In a new, exhaustive clinical trial, researchers found that older adults who stuck with a structured, coach-led lifestyle program showed huge improvements in cognitive function. These gains appeared much higher than those seen in participants who followed a more casual, self-guided approach to maintaining brain health.
The U.S. POINTER study included 2,111 sedentary adults between the ages of 60 and 79. And all the participants were at elevated risk of cognitive decline based on factors such as poor diet, family history, cardiometabolic risk, or by simply being part of an historically underserved racial or ethnic group. For two years, researchers randomly participants to one of two lifestyle intervention programs. Both of them focused on increasing physical and mental activity, improving diet, staying socially engaged, and managing cardiovascular health. But they did vary based on how much structure and support they provided.
The results, published in The Journal of the American Medical Association (JAMA) and presented at the Alzheimer’s Association International Conference 2025 in Toronto, show that while the health of both groups improved, the structured intervention delivered a small but statistically significant edge in preserving global cognitive function. Researchers noticed the improvement most in areas such as executive function and processing speed.
“As the burden of dementia grows worldwide, U.S. POINTER affirms a vital public health message: healthy behavior has a powerful impact on brain health,” Alzheimer’s Association President and CEO Joanne Pike, PhD, said in a statement. “The positive results of [the] U.S. POINTER encourage us to look at the potential for a combination of a lifestyle program and drug treatment as the next frontier in our fight against cognitive decline and possibly dementia.”
Methodology
Participants in the structured group met 38 times over two years in peer teams guided by trained facilitators. They received tailored exercise routines, nutritional guidance based on the MIND diet, online brain-training tools, and consistent medical feedback.
The self-guided group, on the other hand, met just six times and received general educational materials with little hands-on coaching.
After two years, the structured group saw their cognitive scores improve by an average of 0.243 standard deviation units per year – compared to 0.213 in the self-guided group. That 0.029 SD edge might seem modest, but the researchers argued that it matches or exceeds gains seen in earlier landmark trials like Finland’s FINGER study, which served as the prototype for POINTER.
“The potential to improve cognition with fewer resources and lower participant burden is compelling. It highlights that while not everyone has the same access or ability to adhere to more intensive behavior interventions, even modest changes may protect the brain,” U.S. POINTER principal investigator and Wake Forest University Professor of Gerontology and Geriatrics, and Internal Medicine Laura D. Baker, Ph.D, explained.
Diverse Participant Pool Yields Consistent Results
Unlike earlier studies, POINTER recruited a diverse population more reflective of real-world risk. Nearly a third of the participants identified as part of a racial or ethnic minority group, and 30% were carriers of the APOE ε4 gene variant linked to Alzheimer’s risk.
Notably, benefits from the structured intervention persisted regardless of APOE status.
Those with lower baseline cognition benefited the most from the structured program, showing nearly double the improvement compared to participants who started with stronger cognitive scores.
The intervention also appeared to benefit those with cardiovascular disease more than those without.
While the structured group had the statistical edge, the self-guided group enjoyed some improvements. Both groups demonstrated high levels of adherence (91% for structured, 95% for self-guided), and no major safety concerns cropped up. Additionally, aerious adverse events were slightly lower in the structured group (12% vs. 14%).
What’s Next?
The researchers stress that while the findings are certainly encouraging, additional data could help determine whether these cognitive gains will translate into meaningful protection against dementia in the longer term. But the message couldn’t be clearer. Lifestyle changes matter, and it’s never too late to start.
“These are the initial results. Over the coming weeks and months, study leadership will be exploring all of the data collected in the trial to paint an even more comprehensive picture of the U.S. POINTER intervention effects on brain health,” Baker added.
With dementia cases expected to skyrocket as the population ages, the POINTER trial offers a hopeful reminder that prevention doesn’t have to be elaborate or even expensive. It just needs to be high-touch.
Further Reading
Exercise is Even Better Than We Thought for Brain Health
Study Suggests We’re Surrounded by Threats to Brain Health
Study Links Abdominal Fat to Brain Function — But Only in Men
