Lifestyle Intervention for Alzheimer Disease Shows Neurovascular, Sleep, and Imaging Benefits

New findings from 3 ancillary studies to the US POINTER trial (NCT03688126)—presented at the 18th annual Clinical Trials in Alzheimer’s Disease (CTAD) conference—show that structured lifestyle interventions improve not only cognitive function, but also sleep health, blood pressure regulation, and cognitive resilience in the presence of Alzheimer disease (AD)-related brain changes. The studies, funded by the National Institutes of Health’s (NIH) National Institute on Aging, provide a more complete understanding of the mechanisms supporting brain health in older adults at risk for cognitive decline.

The US POINTER trial included 2111 adults aged 60 to 79 years with a sedentary lifestyle who had an elevated dementia risk. Participants were randomized 1:1 to receive either a structured, coach-supported lifestyle program or a self-guided version. The structured intervention incorporated regular contact, goal setting, and accountability across domains of physical activity, nutrition, cognitive stimulation, social engagement, and vascular risk monitoring.

POINTER-zzz: Sleep Study Design and Key Results

A total of 780 US POINTER participants were enrolled in POINTER-zzz and underwent home-based sleep apnea testing and actigraphy over 2 years.

• Apnea-Hypopnea Index (AHI) decreased significantly more in the structured group than the self-guided group (–1.76 vs. –0.50 events/hour; adjusted difference –1.26; P=.028).
• Improvements were seen across subgroups, including those with moderate/severe baseline apnea.
• Sleep apnea severity did not alter cognitive gains, indicating independent benefit from intervention.

POINTER-NV: Neurovascular Study Design and Key Results

A total of 491 participants from the US POINTER study were enrolled in POINTER-NV. These individuals received comprehensive vascular testing at baseline, 12 months, and 24 months. Outcome measures included baroreflex sensitivity, arterial stiffness, autonomic function, and carotid hemodynamics.

• The structured group showed greater improvement in baroreflex sensitivity compared with the self-guided group (adjusted difference +0.89 ms/mmHg; 95% CI, 0.12 to 1.65; P=.023).
• Significant gains were seen in heart rate variability, aortic pulse wave velocity, and carotid transmission coefficient in the structured group.
• Benefits consistent across key subgroups, including those with cardiovascular disease, hypertension, or high Framingham risk scores.

POINTER-Neuroimaging: Imaging Study Design and Key Results
In the POINTER-Neuroimaging study, a group of 47% of participants from the US POINTER study underwent PET and MRI scans at baseline and follow-up to evaluate the effects of intervention on structural and molecular imaging markers.

• There was no difference in 2-year imaging change, and both groups had similar changes in amyloid burden, entorhinal tau, hippocampal volume, and white matter hyperintensity volume.
• Cognitive benefits were found to be moderated by baseline biomarkers: participants with lower hippocampal volume or higher tau levels at baseline showed greater cognitive benefit from the structured intervention.
• Amyloid status did not influence benefit, suggesting the intervention may enhance resilience independently of amyloid pathology.

Source: Alzheimer’s Association. The U.S. pointer structured healthy lifestyle program -- previously shown to improve cognition -- may also improve sleep apnea, blood pressure regulation, and cognitive resilience. PR Newswire. Published December 2, 2025. Accessed December 3, 2025. https://prnmedia.prnewswire.com/news-releases/the-us-pointer-structured-healthy-lifestyle-program--previously-shown-to-improve-cognition--may-also-improve-sleep-apnea-blood-pressure-regulation-and-cognitive-resilience-302629883.html