Inside the U.S. POINTER Study: How Lifestyle Changes Improved Memory

Can lifestyle adjustments improve brain health? The everyday lifestyle choices we make may add up to extra years of clearer thinking. The U.S. POINTER study examined whether changes in diet, exercise, social engagement, and health monitoring reduced the risk of cognitive decline in older adults. For millions worried about cognitive decline, the findings point to everyday steps that couple preserve independence and brain health. 

The trial was led by Laura Baker, PhD, professor of gerontology and geriatric medicine at Wake Forest University School of Medicine. Backed by the Alzheimer’s Association and inspired by Finland’s landmark FINGER study, POINTER was designed to test whether lifestyle can protect brain health in a diverse U.S. population. Baker and team enrolled 2,111 adults ages 60 to 79 in five regions across the U.S. Those who were not already exercising or eating a Mediterranean-style diet, engaged in lifestyle changes in four areas: physical activity, nutrition, cognitive and social engagement, and tracking changes in blood pressure and blood sugar.

In this interview with Being Patient’s Mark Niu, Baker traces how POINTER was designed, what a coach-supported lifestyle program looks like in practice, and why community partners matter. She also previews what’s ahead — from brain imaging to sleep and vascular findings — and offers practical guidance for caregivers and older adults.

Being Patient: Can you first briefly tell us about what the U.S. study is and how it all began?

Laura Baker: POINTER is a randomized clinical trial that we’ve just completed. The goal was to test whether changing to a healthier lifestyle could protect brain health and ultimately protect against decline to dementia. It’s not a drug; it’s a lifestyle where you change your behavior, and we’re testing whether it has benefits for the brain.

Back in 2015, there was a similar study in Finland called the FINGER trial. They had 1,200 people, about the same age as our participants, and found that changing lifestyle could protect brain health for people at risk for cognitive decline. The Alzheimer’s Association said, “If this works in Finland, maybe we should test this in the United States.” 

What works in Finland may not work here — we have different cultures, ways of living, and relating to our health — so it was important to bring it over. The Association took the lead, and I was called to help lead the study.

The point was to see if we could replicate what they found in Finland. Does it work for Americans? Can we protect brain health here? We use health care differently; they go to the doctor more often; they eat and move differently; even the darkness in the winter might have an effect on their behavior. We’re different. That was the primary goal: replicate in a more diverse population.

Being Patient: Who did you recruit? What were the requirements?

Baker: Diversity was important because that is our fabric in the United States. We wanted people from rural areas, from the cities, different races and cultures, older and younger within our range, people at risk for different reasons.

Our clinical sites were in five locations: Northern California, Texas, Chicago area, New England, and the Southeast (Winston-Salem, North Carolina). We wanted [regional] diversity.

To get in, you had to be between 60 and 79 years old. You had to be not a regular exerciser. If you were already exercising weekly [or] eating a super healthy diet like a Mediterranean diet, you were out. We had no problem finding Americans who were not regular exercisers and were eating a typical American diet.

You also had to have a few risk points to get in. You got an extra point if you were over 70; an extra point for mild cardiovascular disease (mildly elevated blood pressure, blood sugar, or cholesterol); an extra point if you were from an ethnic group with higher risk for cognitive decline; and an extra point if you had a first-degree family history of memory impairment. Those are our people — 2,111 folks who signed on to be a participant in POINTER.

Being Patient: Before we get to the results, what other things did they do besides diet?

Baker: In any clinical trial, you have at least two groups, [and] you are assigned—you don’t pick. That keeps everyone starting at the same place. The two groups were self-guided and structured. Both were lifestyle interventions focused on four pillars: (1) physical activity/exercise; (2) nutrition; (3) cognitive and social engagement; and (4) knowing your numbers (blood pressure, blood sugar, weight).

Self-guided participants picked what they wanted to work on, set their own goals, and tried to achieve their own goals. There were staff who were trained to help them provide some general support, but there was no goal-setting; the participant had to do that. The structured group was given a highly structured program based on the four pillars and more support. The self-guided group met in peer teams six times over two years. The structured group met with peers, assigned to the same group, 38 times over two years. The amount of support [differed substantially].

Being Patient: Let’s find out the actual results—some key findings. What do we see?

Baker: We looked at cognition: What’s going on up here? How can you remember? How can you pay attention and focus? How do you problem-solve? This is our main focus because this is what we’re watching when people start to decline. It’s these abilities that start to decline. We’re trying to protect against decline. Our measure was global cognitive function. It’s a mix of memory, attention, processing speed, how fast you can think, your thinking speed, and problem-solving. It’s a mix of all that, but we got one score, global cognitive function. We wanted to see, does global cognitive function change differently for the two groups over two years?

Both groups showed a rise in global cognitive function; both improved. The self-guided group [received] more than standard care — most of us don’t get team meetings and support in usual health care. We also saw a statistically significant extra benefit for the structured group on cognition over and above the self-guided group.

What does that mean for real life? Using [data] on expected cognitive change over time in large groups, our best scientific estimate is that the extra benefit in cognition for the structured group was like slowing the cognitive aging clock by one to two years. The people in the structured group, at the end of two years, their cognitive scores were similar to people one to two years younger. This is a large, rigorous, randomized controlled trial, so we have every reason to believe this is a real effect.

