Science shows that aging is not synonymous with dementia when lifestyle changes
Diet, exercise, and social interaction: A Latin American study involving multidomain interventions adapted to local contexts achieved a 55% improvement in the overall cognition of participating older adults
Lifestyle and behavior changes must be taken seriously in public policies, and people need support to make these changes – Photo : Freepik/Magnific
The improvement was observed in the group that participated in supervised interventions involving physical activity, cognitive training, diet, and cardiovascular risk factor management, compared with a group that received only guidance in these areas. Overall cognition is a composite measure that includes episodic memory (memory of specific events), executive function (also known as cognitive control), and processing speed (the time required to respond to information or stimuli). However, improvements were also observed when each of these domains was assessed separately.
A greater effect from the interventions had already been anticipated compared with the studies that inspired this research, conducted in Finland and the United States, because Latin American populations have higher cardiovascular risk, a higher prevalence of diabetes, and lower educational attainment. In other words, interventions may have an even greater impact in a more vulnerable population. “Even so, we were surprised by the results”, said Claudia Suemoto, professor at USP’s Medical School (FM) and one of the authors of the article, which has just been published in The Lancet.
“One of the most important lessons from these studies is that interventions are much more successful when implemented using a multidomain approach that combines several dimensions, rather than focusing on physical activity alone, diet alone, or cognitive training alone”, commented Mônica Yassuda, professor in the Gerontology Program at the USP School of Arts, Sciences and Humanities (EACH) and also one of the article’s authors.
“We will be able to reduce the risk of dementia if we implement a package of interventions. This is something that can be done within the Brazilian Unified Health System (SUS) through primary care. Primary healthcare units already offer services covering almost all of these areas—the missing piece is integrating them”, she added.
Context matters
The interventions were adapted to the sociocultural context of each participating country across every aspect of the program. Developed from the Mediterranean diet and with reduced sodium content, the MIND diet is recommended to lower the risk of cognitive decline, but it was originally designed around foods commonly consumed in the Northern Hemisphere.
“When I teach about the MIND diet to medical students, some of them become quite frustrated and ask me, ‘How are we supposed to apply this at Hospital das Clínicas?’ And they are absolutely right—it simply isn’t feasible. Nowadays, even for a middle-class person, buying the foods included in this diet is difficult”, said Claudia Suemoto.
In Latin America, many of these foods are not only expensive but also difficult to find. One example is berries such as blueberries and raspberries, which were replaced by fruits rich in natural antioxidants, such as açaí, and fruits with a low glycemic index, such as melon. In cooking, olive oil has no true substitute in terms of brain-protective compounds, but participants were advised to reduce the overall use of cooking oils, avoid fried foods, and increase their intake of foods containing “healthy” fats, such as fish, avocado, and oilseeds, including peanuts and pumpkin seeds.
The cognitive training, conducted through computer-based activities and games using a validated program called BrainHQ, also had to be adapted in each participating country. The older participants included in the study (60 to 77 years of age) had difficulty getting started. In Brazil, for this reason, sessions were held to teach them everything from connecting to Wi-Fi to logging into the program, and ongoing support was also provided throughout the study. According to Mônica Yassuda, Brazilian participants preferred to complete the activities on their mobile phones.
She noted that future studies may need to offer additional types of cognitive training with different approaches, beyond these specific online games, which generated strong engagement among some participants but relatively low adherence among others. She also argued that the field has evolved and has demonstrated particular success when integrated into multidomain intervention programs.
“Since I entered this field in the 1990s, it has received considerable criticism and undergone systematic reviews questioning its methods. At that time, training was largely based on mnemonic techniques and focused heavily on episodic memory. Today, it is much more process-oriented, helping people process information and make decisions more quickly. There are now well-designed, robust studies suggesting that cognitive intervention—both stimulation and training—tends to produce significant improvements in performance.”
The aerobic and resistance exercises were intensive and performed at least four times a week. They also included activities that are culturally popular across Latin America, such as salsa, tango, Zumba, and other forms of dance.
