Scientists have unveiled the strongest evidence yet that a combination of diet, exercise and brain training can improve thinking and memory in older Americans.
A study of more than 2,100 sedentary people in their 60s and 70s found that those who spent two years on the intensive regimen not only improved their mental abilities but appeared to reduce the usual declines associated with aging.
"These people are obtaining cognitive function scores that are similar to people [like them who are] one to two years younger than they are," says Laura Baker, one of the study's principal investigators and a professor of gerontology and geriatrics at Wake Forest University School of Medicine.
"This is really showing that we can change people's trajectories over time," says Jessica Langbaum of the Banner Alzheimer's Institute in Phoenix, who was not involved in the research.
Results of what's known as the POINTER study were reported at the Alzheimer's Association International Conference in Toronto. They were published simultaneously in the Journal of the American Medical Association.
The results are consistent with earlier findings from a smaller Finnish study, which involved a less diverse population. They are also consistent with decades of research suggesting that single interventions, like exercise, could reduce brain and cognitive changes associated with aging.
A study of people at risk
The POINTER study was limited to people ages 60 to 79 who had normal memory and thinking but were at elevated risk for cognitive decline and Alzheimer's disease.
"You had to be sedentary, not a regular exerciser, and you had to be consuming a suboptimal diet," Baker says.
Half the participants were asked to come up with their own plan to eat better and exercise more.
The other half entered an intensive, highly structured program that included aerobic exercise four times a week, adherence to a heart-healthy Mediterranean diet, online cognitive training, mandatory social activities and monitoring levels of blood pressure and blood sugar.
Both groups improved on tests of memory and cognition, but the intensive group did markedly better.
Though difficult, the intensive regimen was "life-changing" for many participants, Baker says. Most were able to make substantial and lasting changes, thanks to coaching, supervision and lots of encouragement, she says.
"There is no way to form a new habit or change behavior without intentional work on a regular basis," Baker says. "It's impossible."
Next comes the hard part
The Alzheimer's Association spent nearly $50 million conducting the POINTER study. The National Institutes of Health spent an even greater amount to have many of the participants undergo brain scans, blood tests and sleep studies that, once published, will provide additional information.
The results are limited to changes in normal brain aging, not Alzheimer's disease. But scientists think lifestyle changes that improve cognition and reduce "brain age" are likely to delay dementia, including Alzheimer's.
So the Alzheimer's Association is planning to invest another $40 million over four years to implement what they've learned from POINTER.
"The translation from the POINTER prescription to how we then deliver that into the community is absolutely the next step," says study co-author Heather Snyder, a senior vice president at the Alzheimer's Association.
To do that, the group will be asking a range of questions, Snyder says: "What's somebody going to respond to? Is it going to be something from their health care provider? Is it some sort of app, a motivation using technology? Is it something in their technology that they go do?"
These kinds of efforts to change behavior nationwide should be bolstered by Americans' growing desire for guidance on how to improve their brain health, she says.
"At the Alzheimer's Association, it's one of the top questions we get," she says. People often say things like, 'My mother had dementia, my father had memory problems — what can I do?' And that's a motivating question for someone."
One important step will be buy-in from the nation's health care providers, Langbaum says.
"Doctors should be treating lifestyle interventions as they would a drug," she says. That would mean prescribing regimens like the one in POINTER and getting insurance companies to cover those prescriptions.
Another boost to implementation could come from study results still in the works. These include analyses of brain scans and blood tests indicating whether a person's cognitive improvement was accompanied by measurable changes in brain health.
Those results are expected to be published later this year. In the meantime, Langbaum says, even people who are living a healthy lifestyle might want to up their game.
"If you already do the Sunday crossword puzzle and it's not challenging, pick up something new, find that exercise regimen that you'll adhere to," she says, "and if you can do it around people, that's even better."
Langbaum notes that socializing is one of the best ways to keep your brain young.
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