Lifestyle, Behavior, and Cognitive Training Intervention Research

Clinical trials on nondrug interventions show promise in preventing or slowing the development of Alzheimer’s and related dementias

Dementia-related changes in the brain start a decade or more before symptoms appear. Lifestyle, behavioral, and cognitive training interventions may help some people lower their risk of dementia earlier in life and protect their brain health as they age.

NIH is dedicated to further studying the impact of blood pressure control, regular exercise, and other nondrug interventions on dementia prevention and care. The agency currently funds more than 130 clinical trials testing these types of approaches in the following broad areas:

• Physical activity
• Cognitive (e.g., memory) training
• Neurostimulation, which involves electrical stimulation to specific areas in the brain
• Sleep-related interventions
• Diet and dietary supplements
• Combination therapy, which involves the use of two or more interventions

Compared with drug options, many nondrug interventions are less invasive and less expensive and may be less likely to cause harmful side effects. When a population study identifies a strong association between a lifestyle factor and dementia, one of the next steps is to test the intervention in a clinical trial. This can shed light on whether the lifestyle factor reduces risk of dementia in people who adopt it. The following are some examples of nondrug interventions currently being tested in NIH-funded clinical trials:

• Cognitive training to improve brain function in older adults with Alzheimer’s or a related dementia and delirium
• Personalized computerized cognitive training to improve brain health in older adults with memory loss or MCI
• Mobile-health technology to motivate people with mild cognitive impairment (MCI) to stick to game-based training at home
• Cognitive training to promote independent living skills in older adults with MCI
• Using a new interactive exercise and cognitive training system for in-home use to improve or maintain brain function in people with MCI
• Using cocoa flavanols to boost brain function by reducing inflammation in healthy older adults
• Combining cognitive training and a diet high in polyphenols to prevent or delay cognitive impairment in older adults with lower education levels

If effective, these nondrug interventions hold promise for implementation broadly at the community level through evidence-based dissemination approaches that ensure the interventions reach the most people possible, especially at-risk groups. This in turn could help improve health equity in dementia prevention and care.

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Speed of processing training may delay cognitive impairment

A specific type of cognitive training called speed of processing training (SPT) may delay cognitive impairment. Results from a secondary data analysis of the NIH-funded Advanced Cognitive Training and Vital Elderly (ACTIVE) study suggested that SPT may significantly delay cognitive impairment over a 10-year period. Based on this finding, NIA awarded a research grant to the University of South Florida to support a large-scale, randomized controlled study to clarify whether SPT reduces or delays the onset of clinically diagnosed MCI or dementia in older adults. Researchers estimate that if SPT could delay dementia onset by just one year, there would be 9 million fewer cases by 2050 than currently projected.

NIH is effectively addressing the urgent need for more research on social and behavioral interventions for dementias

A National Academies of Sciences, Engineering, and Medicine consensus study, sponsored primarily by NIA with support from co-funders, offers a blueprint for the next decade of social and behavioral science research on Alzheimer’s and related dementias. The study suggests that as many as 40% of dementia cases might be caused by risk factors that can be controlled and that social and behavioral changes could have a clear, measurable impact on dementia prevention and treatment.

This study report, released in 2021, features a proposed 10-year research agenda that prioritizes the following areas, which are likely to have the greatest impact:

• Innovative interventions that improve dementia prevention and treatment, and policies that promote the dissemination of those interventions for widespread use
• Strategies to promote health equity across all communities
• Policies to lower the economic burden caused by dementias, including providing affordable health care and housing, protection from financial abuse, and access to critical services
• Approaches to improve the dementia research pipeline

Through these and related efforts, NIH’s social and behavioral science research can help lower the impact of Alzheimer’s and related dementias in the United States and across the world.

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