POINTER: Lifestyle Shifts Improve Sleep and Brain Blood Vessels

New findings from the U.S. POINTER trial presented at the 2025 Clinical Trials on Alzheimer’s Disease conference suggest that structured support for a healthy lifestyle improved sleep apnea and several aspects of blood vessel health and function, though it had little effect on changes in the brain linked to Alzheimer’s disease. 

The trial enrolled more than 2,000 sedentary older adults, with an average age of 68, to test whether lifestyle changes such as eating healthier, exercising more, keeping the brain active, and managing heart health could improve brain health. Participants all had a poor diet, and two additional dementia risk factors, such as high blood pressure or a family history.

Results from earlier this year showed that after two years, participants who received a structured program, including coaching, regular checkups, and goal-tracking did a little better on cognitive tests compared to the self-guided group. These latest findings on improved sleep and blood vessels add evidence that a supportive program of lifestyle interventions is beneficial.

“Translating the U.S. POINTER clinical trial intervention to the community is a high priority for the Alzheimer’s Association,” Heather M. Snyder, senior vice president of the Alzheimer’s Association, told Being Patient. “To do this, the Alzheimer’s Association has committed funding to teams around the country – including health systems, community organizations and public health agencies – to develop pilot implementation plans.”

A lifestyle recipe to improve sleep 

Many older adults develop sleep apnea, which disrupts their breathing, lowers blood oxygen levels, impairs sleep quality, and raises dementia risk. 

A group of 780 POINTER participants donned watch-like devices overnight to measure their sleep quality. Among them, about 65 percent had mild or moderate sleep apnea. Participants who received the structured intervention showed a small improvement in sleep apnea over two years, which is measured through the apnea-hypopnea index. This index is a count of hourly breathing interruptions that substantially restrict airflow and oxygen saturation. 

But the effect was small. Participants in the structured group had the number of apnea-related events drop from 10.1 to 8.3 per hour. According to Laura Baker, professor at the Wake Forest University School of Medicine, who ran this study, it translated to roughly two minutes of improved airflow and oxygen during a single night’s sleep, or a total of 15 hours over the course of a year. “Small benefits add up over time,” Baker told Being Patient via email.

Researchers are continuing to analyze data including other aspects of sleep quality.

POINTER improved the health and function of blood vessels

Many POINTER participants had cardiovascular risk factors like high blood pressure that strain the brain’s blood vessels. Researchers tested 491 with ultrasound and continuous blood pressure monitoring to see if the lifestyle recipe made a difference. 

The structured group improved baroreflex sensitivity — the body’s ability to adjust heart rate in response to blood pressure changes. 

Wake Forest University researchers leading the study, associate professor Tina Brinkley and professor Hossam Shaltout, told Being Patient over email that based on prior studies, researchers haven’t yet established how much of a change is meaningful. However, since previous research has shown a steady drop in baroreflex sensitivity with age, the benefit in the structured group is equivalent to turning back the clock about eight years.

The structured group also showed gains across several other measures of blood vessel health and function, they said.

The POINTER formula didn’t affect Alzheimer’s pathology

In another substudy presented at the conference, researchers analyzed the brain scans of 983 participants. Unfortunately, the structured intervention did not slow the build-up of amyloid plaques or tau tangles. It also failed to prevent shrinkage of the hippocampus, the region of the brain responsible for memory, or reduce damage to the brain’s blood vessels. 

Jessica Langbaum, senior director at the Banner Alzheimer’s Institute and co-director, Alzheimer’s Prevention Initiative, who wasn’t involved in the study, said she wasn’t surprised. “Most of our studies have much longer follow up to see movement” on these imaging biomarkers from various treatments or interventions, she told Being Patient.

Participants with levels of tau in one specific region of the brain at baseline, the entorhinal cortex, and those with a smaller hippocampus gained greater cognitive benefits from the structured intervention compared to the self-guided one. If there is an effect on Alzheimer’s, the researchers suspect that the trial was too short to see the benefits.

Susan Landau, a research scientist at University of California, Berkeley, who led the imaging study explained that in the new data, people in the structured intervention group achieved cognitive improvements regardless of whether they had Alzheimer’s-related changes in the brain.

“This finding is actually quite important in that it means that lifestyle changes are similarly beneficial to people regardless of their Alzheimer’s biomarker status,” Landau said by email.

What’s next?

The U.S. POINTER study will continue following up on participants for four years to provide more information on how well this lifestyle recipe protects people in the long-run, how they impact the microbiome, and whether they shift blood biomarkers of Alzheimer’s.

Scaling these interventions equitably remains a priority for researchers and public health experts. 

One key difference between the structured group and the self-guided group was the social support. The structured participants received a total of 38 coached team meetings, 26 phone calls, and seven in-person health checkups. The self-guided group only received six meetings and four phone calls with an advisor, and were left to manage their efforts to incorporate healthier lifestyle habits on their own. 

“That could potentially be replicated in an online forum that also provides accountability to people,” said Langbaum. Moving online would also make these interventions more accessible for those who work irregular hours or are homebound. “We really have to look at more online, interactive engagement that can provide structure and some social interaction,” she said.