seemed to benefit the most.
  • The program worked well for all types of people — including those with genetic risks.
  • Benefits were seen across risk groups (e.g., genetics, demographics).
  • Fewer health problems (like falls or medical events) were reported in the structured group.

 

 

What Improved—And What Didn’t

 

  • Executive function (skills like planning, decision-making, and focusing) showed the clearest benefit: the structured group had better improvement than the self-guided group by 0.037 SD per year.

 

  • Memory and Processing Speed didn’t show significant differences between the groups.

 

  • So, structured support seemed especially helpful for tasks that involve organizing, staying focused, and thinking clearly—not necessarily remembering lists or doing things faster.

 

Key parts of a brain-healthy routine:

 

  • Regular physical activity
  • Nutritious diet
  • Social connection
  • Brain exercises and learning
  • Managing blood pressure, diabetes, and cholesterol
 
Takeaway

 

Even small steps in daily life — moving more, eating well, staying socially and mentally active — can help protect memory.

 

When possible, having a structured program or support system makes it easier to stick with and more effective.

 

The lifestyle package (nutrition, exercise, brain training, social engagement, vascular risk control) produced modest overall gains and notably larger improvements in mental speed and executive skills—areas that often matter for everyday tasks like managing meds, planning meals, and staying safe.

 

It’s not a cure, but it’s a safe, feasible approach that nudges cognition in the right direction over two years.

 

The POINTER study is a population-level prevention strategy “one size fits many” — focused on practical changes anyone at risk can adopt. Small studies suggest more significant meaningful changes may be made following precision medicine, an individualized prevention/treatment strategy — “one size fits one” — focused on customized interventions.

 

 
Summary of A Successful Pilot Study using a Precision Medicine Approach

Toups K, Hathaway A, Gordon D, et al. Precision Medicine Approach to Alzheimer's Disease: Successful Pilot Project. J Alzheimers Dis. 2022;88(4):1411-1421. doi:10.3233/JAD-215707

 

What Was This Study About?

 

Instead of using just one drug or treatment for everyone, this study tested a personalized medical plan—a “precision medicine” approach—for people with mild memory problems or early dementia due to Alzheimer’s. Each person was tested for different health factors that might affect their memory—such as inflammation, infections, poor blood sugar control, hormone issues, nutrient deficiencies, and toxin exposures—and then received a tailored treatment plan addressing those issues

 

 

Who Took Part?

 

  • 25 adults, aged 50 to 76, with mild cognitive impairment or early Alzheimer’s.

 

  • All participants had fairly decent thinking scores at the start (MoCA score ≥19). 

 

 

What Happened During the Study?

 

Health Testing:

  • Participants were tested for a range of things—including inflammation and blood sugar issues, possible toxins, hormone levels, nutrition, and sleep breathing problems.

 

Personalized Plans:

  • Each person followed a medically guided, individualized plan for 9 months.

 

Check-Ins at 3, 6, and 9 Months

  • Their thinking and memory were assessed several times during the study. Everyone completed the full 9-month program.

 

 

What were the benefits and risks?

 

  • Thinking and memory scores improved: Tests like the MoCA, the CNS Vital Signs test, and the Alzheimer’s Questionnaire showed statistically significant improvement. 

 

  • Brain imaging looked better: MRI scans showed improvements in brain volumes (less loss), suggesting better brain health.

 

  • No serious side effects: The program appeared safe—no one experienced serious problems related to the interventions.

 

Takeaway
 
This means that looking at and treating each person's unique health issues—not just Alzheimer’s symptoms—might help slow cognitive decline or even improve thinking.

 

Personalized care matters

The approach treats the whole person, not just the brain.

 

Safe so far

The program didn’t cause harm in this group.

 

Promising early results

A larger, controlled study is justified to further evaluate this method.

 

The researchers found that by looking at each person's overall health and treating problems like inflammation, poor blood sugar control, or nutrient shortages, participants often thought a bit better after nine months—and their brain scans even looked healthier. Importantly, no one had serious harm. It’s early, but it gives hope that a tailored treatment plan—rather than a one-size-fits-all pill—might work better for some people with early Alzheimer’s.

 

Lifestyle as Medicine: Key Takeaways from the Ornish Trial

Ornish, D., Madison, C., Kivipelto, M. et al. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alz Res Therapy 16, 122 (2024). 

What Did the Study Do?

 

Doctors wanted to see if making very healthy lifestyle changes could help people with mild memory problems or early Alzheimer’s disease. They compared two groups:

 

  • One group followed an intensive “healthy living” plan—eating a plant-based diet, exercising, doing stress-management, and joining group support sessions.

 

  • The other group continued their usual habits for 20 weeks, without making these changes.

 

 

Who Took Part?

 

  • 51 people with mild cognitive impairment or early-stage Alzheimer’s, average age about 73 years.

 

  • Most stayed with the study—only two people dropped out

 

 

 

What Happened After 20 Weeks?

 

Better Thinking & Daily Abilities

  • On several standard tests, included global clinician impressions and memory/function ratings, the healthy-living group improved or stayed steady, while the usual-care group got worse. One test of thinking showed nearly significant improvement. 

