An estimated 7.2 million Americans over age 65 are currently living with Alzheimer’s disease, a number projected to nearly double by 2060. Researchers from Florida Atlantic University’s Charles E. Schmidt College of Medicine have called for coordinated efforts to support lifestyle-based interventions that could help reduce the burden of cognitive decline in the United States and globally.
In a commentary published in The American Journal of Medicine, the researchers urged clinicians, public health professionals, and policymakers to implement strategies focused on modifiable risk factors such as physical inactivity, poor diet, obesity, alcohol use, hypertension, diabetes, depression, and social or intellectual isolation.
“While deaths from cardiovascular disease have declined since 2000, deaths from Alzheimer’s disease have surged by more than 140%,” said Charles H. Hennekens, M.D., FACPM, FACC, co-author and senior academic advisor at the Schmidt College of Medicine. “At the same time, it is estimated that up to 45% of dementia risk could be attributed to modifiable lifestyle and environmental factors.”
The authors referenced findings from POINTER—the first large-scale U.S.-based randomized trial testing whether intensive lifestyle changes can improve cognitive outcomes in older adults at high risk for decline. In this study, participants who engaged in structured interventions involving regular physical activity; Mediterranean and DASH-style diets; cognitive stimulation; and social engagement showed significant improvements in global cognition over two years. These results were particularly notable in executive functions like memory and decision-making.
Similar benefits were observed in Finland’s FINGER trial among participants with elevated cardiovascular risk scores who adopted multidomain lifestyle approaches.
“The data from both these landmark, large scale randomized trials demonstrate that lifestyle changes – previously shown to reduce heart disease and cancer – also hold transformative potential for brain health,” Hennekens said.
Researchers discussed possible biological mechanisms behind these benefits. Physical activity may increase brain-derived neurotrophic factor supporting hippocampal growth while improving blood flow and reducing inflammation. Healthy dietary patterns can lower oxidative stress and improve insulin sensitivity as well as cardiovascular risks. Quitting smoking may help preserve brain structure integrity; regular social and cognitive engagement supports neuroplasticity.
“The implications for clinical practice, public health and government policy are potentially enormous,” said Parvathi Perumareddi, D.O., co-author and associate professor of family medicine at the Schmidt College of Medicine. “Clinicians now have powerful, evidence-based tools to help their patients prevent or slow cognitive decline – tools that go beyond medications, are generally low-risk, and are cost-effective. Public health agencies could adopt the framework of trials like POINTER and FINGER to develop brain health programs.”
The commentary noted that reducing key risk factors by even modest amounts each decade could lower overall cognitive decline burden by up to 15%. This approach could offer significant cost savings compared with pharmacologic agents that often come with side effects ranging from nausea to more serious risks like gastrointestinal bleeding.
In addition to direct medical costs, dementia places a heavy societal burden: nearly 12 million family members and unpaid caregivers provided an estimated 19.2 billion hours of care in 2024—valued at more than $413 billion—and often face mental health challenges due to caregiver burnout.
“While more research is needed, the current totality of evidence supports a clear path forward: invest in lifestyle-based strategies to protect brain health,” said Hennekens. “Doing so will not only benefit individuals at risk but also serve as a powerful tool for reducing national and global health care burdens related to cognitive decline.”
John Dunn, a medical student at FAU’s Schmidt College of Medicine is first author on the commentary.
