Original Investigation

Structured vs Self-Guided Multidomain Lifestyle Interventions for Global Cognitive Function

JAMA 10.1001/jama.2025.12923

July 28, 2025 at 2:00 PM EDT

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

Corresponding Authors: Laura D. Baker, PhD (laura.d.baker@advocatehealth.org), and Mark A. Espeland, PhD (mark.espeland@advocatehealth.org), One Medical Center Blvd, Sticht Center on Aging and Alzheimer’s Prevention, Winston-Salem, NC 27157.

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