When the first volunteers joined the U.S. POINTER study, many were already slightly concerned about their memory.
Some had watched parents or grandparents develop dementia. Others noticed small lapses—misplaced keys, forgotten words—that made them wonder about the future, and not in a good way.

Over two years, more than 2,100 older adults, ages 60 to 79, took part in one of the largest and most diverse brain health trials in the U.S. The results, published last week in JAMA and recently presented at the Alzheimer’s Association International Conference in Toronto, offer strong evidence that a proper lifestyle program—blending exercise, healthy eating, social engagement, and brain training—can help maintain and even improve thinking and memory in people at higher risk of cognitive decline.

The improvements were modest but notable: participants in a structured, high-intensity program improved their scores at a rate similar to having a brain one to two years “younger” than those in a less intensive, self-guided program.

Two Paths to a Healthier Brain

The trial compared two lifestyle interventions, both built on the same foundation: physical activity, the MIND diet, cognitive challenge, social engagement, and heart health monitoring. The difference was in how the plans were delivered.

In the self-guided program, participants received educational materials, met six times in two years for encouragement, and tailored their own health changes.

In the structured program, participants met 38 times in small peer groups. They had exercise plans that included four aerobic sessions a week, plus resistance and stretching routines. They followed the MIND diet—rich in vegetables, berries, nuts, and whole grains, with limits on red and processed meats—and trained their minds through web-based brain games three times a week. Health coaches tracked their progress and reviewed lab results every six months.

The difference showed up in the data: the structured group’s composite cognition score rose 0.243 standard deviations per year, compared to 0.213 for the self-guided group—a statistically significant advantage. The biggest edge came in executive function, the brain’s control center for planning, focus, and self-control. Memory scores rose in both groups, but without a significant gap between them.

“This is really showing that we can change people’s trajectories over time,” Jessica Langbaum of the Banner Alzheimer’s Institute, who was not involved in the research, told NPR.

A Diverse, Real-World Trial

U.S. POINTER was designed to reflect the country’s demographics—and its disparities. Thirty-one percent of participants were from racial or ethnic minority groups. Nearly four in five had a family history of memory impairment. All had risk factors such as sedentary lifestyles, poor diet, or cardiovascular issues.

Recruitment focused on local outreach, using church bulletins, neighborhood clinics, and community groups to connect with people often underrepresented in dementia research. “We really wanted to make sure we had representation from many different microcultures across the U.S.,” principal investigator Laura Baker of Wake Forest University School of Medicine, told The Washington Post.

That diversity matters. The landmark Finnish FINGER trial in 2015 proved that multidomain interventions could help cognition, but its population was largely homogeneous. POINTER tested whether those benefits could hold in a more varied—and more at-risk—American population.

The answer appears to be yes. The structured intervention helped regardless of age, sex, cardiovascular health, or whether participants carried the APOE ε4 gene variant, the strongest genetic risk factor for Alzheimer’s.

Hope, Caveats, and What’s Next

Both groups improved over time—a fact that surprised some researchers. Without a no-intervention control group, it’s hard to know how much of that improvement was due to real brain changes versus “practice effects,” where repeated testing boosts scores. Still, the gains in the structured group were larger, suggesting the extra coaching and accountability mattered.

For participants, the impact was often life-changing. Phyllis Jones, 66, entered the trial overweight, sedentary, and discouraged after a job loss. “I was circling the drain, and I felt it,” she said. Starting with just ten minutes of exercise a day, she built up to regular workouts, lost 30 pounds, and now starts mornings with virtual reality fitness sessions.

Even the self-guided group saw transformations. Peter Gijsbers van Wijk, 72, took up daily walks and yoga, and began volunteering to stay socially connected. “The most important thing is try out a little bit and see what you enjoy,” he said, “because if you enjoy it, then you will be able to sustain.”

The Alzheimer’s Association, which invested nearly $50 million in the trial, is already planning to roll out community-based versions of the structured program. The study team will follow participants for another four years, tracking whether benefits endure and whether they translate into fewer cases of dementia. Brain scans, blood tests, and sleep studies could reveal the biological changes underlying the cognitive gains.

For now, the advice from researchers is clear: move more, eat better, connect socially, and challenge your mind. And if possible, do it with others—because a healthy brain, like a healthy body, often thrives in company.