 

​​​​​​Biological Signs Improved

  • Blood markers related to Alzheimer’s (like the Aβ42/40 ratio) went up in the intervention group and down in the usual-care group. 
  • Gut bacteria (“microbiome”) also improved only in the healthy-living group. 

 

Greater Effort, Greater Gain

  • The more closely participants followed the plan (diet, exercise, stress relief, support groups), the more they improved on both cognitive tests and biomarkers.

 

 

A Few Important Things to Know

 

Study size was small (51 people), which limits how broadly we can apply the results.

 

Blinding was not possible—participants knew if they were making lifestyle changes, which could affect outcomes. 

 

Short duration (20 weeks). Longer studies are needed to see if the benefits last. 

 

Not everyone improved. In the lifestyle group: some improved, some stayed the same, some worsened.  A big reason seemed to be how well they followed the program.

 

Takeaway

 

Many participants showed signs of improvement—or at least slowed decline—in memory and functioning after just 20 weeks of lifestyle changes.

 

Biological changes supported these improvements, lending strength to the results.

 

If you do follow a healthy lifestyle plan—eating well, walking, managing stress, and linking up with others—you may notice you think a little better or hold steady longer. Yes, the study is small and short—but it gives hope that what’s good for the heart might be good for the brain too.

 

Summary of a Case Study Report using Precision Medicine Approach to Treat Alzhiemer's Disease 

Ross MK, Raji C, Lokken KL, et al. Case Study: A Precision Medicine Approach to Multifactorial Dementia and Alzheimer's Disease. J Alzheimers Dis Parkinsonism. 2021;11(Suppl 5):018.

 

What Was This Study About?

 

This report tells the story of one person with mixed dementia (Alzheimer’s plus other possible causes of memory loss) who was treated using a personalized, multi-part medical plan. Instead of using a single medication, doctors looked at many possible factors that might affect thinking and memory—and addressed each one carefully.

 

 

What Did “Precision Medicine” Mean Here?

 

  • The doctor team examined the individual's health in detail: this included looking at liver and thyroid function, infections, toxins, hormone levels, diet, and inflammation.

 

  • They then designed a customized plan to treat each issue—such as adjusting diet to reduce liver inflammation due to a condition called primary biliary cholangitis 

 

  • The idea was to improve brain health by addressing the many “little things” that together affect thinking.

 

 

 

What Happened Over 3.5 Years?

 

Participants showed sustained improvement in several areas:

 

  • Cognitive tests (measuring thinking and memory) improved.

 

  • Brain imaging (MRI and PET scans) showed healthier brain structure.

 

  • Blood tests reflected positive changes in inflammation and other markers.

 

  • The individual also felt and functioned better overall.
Takeaway

 

Rather than taking just one medicine for Alzheimer’s, doctors carefully looked at everything affecting this person—like liver health, hormones, toxins in the environment—and created a step-by-step health plan.

 

Precision matters

  • Treating each person's unique health issues—not just the memory symptoms—can help.

 

Small fixes, big impact

  • Addressing multiple health factors like diet, liver health, and toxins can help stabilize or improve thinking.

 

Long-term improvement

  • Over more than 3 years, this person experienced real, lasting benefits.

 

Whole-person approach

  • This method treats the entire body—brain and body health go hand in hand.

Science-Backed Lifestyle Adaptations for Brain Health

 

Many people facing memory changes or Alzheimer’s ask:

 

“What can I do, beyond medications?”


The science continues to show that daily habits have real biological effects on brain function, cognition, and long-term resilience. When paired with conventional care these adaptations support overall health and may slow decline over time.

 

 

Quick Navigation

Why Lifestyle Matters

Key Clinical Evidence

  • U.S. POINTER Trial
  • FINGER Trial
  • Digital/Online Interventions
  • Early Alzheimer’s / MCI Lifestyle Trials
  • Precision & Personalized Plans

Daily Habits for Brain Health

How Lifestyle Supports Treatment

Frequently Asked Questions

References

Why Lifestyle Matters

 

Alzheimer’s and cognitive decline are influenced by multiple factors—metabolic, vascular, inflammatory, and lifestyle-related. Lifestyle adaptations cannot replace medications, but they complement conventional and disease-modifying therapies by:

 

  • Improving blood flow and metabolism

 

  • Reducing inflammation and oxidative stress

 

  • Supporting sleep, mood, and neural resilience

 

  • Enhancing daily cognitive function and quality of life

 

 

Evidence shows that targeting multiple factors at once is more effective than focusing on a single habit.

Key Clinical Trial Evidence on Lifestyle & Brain Health

 

The U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) is a large, 2-year randomized clinical trial in adults aged 60–79 at increased risk for cognitive decline. It compared a structured multidomain lifestyle program (diet, exercise, cognitive and social engagement, health monitoring with accountability) to a self-guided program.

 

Results showed cognitive function improved in both groups over two years, with the structured intervention providing greater benefits in global cognition and executive function compared with standard guidance. These effects were consistent across age, sex, heart health status, and APOE-ε4 genetic risk, suggesting lifestyle change can benefit a wide range of individuals at risk for dementia.

