An intensive program that combines healthful eating, regular exercise, “brain training” and the medical management of risk factors associated with dementia (such as high blood pressure) may help slow down mental decline in older adults, according to a new study from Finland.
Yes, other research has linked each of those behaviors to better cognitive health in older people. But this is the first time that such lifestyle factors have been investigated in a large randomized controlled trial, according to the study’s authors. Such clinical trials are generally considered the “gold standard” for evaluating the effectiveness of a medical intervention.
The new study included 1,260 people, aged 60 to 77, from six different areas of Finland. At the start of the study, all the participants scored at or slightly below average for their age on standard cognitive performance tests. None, however, had been suspected of, or diagnosed with, dementia.
The participants were randomly assigned to either an intervention group or a control group. Those in the control group received standard health advice. Those in the intervention group, however, met regularly with physicians and other healthcare professionals.
During these meetings, they were given detailed guidance about diet, exercise and cognitive (“brain”) training. Their risk factors for heart disease and other chronic health problems were also assessed, and if a problem (such as high blood pressure) was identified, the participants were advised on what to do, including asking their family doctor about medications.
The diet advice generally focused on high amounts of fruits, vegetables and whole grains, as well as low-fat milk and lean meats. The participants were also encouraged to eat fish at least three times a week and to limit their alcohol consumption to no more than 5 percent of their daily calories and their sugar consumption to no more than 10 percent. The recommendations were tailored to fit the needs and lifestyles of each individual participant.
The exercise advice was two-fold: Participate in some kind of aerobic exercise (such as walking or biking) two to five times a week and in an anaerobic exercise program (progressive muscle strengthening) one to three times a week. Participants were provided guided training by physiotherapists at a gym.
For “brain training,” participants were given individual and group instruction on strategies for preserving and improving their cognitive skills and memory. Those strategies included regular home use of Web-based computer programs that randomized controlled trials had shown to be effective at building such skills.
After two years, the participants had their cognitive skills re-tested. Those in the intervention group scored 25 percent higher, overall, than those in the control group. On certain parts of the test, the differences were even greater. Executive function — the high-level cognitive functions that make it possible to organize and prioritize thoughts and then make decisions — was 83 percent higher in the intervention group. Processing speed was 150 percent higher. No difference was found between the two groups’ memory scores, however.
The intervention group experienced no serious side effects, and none of them was hospitalized as a result of following the prescribed program. Thirty two (5 percent) of them did, however, developed exercise-related muscle pain, compared to none in the control group.
The participants in the intervention group reported a high rate of adherence to the program. For example, 100 percent of them said they followed at least some of the nutrition advice, and 90 percent said they did the same with advice about physical exercise.
Like all studies — even randomized controlled clinical trials — this one has several limitations. The participants were all Finnish, so the findings may not be applicable elsewhere, including here in the United States. In addition, the four-part intervention program used in this study was very comprehensive and involved multiple health professionals. It’s not clear how practical — and affordable — such an intervention would be across much larger populations.
Another limitation of the study is that it wasn’t set up to determine how many of the individuals who were referred to their family physicians under the medical management part of the study received drug treatments for high blood pressure or other health issues. That factor could have affected the study’s results.
Finally, the study followed the participants for only two years, a relatively short time. The researchers do intend, however, to continue the study for at least another five years.
Still, this study offers some of the best and most objective evidence to date that healthful lifestyle behaviors can have a positive effect on warding off certain types of age-related cognitive decline.
The study was published online Thursday in The Lancet.