Multidomain Lifestyle Interventions Enhance Cognitive Function in Older Adults

    With Alzheimer's disease affecting millions globally, researchers explored whether lifestyle changes could slow or even reverse mild cognitive impairment (MCI) and early Alzheimer's disease (AD). A U.S. study involved 51 participants (average age 73.5) without significant initial differences; only two withdrew. Participants were randomly assigned to either an intensive lifestyle intervention or standard care. The comprehensive 20-week lifestyle program addressed diet, exercise, stress management, and group support (1).

     Participants followed a whole-food, plant-based vegan diet low in unhealthy fats, sugar, and refined carbohydrates. Meals and snacks were provided free to ensure adherence. Participants ate until satisfied, with additional portions available. Supplements included omega-3, curcumin, multivitamins, CoQ10, vitamin C, vitamin B12, magnesium L-threonate, lion’s mane mushroom, and probiotics, each selected for cognitive benefits (1).

    Exercise included daily aerobic activity (at least 30 minutes) and supervised strength training (at least three times weekly), tailored to individual fitness levels (1).

    Stress management comprised daily one-hour practices such as meditation, yoga, breathing exercises, and progressive relaxation, guided by experts. Participants also received tools to promote restful sleep (1).

    Group support involved three weekly one-hour sessions led by mental health professionals to build community, emotional support, and motivation. Additionally, structured four-hour Zoom sessions occurred three times a week, integrating supervised exercise, stress management, group support, and educational lectures (1).

    After 20 weeks, the intervention group showed significant improvement in cognitive and daily life assessments, notably the Clinical Global Impression of Change (CGIC), Clinical Dementia Rating (CDR), and borderline improvements in ADAS-Cog (1). This demonstrated that comprehensive lifestyle changes significantly enhance cognitive functions and daily activities in individuals with mild cognitive impairment or early Alzheimer’s (1).

    Building upon similar concepts, a Japanese study involved cognitively healthy older adults (ages 65–85) with diabetes or high blood pressure. Participants were randomly assigned to intervention or control groups, with the intervention group undergoing weekly 90-minute sessions for 18 months. This program included chronic disease management, physical exercise, nutritional counseling, and cognitive training, measured by seven cognitive tests. Of 203 participants, 178 completed the study (2).

    Participants managed chronic diseases with professional healthcare guidance, adhering to established guidelines for diabetes, blood pressure, and cholesterol (2).

    Exercise included aerobic activity (progressing from moderate to vigorous), resistance and dual-task exercises, and group discussions, supervised weekly by therapists (2).

    Nutritional counseling involved personalized face-to-face meetings every six months and regular phone check-ins, emphasizing foods beneficial for brain health (2).

    Cognitive training utilized tablet-based software called BrainHQ, focusing on attention, memory, processing speed, cognitive flexibility, and spatial skills. Participants trained at least 30 minutes daily, four or more days weekly, with feedback every three months (2).

    After 18 months, intervention participants showed significantly better cognitive performance than controls, underscoring the effectiveness of structured lifestyle programs in cognitive enhancement and dementia prevention (2).

    Further exploring multidomain interventions, a South Korean study included 300 participants (ages 60–85) with MCI and dementia risk factors. Participants were randomly assigned to either a structured 24-week intervention or standard care. Intervention activities included health risk management, cognitive training, exercise, nutrition education, and motivational sessions, facilitated using tablets loaded with SUPERBRAIN and ZOOM apps, elastic exercise bands, and floor plates (3).

    Participants attended small-group sessions every 1–2 weeks, covering health management, nutrition education, and motivational workshops. Cognitive training addressed memory, attention, calculation, problem-solving, and visual skills, guided by health professionals (3).

    Exercise sessions, conducted three times weekly for approximately 50 minutes, involved cardio, strength, balance, flexibility, and fine-motor skills, alternating between in-center and online formats, progressively increasing in intensity every eight weeks (3).

    At 24 weeks, the intervention group exhibited significantly greater cognitive improvements compared to controls (8.43 vs. 4.26 points), a meaningful difference of 4.17 points. Improvements were already evident at 12 weeks, supporting structured multidomain interventions as effective tools for cognitive enhancement (3).

