Now We Have It -- Results of the US Pointer Study

Back in 2020, in Beating the Dementia Monster, we expressed hope that the US POINTER study by the Alzheimer's Association, then in progress, would confirm the results of an important earlier study, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER).  The FINGER study was to be the "first study to apply a multidomain approach to dementia prevention. The main aim was to prevent cognitive impairment, and secondary aims include decreasing disability, cardiovascular risk factors and related morbidities, depressive symptoms, and to have beneficial effects on the quality of life."  We first discussed the FINGER study in 2018 and have revisited it several times since.  You will also recall that the multidomain approach to battling Alzheimer's disease was an important theme of Beating the Dementia Monster.

The FINGER study applied the multiple domains of: 1) Dietary guidance, 2) Physical activity, 3) Cognitive training and social activities, and 4) Intensive monitoring and management of metabolic and vascular risk factors.

While the FINGER study provided valuable information on the power of lifestyle to offset cognitive decline in the elderly, it had its critics.  The strongest criticism was that the subjects were uniformly white northern Europeans.  We know that dementias manifest differently in diverse populations.  And it's a principle of the scientific method that others should duplicate the results of your findings.  Therefore, several countries around the world set out to confirm the findings, although not necessarily by exactly duplicating the study.  In the United States, it was the US POINTER study.

But then there was Covid.  As with the MIND diet study, the lockdowns seriously disrupted and delayed progress on completing the study and analyzing the results.  So we had hoped to see results by 2022, but we're only seeing them now.

It's important to note that both the FINGER study and the US POINTER studies were randomized controlled trials.  Unlike longitudinal studies, they actually changed peoples' lifestyles and then measured the results.  Results were compared to a control group whose lifestyle was not directly changed.  This is far superior to the much more common longitudinal studies, in which populations are studied for correlations between, say, lifestyle and incidence of dementia.  In longitudinal studies you find correlations, but correlation is not causation.  And confounding factors can fly under the radar and bias your results.  Randomized controlled trials are much harder and more expensive to conduct, but they yield much more reliable results.

Topline results of the US POINTER study were announced at the recent Alzheimer's Association International Conference in Toronto.  The results were very positive, however I was a bit disappointed.  At least so far.  

Here's what they said: "... a structured lifestyle intervention of regular moderate- to high-intensity physical exercise, adherence to the MIND diet, cognitive challenge and social engagement, and cardiovascular health monitoring led to a statistically significant greater improvement in global cognition over 2 years relative to a lower-intensity self-guided intervention."  To which has been added, "Cognitive benefits were consistent across age, sex, ethnicity, heart health status, and APOE4 genotype."

Note the use of the word "improvement."  They didn't find that decline was slowed or even stopped, memory and cognition actually improved. 

Note that, rather than with a traditional control group, they compared test participants on a structured program to participants on a lower intensity, self-guided program.  For the test participants, they aggressively supervised them in changes to their lifestyles, while, for the "control group," they simply advised people on how to live well.  (They thought it would be unethical to discourage anyone from adopting a healthy lifestyle just to help their study.) 

For you nerds, here are the published results, or at least what's available if you don't purchase the whole thing.  There's a little more here.  And more here.

So this is a ringing endorsement of the multidomain approach to brain health.  But these were the "topline" results.  Some things remain to be discerned.  Note that they never mentioned Alzheimer's disease.  I think we can think of "topline" as "preliminary."  They haven't finished evaluating the results, and they haven't gotten to the point of saying anything about Alzheimer's.  They still need to publish information about how many test participants in the structured group developed Alzheimer's (during the two-year period) compared to how many did in the unstructured ("control") group.  That's what I was looking for back in 2020, and I'm still waiting.