Five habit changes delay cognitive decline in the elderly, study shows

The clinical trial, called Latam-Fingers, followed, for two years, 1,065 people aged between 60 and 77 years with risk factors for dementia and cognitive performance below expectations for their age.

Participants were recruited from Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Peru, Dominican Republic and Uruguay.

The volunteers were divided into two groups. One of them participated in a structured program that combined physical activity, healthy eating, strict control of cardiovascular risk factors, cognitive training and socialization activities. The other only received general guidance on healthy habits.

At the end of follow-up, both showed an improvement in cognitive function, but the group that underwent structured intervention improved significantly more.

Gains were observed both in global cognition and in specific skills, such as episodic memory, attention and executive functions - abilities linked to planning, organization and decision-making.

The researchers state that this is the first demonstration, on a large scale, that a multidomain intervention adapted to the Latin American reality can delay cognitive decline in a population historically underrepresented in studies on dementia prevention.

"It's not about recommending in isolation that people exercise or have a better diet. What we demonstrated is that the effect appears when the five pillars are worked on simultaneously", says neurologist Paulo Caramelli, professor at the UFMG Faculty of Medicine and one of the Brazilian coordinators of the study.

According to him, this aspect is particularly important because dementia usually results from the combination of different biological processes.

"Even if in the future there is a medicine capable of curing Alzheimer's disease, the problem of dementia will continue to exist, because many elderly people have more than one cause for cognitive impairment. Prevention acts precisely on several mechanisms at the same time", he says.

The study adapts the model originally developed in Finland, considered a milestone in the prevention of dementia, to Latin America.

The main novelty, according to the authors, is to show that the strategy also works in middle-income countries, marked by greater social inequality, less access to prevention and a high prevalence of hypertension, diabetes and high cholesterol without adequate treatment.

"Here we start from a different reality than in developed countries. We have more poorly controlled cardiovascular risk factors and less access to health promotion programs. This means that our window of opportunity for prevention is enormous", says Caramelli.

The adaptations even involved dietary recommendations. In Belo Horizonte, for example, researchers adjusted nutritional guidelines to local habits, marked by greater consumption of meat and fats and difficulty in accessing some foods, such as fish.

Group physical activities and socialization actions were well accepted among Brazilian participants.

Geriatrician Claudia Kimie Suemoto, professor at the USP Faculty of Medicine and member of the study's executive committee, states that the magnitude of the benefit caught the team's attention.

"The observed effect was almost three times greater than that found in similar studies carried out in other countries."

The research also showed that the strategy is feasible in the region. More than 82% of participants completed the two years of follow-up, and those submitted to the structured program adhered, on average, to 72% of the proposed activities.

Although adverse events were recorded, mainly musculoskeletal pain related to exercise, no serious events or deaths were attributed to the intervention.

The authors emphasize that the results do not mean that it is possible to completely prevent the onset of dementia, but they reinforce that sustained changes in lifestyle can delay cognitive impairment and reduce the risk of disease progression.

Today, it is estimated that 2.46 million Brazilians aged 60 or over live with some type of dementia. This number is expected to almost triple by 2050 due to the rapid aging of the population.

The scenario is worsened by underdiagnosis. Around 80% of people with dementia in the country do not receive a formal diagnosis, according to research coordinated by Caramelli.

"Many families still confuse the first symptoms with normal aging and only seek care when the disease is already at a moderate or advanced stage", says the neurologist.

He also points out difficulties in accessing diagnosis, especially outside large centers, and assesses that the National Policy for Comprehensive Care for People with Alzheimer's Disease and Other Dementia, approved in 2024, is still progressing slowly.

For the authors, the results reinforce that the prevention of dementia must become part of routine primary care actions, as is already the case with hypertension, diabetes and depression.

"The next step will be to test this strategy within basic health units to see if it can be incorporated into the SUS and transform scientific results into concrete benefits for the population", says Caramelli.

Participants will continue to be followed for another four years to assess whether the habits acquired during the intervention are maintained and whether the cognitive benefits persist after the end of the researchers' intensive follow-up.

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