 

What this means: Structured, supported lifestyle changes may help protect thinking and memory from typical age-related decline, especially when multiple risk factors are targeted together.

 

 

🔘 Talk With a Pharmacist About Your Options

The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is one of the earliest large, multidomain lifestyle trials targeting older adults at risk for dementia. Participants received interventions in diet, exercise, cognitive training, and vascular/metabolic risk monitoring.

 

After two years, the FINGER intervention was associated with significant cognitive benefits, including improvements in global cognitive scores relative to control. This trial helped demonstrate that combined lifestyle approaches can positively influence brain health and is the foundation for similar programs around the world.

 

What this means: Modifying multiple lifestyle factors together—not just one at a time—may provide measurable cognitive benefits in people at risk for Alzheimer’s.

 

 

 

🔘 Talk With a Pharmacist About Your Options

A large online multidomain lifestyle intervention trial evaluated an internet-based program targeting physical activity, nutrition, cognitive activities, and mental health support in adults aged 55–77 without dementia.

 

Over three years, individuals assigned to personalized online lifestyle coaching showed significantly better global cognitive function compared with a control group receiving general information only. This suggests that even scalable, digital lifestyle support may help maintain cognition in at-risk adults.

 

 

🔘Talk to a Pharmacist

 

In a smaller randomized controlled clinical study focused on adults with mild cognitive impairment (MCI) or early Alzheimer’s dementia, an intensive multidomain lifestyle intervention (diet, exercise, stress management, group support) led to significantly better cognitive and functional outcomes over ~20 weeks compared with usual care, including improvements on global measures and reduced functional decline.

 

What this means: Even in early symptomatic stages, comprehensive lifestyle changes may influence cognition and daily function.

 

 

🔘 Request a Pharmacy Consult

Daily Habits You Can Start Today

 

🥦 Eat for Your Brain

 

Focus on balanced meals with:

 

Colorful veggies and fruits

Whole grains and legumes

Healthy fats (e.g., olive oil, nuts, fish)

 

Tip: Small meals high in fiber and low in added sugar support both metabolism and brain function.

 

 

🚶 Move Daily

 

Aim for daily movement—whether walking, resistance training, or yoga—to improve circulation, insulin sensitivity, and mood.

 

 

🧩 Keep Your Mind Active

 

Learning new skills, social games, puzzles, and purposeful engagement help maintain neural connections.

 

 

🛌 Prioritize Sleep & Stress Relief

 

Chronic stress and poor sleep increase inflammation and slow recovery—both harmful to the aging brain.


Practices like meditation, gentle breathing, and routines support restorative rest.

How Lifestyle Works With Alzheimer’s Treatment

 

Lifestyle adaptations don’t replace medications, but they can enhance the environment in which medications and personalized therapies work:

 

🔹 Healthier diet and exercise help maintain blood flow and reduce brain inflammation.
🔹 Strong social networks support emotional well-being and cognitive engagement.
🔹 Better sleep and stress resilience support memory consolidation and brain repair.

 

Evidence shows that targeting multiple factors at once is more effective than focusing on a single habit

.

 

👉 For more on how lifestyle supports specific treatments, see:
🔗 Drugs That Slow the Disease Process / Drugs That Treat Symptoms

 

Next Steps

 

If you’re navigating Alzheimer’s risk, early cognitive changes, or caregiving challenges, a personalized consultation can help you turn these science-backed habits into a plan that fits your life.

 

 

👉 Book a Personalized Pharmacist Consult Today – Together we’ll tailor lifestyle adaptations to your goals, medications, and health profile.

 

 

1. Alzheimer’s Association. (n.d.). U.S. POINTER study results. U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk. Retrieved January 2026, from https://www.alz.org/us-pointer/study-results.asp

2. Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., ... & Kivipelto, M. (2015). A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet Neurology, 14(3), 1-10. https://doi.org/10.1016/S1474-4422(14)70324-7

3. Ngandu, T., Lehtisalo, J., Levälahti, E., Solomon, A., & Kivipelto, M. (2018). Multidomain interventions for the prevention of cognitive decline: insights from the FINGER study. Nature Reviews Neurology, 14, 1–13. https://www.nature.com/articles/s41582-018-0070-3

4. Ng, T. P., Feng, L., Yap, K. B., Lee, T. S., & Tan, C. H. (2024). Digital multidomain lifestyle interventions for cognitive health: Results from an online randomized controlled trial. Nature Medicine. https://www.nature.com/articles/s41591-024-03351-6

5. Bredesen, D. E. (2014). Reversal of cognitive decline: A novel therapeutic program. Aging (Albany NY), 6(9), 707–717. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4158970/

6. Institute for Functional Medicine. (n.d.). Lifestyle medicine and functional approaches. Retrieved January 2026, from https://stg.ifm.org/lifestyle

7. Alzheimer’s Association. (n.d.). Drugs that slow the disease process / treat symptoms. Retrieved January 2026, from https://www.functionalpharmacyco.com