    The Finnish Geriatric Intervention Study (FINGER) examined whether simultaneously addressing multiple lifestyle and vascular risk factors could prevent cognitive decline in older adults at dementia risk (ages 60–77). Participants were randomly assigned to either a two-year intervention covering diet, exercise, cognitive training, and vascular health monitoring or general health advice (4).

    Enrolling 1,260 participants from 2009 to 2011, the intervention group demonstrated modest yet statistically significant cognitive improvements compared to controls, indicating potential protection against dementia through active management of multiple risk factors (4).

    Finally, researchers in Taiwan addressed frailty—a critical aging challenge—through comprehensive programs targeting physical and cognitive decline among community-dwelling adults aged 65 and older who were prefrail or frail (5).

    Two studies were conducted: The Efficacy Study compared quarterly telephone consultations with intensive group sessions featuring physical and cognitive exercises, nutrition guidance, and health education. The Empowerment Study compared the standard multidomain intervention to an enhanced, motivation-focused version (5).

    Primary outcomes included frailty scores, gait speed, handgrip strength, and cognitive function (MoCA). Secondary outcomes were daily activities, depression, and malnutrition risk. The intensive intervention significantly improved these outcomes at 12 months (5).

    Both standard and enhanced interventions effectively improved frailty and cognitive performance, especially in participants aged 75 and older. The enhanced intervention offered additional improvements in physical activity, walking speed, memory, and cognitive function, even after the intervention ended (5).

Collectively, these studies strongly support that structured lifestyle interventions, echoing the principles of 'ikigai,' significantly enhance cognitive health and support longevity.

References:

1.     Ornish D, Madison C, Kivipelto M, Kemp C, McCulloch CE, Galasko D, Artz J, Rentz D, Lin J, Norman K, Ornish A, Tranter S, DeLamarter N, Wingers N, Richling C, Kaddurah-Daouk R, Knight R, McDonald D, Patel L, Verdin E, E Tanzi R, Arnold SE. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease: a randomized, controlled clinical trial. Alzheimers Res Ther. 2024 Jun 7;16(1):122. doi: 10.1186/s13195-024-01482-z. PMID: 38849944; PMCID: PMC11157928.

2.     Oki Y, Osaki T, Kumagai R, Murata S, Encho H, Ono R, Yasuda H, Kowa H. An 18-month multimodal intervention trial for preventing dementia: J-MINT PRIME Tamba. Alzheimers Dement. 2024 Oct;20(10):6972-6983. doi: 10.1002/alz.14170. Epub 2024 Sep 4. PMID: 39229900; PMCID: PMC11485327.

3.     Moon SY, Park YK, Jeong JH, Hong CH, Jung J, Na HR, Cho SH, Kim HS, Song HS, Choi M, Ku BD, Moon YS, Han HJ, Hong YJ, Kim EJ, Kim GH, Kim KW, Jang H, Yoon SJ, Kim HJ, Choi SH. South Korean study to prevent cognitive impairment and protect brain health through multidomain interventions via face-to-face and video communication platforms in mild cognitive impairment (SUPERBRAIN-MEET): A randomized controlled trial. Alzheimers Dement. 2025 Feb;21(2):e14517. doi: 10.1002/alz.14517. Epub 2025 Jan 22. PMID: 39840755; PMCID: PMC11848216.

4.     Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R, Bäckman L, Hänninen T, Jula A, Laatikainen T, Lindström J, Mangialasche F, Paajanen T, Pajala S, Peltonen M, Rauramaa R, Stigsdotter-Neely A, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015 Jun 6;385(9984):2255-63. doi: 10.1016/S0140-6736(15)60461-5. Epub 2015 Mar 12. PMID: 25771249.

5.     Chen LK, Hwang AC, Lee WJ, Peng LN, Lin MH, Neil DL, Shih SF, Loh CH, Chiou ST; Taiwan Health Promotion Intervention Study for Elders research group. Efficacy of multidomain interventions to improve physical frailty, depression and cognition: data from cluster-randomized controlled trials. J Cachexia Sarcopenia Muscle. 2020 Jun;11(3):650-662. doi: 10.1002/jcsm.12534. Epub 2020 Mar 5. PMID: 32134208; PMCID: PMC7296266.

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