“the extra benefit in cognition for the structured group was like slowing the cognitive aging clock by one to two years.”

Being Patient: How did that compare to the FINGER study results, and how did it compare to your expectations?

Baker: Same pattern. FINGER showed a benefit in global cognitive function over two years for the more structured group versus their usual care (which is still better than our usual care, similar to our self-guided). We’re in the process of doing a head-to-head comparison using the exact same way of looking at the data.

The studies were conducted over 10 years in a different period of time. Methods and technology are more contemporary than 10 years ago. We use the most contemporary methods. We didn’t do exactly what they did in terms of analysis. But the pattern of results, if you put them side by side, you’d say, it worked. It worked twice. It worked in the Finns, and it worked in the Americans as well.

Being Patient: Was health coaching done by professional health coaches, primary care providers, or nurses?

Baker: We hired people from the community and worked with community partners like the YMCA. We hired health educators, exercise experts, and nutritionists — people from the community, not academics. To get hired to be part of our navigator team, they had to either have exercise expertise, nutrition expertise, health education expertise, or counseling expertise, expertise in behavior change, forming new habits. They were experienced people.

Being Patient: Can this lifestyle help those already diagnosed and in early Alzheimer’s?

Baker: I can have an opinion about that. As a scientist, I can only speak to what we’ve done in our study. Our folks did not have dementia coming into the study. Some of our people do have mild cognitive impairment. They’ve crossed the line. They’re in the gray zone. They [don’t have] dementia yet, but they do have some cognitive impairment. We saw stronger benefits for people who were the lower performers at baseline. We saw bigger improvements with the structured group for those people. I would say that it is not too late. 

“We saw stronger benefits for people who were the lower performers at baseline.”

Being Patient: Will participants be followed further? What’s next?

Baker: We’ve got 2,111 participants. 80 percent of them have said, sign me up for another four years. We’re following our people for another four years. They’re not doing the intervention with us. We’re encouraging them to continue it on their own with support from their community, family, friends. They still come in to see us once a year for full assessments of cognition and other things.

We see them in the community. We do community events encouraging them to stick with it. We’re going to have four more years. In the end, we’re going to have six years of watching these individuals to see what the effects of the lifestyle intervention has been on them for a long period of time.

Being Patient: You have other studies—POINTER “spawn” studies. Tell us about those.

Baker: We call them ancillary or sub-studies. Four were attached to the parent trial. It expands our scientific footprint.

The four studies are:

1. Brain imaging. We’re doing MRI to get structure of the brain, and PET imaging. We’re imaging the Alzheimer’s pathological features, amyloid and tau. A thousand people signed up for that. We have those results that will be reported in December of this year in San Diego at a meeting.
2. Sleep. We send people home with equipment, and we get objective measures of how they’re sleeping, and sleep apnea in particular. Eight hundred people agreed to that of our 2,000. That’s going to be reported in December also.
3. Vascular health. We have measures of imaging of your vessels, look at the health of your vessels to see what age your vessels are and whether the intervention changed the age of your vessels. Reported in December as well.
4. Gut microbiome. What’s going on in that gut? We are learning so much now about how the health of your gut has everything to do with the health of your brain. We’ve collected stool samples and blood from another 800 people. These are not all different sets of people. A lot of them signed up for all four of these. We’ve got some people that signed up for the parent study and four of these spawn studies.

Being Patient: Any other findings we should know?

Baker: I care that the intervention is applicable to everyone, that it leaves nobody out, that anybody can do it. We looked at subgroups: men versus women, older versus younger, people who have lower cognitive function based on maybe a memory impairment versus those who don’t, people who have cardiovascular disease versus those who don’t.

We found that for the most part, it didn’t matter. All these subgroups had the same extra benefit in the structured group. It works for everybody. We looked at the APOE genotype. People who have the E4 genotype versus those who don’t, no difference. We had the same extra benefit. The magnitude of the difference was the same. It did not matter whether you’re APOE4 negative or positive. The only one I mentioned earlier is that people with a lower cognition at baseline, maybe those with some memory impairment, seemed to have a stronger response to the structured intervention.

Being Patient: Can many of the things you did — like brain training — be done by others? Is it available for everybody?

Baker: Yes — BrainHQ is publicly available for a monthly fee. Tasks are gamified and challenging — that’s the key: get out of your comfort zone. If it’s easy, it won’t help much. They want you to be uncomfortable and challenge yourself as much as possible.

If you don’t do those things, what else can you do? Other options: anything in your regular life that gets you out of your comfort zone. Learn something new. Watch documentaries that are challenging. Learn more about people. Ask people questions. Learn about their lives. Join a book club. Learn a new recipe. Learn how to cook. Learn how to paint. Take a class.

How do you know if you’re getting out of your comfort zone? You say, I don’t know if I want to do it. I’m tired. I’m scared. That’s when you know you’re getting out of your comfort zone and then do it. If you come home and say, that was horrible. I feel stressed. I can’t do that. You’ve gone too far. If you say, I didn’t want to do it, but that was kind of fun, that’s your sweet spot. Challenge yourself to where you need to be. Don’t let someone else tell you what’s going to be challenging for you.