A two-year randomized clinical trial involving 2,111 older adults found that participants who engaged in a structured, coach-supported lifestyle program showed greater improvement in cognitive performance than those following a self-guided plan.
The structured intervention led to a statistically significant increase in global cognitive function, especially in executive function, and was associated with fewer adverse events.
Participants, aged 60 to 79 years, were sedentary, had suboptimal diets, and met at least two additional risk criteria, including family history of memory impairment, cardiometabolic risk, or older age. They were randomly assigned to either a structured intervention group (n = 1,056) or a self-guided group (n = 1,055).
Both interventions promoted physical activity, cognitive and social engagement, a healthy diet, and cardiovascular health monitoring. The structured group attended 38 facilitated team meetings over two years, received individualized activity plans, and had regular support from trained interventionists. The self-guided group attended six peer meetings and was provided educational materials without personalized coaching.
The primary outcome was the annual rate of change in a global cognitive composite score derived from tests of executive function, episodic memory, and processing speed. The structured group improved by 0.243 standard deviation units per year (95% CI, 0.227 to 0.258), while the self-guided group improved by 0.213 units (95% CI, 0.198 to 0.229). The between-group difference was 0.029 units (95% CI, 0.008 to 0.050; P = .008).
In secondary outcomes, executive function improved more in the structured group (0.160 vs 0.122 standard deviation units per year; difference, 0.037; 95% CI, 0.010 to 0.064). No significant group differences were found in episodic memory or processing speed.
Subgroup analyses showed the structured intervention’s benefit was consistent across sex, APOE ε4 status, age groups, and cardiovascular risk categories. Participants with lower baseline cognition showed greater gains (0.054 standard deviation units; 95% CI, 0.024 to 0.084) compared with those with higher baseline scores (0.004; 95% CI, −0.025 to 0.034; P for interaction = .02).
“Among older adults at risk of cognitive decline and dementia, a structured, higher-intensity intervention had a statistically significant greater benefit on global cognition compared with an unstructured, self-guided intervention,” said Laura D. Baker, PhD from the Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Adherence was high in both groups. Team meeting attendance reached 91.0% in the structured group and 94.8% in the self-guided group. Serious adverse events were fewer in the structured group (n = 151) than in the self-guided group (n = 190; P = .03). Nonserious adverse events were also lower in the structured group (1,091 vs 1,225; P = .005). COVID-19 was the most frequently reported adverse event, with 380 cases in the structured group and 289 in the self-guided group.
Both interventions were associated with cognitive improvements, but the structured lifestyle program yielded greater gains. Further research is underway to evaluate long-term outcomes and the clinical relevance of these findings.
Full disclosures can be found in the study.
Source: JAMA Network