You can slow cognitive decline as you age, large study finds. Here’s how

By Sandee LaMotte, CNN

At 62, Phyllis Jones felt trapped in darkness. She was traumatized by her mother’s recent death, ongoing pandemic stress and an increasingly toxic work environment. A sudden panic attack led to a medical leave.

Her depression worsened until the day her 33-year-old son sadly told her, “Mom, I didn’t think I would have to be your caregiver at this stage in your life.”

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“For me, that was the wake-up call,” Jones, now 66, told CNN. “That’s when I found the POINTER study and my life changed. What I accomplished during the study was phenomenal — I’m a new person.”

The Protect Brain Health Through Lifestyle Intervention to Reduce Risk, or US POINTER study, is the largest randomized clinical trial in the United States designed to examine whether lifestyle interventions can protect cognitive function in older adults.

“These are cognitively healthy people between the ages of 60 and 79 who, to be in the study, had to be completely sedentary and at risk for dementia due to health issues such as prediabetes and borderline high blood pressure,” said principal investigator Laura Baker, a professor of gerontology, geriatrics and internal medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina.

Approximately one-half of the 2,111 study participants attended 38 structured team meetings over two years in local neighborhoods near Chicago, Houston, Winston-Salem, Sacramento, California, and Providence, Rhode Island. During each session, a trained facilitator provided guidance on how to exercise and eat for the brain, and explained the importance of socialization, the use of brain-training games, and the basics of brain health. The team leader also held the group accountable for logging blood pressure and other vitals. Physical and cognitive exams by a physician occurred every six months.

At six team meetings, the other half of the study’s participants learned about brain health and were encouraged to select lifestyle changes that best suited their schedules. This group was self-guided, with no goal-directed coaching. These participants also received physical and cognitive exams every six months.

The two-year results of the $50 million study, funded by the Alzheimer’s Association, were simultaneously presented Monday at the 2025 Alzheimer’s Association International Conference in Toronto and published in the journal JAMA.

“We found people in the structured program appeared to delay normal cognitive aging by one to nearly two years over and above the self-guided group — people who did not receive the same degree of support,” Baker said. “However, the self-guided group improved their cognitive scores over time as well.”

Exercise, diet and socializing are key

Exercise was the first challenge. Like the other groups across the country, Jones and her Aurora, Illinois, team received YMCA memberships and lessons on how to use the gym equipment. Jones was told to use aerobic exercise to raise her heart rate for 30 minutes a day while adding strength training and stretching several times a week.

At first, it wasn’t easy.

The study participants wore fitness trackers that monitored their activity, Jones said. “After that first 10 minutes, I was sweating and exhausted,” she said. “But we went slow, adding 10 minutes at a time, and we kept each other honest. Now I just love to work out.”

Four weeks later, teams were given a new challenge — beginning the Mediterranean-DASH Intervention for Neurodegenerative Delay, or MIND diet. The diet combines the best of the Mediterranean diet with the salt restrictions of the DASH diet, which stands for Dietary Approaches to Stop Hypertension.

“They gave us a refrigerator chart with foods to limit and foods to enjoy,” Jones said. “We had to eat berries and vegetables most days, including green leafy veggies, which was a separate item. We had to have 2 tablespoons of extra-virgin olive oil once every day.”

Foods to limit included fried food, processed meat, dairy, cheese and butter. Restrictions were also in place for sugary sweets. “But we could have dessert four times a week,” Jones added. “That’s awesome because you’re not completely depriving yourself.”

Another pillar of the program was requiring study participants to familiarize themselves with their vital signs, Wake Forest’s Baker said. “If at any point we asked them, ‘What’s your average blood pressure?’ they should be able to tell us,” she said. “We encouraged people to monitor their blood sugar as well.”

Later came brain training, via memberships to a popular, Web-based cognitive training app. While some scientists say the benefits of such online brain programs have yet to be proven, Jones said she enjoyed the mental stimulation.

Becoming better at socializing was another key part of the program. The researchers tasked teams with assignments, such as speaking to strangers or going out with friends.

“I found my best friend, Patty Kelly, on my team,” Jones said. “At 81, she’s older than me, but we do all sorts of things together — in fact, she’s coming with me to Toronto when I speak at the Alzheimer’s conference.

“Isolation is horrible for your brain,” she added. “But once you get to a point where you are moving and eating healthy, your energy level changes, and I think you automatically become more social.”

As the study progressed, the researchers reduced check-ins to twice a month, then once a month, Baker said.

“We were trying to get people to say, ‘I am now a healthy person,’ because if you believe that, you start making decisions which agree with the new perception of yourself,” she said.

“So in the beginning, we were holding their hands, but by the end, they were flying on their own,” Baker added. “And that was the whole idea — get them to fly on their own.”

‘Brain health is a long game’

Because researchers tracked each team closely, the study has a wealth of data that has yet to be mined.

“On any given day, I could go into our web-based data system and see how much exercise someone’s doing, whether they’ve logged into brain training that day, what’s their latest MIND diet score, and whether they’d attended the last team meeting,” Baker said.

“We also have sleep data, blood biomarkers, brain scans and other variables, which will provide more clarity on which parts of the intervention were most successful.”

Digging deeper into the data is important, Baker says, because the study has limitations, such as the potential for a well-known phenomenon called the practice effect.

“Even though we use different stimuli within tests, the act of taking a test over and over makes you more familiar with the situation — you know where the clinic is, where to park, you’re more comfortable with your examiner,” she said.

“You’re not really smarter, you’re just more relaxed and comfortable, so therefore you do better on the test,” Baker said. “So while we’re thrilled both groups in US POINTER appear to have improved their global cognition (thinking, learning and problem-solving), we have to be cautious in our interpretations.”

It’s important to note the POINTER study was not designed to provide the more immersive lifestyle interventions needed for people with early stages of Alzheimer’s, said Dr. Dean Ornish, a professor of medicine at the University of California, San Francisco.

Ornish published a June 2024 clinical trial that found a strict vegan diet, daily exercise, structured stress reduction and frequent socialization could often stop the decline or even improve cognition in those already experiencing from early-stage Alzheimer’s disease, not just for those at risk for it.

“The US POINTER randomized clinical trial is a landmark study showing that moderate lifestyle changes in diet, exercise, socialization and more can improve cognition in those at risk for dementia,” said Ornish, creator of the Ornish diet and lifestyle medicine program and coauthor of “Undo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases.”

“It complements our randomized clinical trial findings which found that more intensive multiple lifestyle changes often improve cognition in those already diagnosed with early-stage Alzheimer’s disease,” Ornish said. “But the US POINTER study showed that more moderate lifestyle changes may be sufficient to help prevent it.”

In reality, two years isn’t sufficient to track brain changes over time, said study coauthor Maria Carillo, chief science officer of the Alzheimer’s Association.

“We really want to make recommendations that are evidence based,” Carillo told CNN. “That’s why we have invested another $40 million in a four-year follow-up, and I believe over 80% of the original participants have joined.

“Brain health is a long game,” she added. “It’s hard to track, but over time, change can be meaningful.”