Deans' stroke musings: Structured vs Self-Guided Multidomain Lifestyle Interventions for Global Cognitive Function The US POINTER Randomized Clinical Trial

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, October 5, 2025

Structured vs Self-Guided Multidomain Lifestyle Interventions for Global Cognitive Function The US POINTER Randomized Clinical Trial

Have your competent? doctor CREATE EXACT PROTOCOLS FOR THIS! You don't want to do it wrong so ask your 'professional' to do it correctly. Oh, your doctor can't do that? Incompetence runs rampant in the stroke medical world, so you'll have to scour the world!

Structured vs Self-Guided Multidomain Lifestyle Interventions for Global Cognitive FunctionThe US POINTER Randomized Clinical Trial

Laura D. Baker, PhD Mark A. Espeland, PhD Rachel A. Whitmer, PhD Author Affiliations Article Information Permissions Metrics JAMA

Published Online: July 28, 2025 2025;334;(8):681-691. doi:10.1001/jama.2025.12923

Question

Can multidomain lifestyle interventions improve or protect cognitive function in older adults at risk of cognitive decline and dementia?

Findings

In this randomized clinical trial of 2111 older adults at risk of cognitive decline and dementia, 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 (mean composite z-score increase of 0.243 SD per year vs 0.213 SD per year, respectively).The structured, higher-intensity intervention had a greater benefit on global cognition than the self-guided, low-intensity intervention. Further research is needed to understand clinical significance and longer-term cognitive effects of both interventions.

Abstract

Identifying new interventions to slow and prevent cognitive decline associated with dementia is critical. Nonpharmacological interventions targeting modifiable risk factors are promising, relatively low-cost, accessible, and safe approaches.

Objective

To compare the effects of two 2-year lifestyle interventions on cognitive trajectory in older adults at risk of cognitive decline and dementia.

Design, Setting, and Participants

Single-blind, multicenter randomized clinical trial enrolling 2111 participants from May 2019 to March 2023 (final follow-up, May 14, 2025) at 5 clinical sites in the US. Participant inclusion criteria enriched risk of cognitive decline and included age 60 to 79 years, sedentary lifestyle, and suboptimal diet plus at least 2 additional criteria related to family history of memory impairment, cardiometabolic risk, race and ethnicity, older age, and sex.

Interventions

Participants were randomly assigned with equal probability to structured (n = 1056) or self-guided (n = 1055) interventions. Both interventions encouraged increased physical and cognitive activity, healthy diet, social engagement, and cardiovascular health monitoring, but differed in structure, intensity, and accountability.

Main Outcomes and Measures

The primary comparison was difference between intervention groups in annual rate of change in global cognitive function, assessed by a composite measure of executive function, episodic memory, and processing speed, over 2 years.

Results

Among the 2111 individuals enrolled (mean age, 68.2 [SD, 5.2] years; 1455 [68.9%] female), 89% completed the year 2 assessment. The mean global cognitive composite z score increased from baseline over time in both groups, with a mean rate of increase per year of 0.243 SD (95% CI, 0.227-0.258) for the structured intervention and 0.213 SD (95% CI, 0.198-0.229) for the self-guided intervention. The mean rate of increase per year was statistically significantly greater for the structured group than the self-guided group by 0.029 SD (95% CI, 0.008-0.050; P = .008). Based on prespecified secondary subgroup comparisons, the structured intervention benefit was consistent for APOE ε4 carriers and noncarriers (P = .95 for interaction) but appeared greater for adults with lower vs higher baseline cognition (P = .02 for interaction). Fewer ascertained adverse events were reported in the structured group (serious: 151; nonserious: 1091) vs the self-guided group (serious: 190; nonserious: 1225), with a positive COVID-19 test result being the most common adverse event overall and more frequent in the structured group.

Conclusions and Relevance 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. Further investigation of functional outcomes, biomarkers, and ongoing extended follow-up will help address clinical relevance and sustainability of the observed cognitive benefits.

Trial Registration ClinicalTrials.gov Identifier: NCT03688126