A new study at Rush University Medical Center aims to determine whether a combination of lifestyle changes can protect memory and thinking skills in people at risk of developing dementia. The two-year US Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (POINTER) clinical trial is the first study to examine combined interventions for dementia in a large-scale, diverse population in the United States. Recruitment for the trial will begin in the fall.

“This study will help us to uncover the factors that impact risk and how these various lifestyle changes may counteract a person’s genetic risk for Alzheimer disease,” said Martha Clare Morris, ScD, lead site investigator for the Chicago hub of the study, which will include five medical centers nationwide. Morris is the director of the Section of Nutrition and Nutritional Epidemiology in the Department of Internal Medicine at Rush University Medical Center.

According to the Alzheimer’s Association, an estimated 5.8 million Americans of all ages are living with Alzheimer dementia. The projected number of people age 65 and older with Alzheimer’s dementia may grow to 13.8 million by 2020.

“As the numbers of new cases of Alzheimer grows, developing preventive and curative interventions for dementia will be essential in slowing the progression of the disease and reducing its financial burden, which is currently estimated to rapidly increase,” said Morris.

Study will track 2,000 participants over two years

The US POINTER clinical trial is a randomized, multi-component, non-pharmacological intervention study that will enroll 2,000 adults between the ages of 60 and 79 who currently do not exhibit problems with memory or thinking and, do not engage in regular exercise, and who have a parent or sibling with memory loss or dementia.

The trial will compare two lifestyle interventions varying in intensity and format. The interventions include physical exercise, nutritional counseling and modification, cognitive and social stimulation, and improved self-management of health.

The study will evaluate whether cognitive benefits from a structured program differ from a self-guided program. Volunteers in both interventions will be evaluated for changes in cognition every six months using "gold-standard" cognitive assessment tools. Vascular and metabolic health, physical function, mood, and quality of life also will be assessed.

In addition to Rush, the study will enroll participants at the University of California–Davis, Baylor College of Medicine & Kelsey Research Foundation; Advocate; and Wake Forest School of Medicine, the host site of the study. Initial results are expected to be released in 2023.

Lifestyle changes can help maintain cognitive health

A recent two-year clinical trial in Finland (the FINGER Study) reported that a combination of physical activity, nutritional guidance, cognitive training, social activities and management of heart health risk factors protected cognition in healthy older adults who were identified as being at increased risk of cognitive decline. Currently no pharmacological treatments are available that rival this effect.

“There is an urgent need to expand this work to test the generalizability, adaptability and sustainability of the FINGER study's findings in geographically and culturally diverse populations in the US and across the globe,” Morris says. “While there is no proven cure or prevention for dementia, current research shows that combining healthy lifestyle factors may counteract risk and help stave off dementia.”

At the Alzheimer’s Association international conference held in Los Angeles in July, researchers at Rush presented study findings that suggest that healthy lifestyle choices such as exercise and cognitive stimulation may decrease cognitive decline and dementia. Using data from 1,845 participants of the Chicago Health and Aging Project (CHAP) and 920 participants of the Rush Memory and Aging Project (MAP), the research team examined how healthy lifestyle mitigates the risk of Alzheimer’s dementia.

The researchers focused on five low-risk lifestyle factors: healthy diet, at least 150 minutes/week of moderate to vigorous physical activity, not smoking, light to moderate alcohol intake, and engaging in cognitively stimulating activities.

During 14 years of follow-up, there were 379 (21%) and 229 (25%) incident cases of Alzheimer dementia in CHAP and MAP, respectively. For study participants who adopted four or five low-risk lifestyle factors, researchers found about 60% lower risk of Alzheimer dementia when compared with participants who did not follow any or only one of the low-risk factors. The researchers found that when engaging in an additional low-risk lifestyle factor, the participant’s risk of Alzheimer dementia decreased by 27%.

“This study highlights the importance of following multiple healthy lifestyle practices for lowering the risk of Alzheimer dementia,” said Dr. Klodian Dhana, assistant professor in Rush Medical College’s Department of Internal Medicine. “In the U.S., adherence to a healthy lifestyle is low, and therefore promoting these lifestyle factors should become the primary goal for public health policies.”