Local characteristics were also used to encourage social connectedness, another well-established protective factor against cognitive decline and dementia. Although this was not a structured or planned component of the intervention, the fact that participants met every week with people of the same age group naturally led to greater social interaction, which they themselves extended by arranging additional gatherings outside the study—such as enjoying a cup of coffee together after exercise, a very Brazilian tradition.
Challenges and limitations
Claudia Suemoto recalls that the team began the study with funding for only one year of research, as a kind of pilot to determine whether it would be feasible to organize a project of this scale in the region. The researchers were also concerned about the study’s lower statistical power, given its smaller sample size compared with previous studies—a concern that was ultimately overcome by the magnitude of the effects observed. “Only later did it evolve into the long-term clinical trial whose results we are now discussing. The Alzheimer’s Association, which funded the study, wanted to know whether it was feasible to conduct a study of this size here, and it was. I think that is excellent news.”
“We spent two years organizing the clinical trial, establishing collaborations, preparing the database, and integrating information from 11 countries. That capacity-building aspect of research may not attract much public attention, but for science in Latin America, it is extraordinary!”, the professor said. She added: “We collected more than 5,000 variables. We are presenting these results now, but there are still many more findings to come.”
“We did not simply translate the U.S. POINTER model for Latin American countries. We adapted it to local cultures and lifestyles while preserving its core components, making the program practical, accessible, and feasible as a public health strategy”, said Lúcia Crivelli, a researcher at the Fleni Neurological Institute in Argentina and the article’s first author, in a statement to the Alzheimer’s Association.
An editorial published in the same issue of the journal by a group of researchers further emphasizes this point:
“(…) non-pharmacological interventions in neurology and medicine will not reach their full potential if they are treated as culturally neutral (…) The study is also important because of where it was conducted and who led it (…) Excluding the regions where dementia incidence is increasing most rapidly is both unjust and a scientific waste. Latam-Fingers is not merely evidence generated in Latin America; it demonstrates that the region was uniquely positioned to produce it (…) The Global South should not be viewed only as the future epicenter of disease burden, but also as a source of scientific leadership.”
Rather than focusing on memory exercises, cognitive training now emphasizes improving the speed with which people process information and make decisions – Photo: Freepik
Funding
Both U.S. POINTER and the Latin American study (Latam-Fingers) are part of the World-Wide Fingers global network, which is based on the original Finnish Finger study demonstrating that multidomain lifestyle interventions can help protect cognitive function in older adults at risk of cognitive decline. Participants were identified as being at risk based on cardiovascular assessments, laboratory tests (such as cholesterol levels and the presence of the APOE4 gene), and cognitive tests indicating early cognitive decline.
The Alzheimer’s Association invested approximately US$7 million in the Latin American study and has recently launched several public brain health initiatives based on the findings emerging from this research. The recently launched (re)think your brain™ campaign helps people move from awareness of brain health to action by offering a “prescription” for healthy habits based on the study findings.
The article Multidomain Lifestyle Intervention for the Prevention of Cognitive Decline in At-Risk Older Adults in Latin America (Latam-Fingers): A Single-Blind, Multicentre, Randomised Controlled Trial has more than one hundred authors from across the continent, including, in addition to Claudia Suemoto and Mônica Yassuda, the Brazilian researchers Ricardo Nitrini and Sonia Maria Dozzi Brucki, from USP, and Paulo Caramelli, Leonardo Cruz de Souza, Maira Tonidandel Barbosa, and Karina Braga Gomes, from the Federal University of Minas Gerais (UFMG).
The article Multidomain Lifestyle Intervention for the Prevention of Cognitive Decline in At-Risk Older Adults in Latin America (Latam-Fingers): A Single-Blind, Multicentre, Randomised Controlled Trial is available online.
For further information: Claudia Suemoto (cksuemoto@usp.br) and Mônica Yassuda (yassuda@usp.br).
*Intern under the supervision of Simone Gomes
English version: Nexus Traduções, edited by Denis Pacheco
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