EFFORTS to boost cognitive function through exercise and aggressive vascular risk control may fall short, as a major trial reports no meaningful improvements in cognitive function among at-risk older adults over two years.
Cognitive Function Background and Rationale
Physical inactivity, hypertension, and hyperlipidaemia are established contributors to declining cognitive function and dementia risk. This study investigated whether targeting these factors could improve cognitive function in older adults with a family history of dementia or subjective cognitive decline, using a rigorous randomised design across multiple clinical centres in the United States.
Methods and Results on Cognitive Function Outcomes
Investigators screened 3290 individuals and randomised 513 participants aged 60 to 85 years. Participants were randomised to aerobic exercise training, IRVR (lowering of systolic blood pressure to <130 mm Hg and serum low-density lipoprotein cholesterol with atorvastatin), IRVR + exercise, and usual care. Data were analysed from December 2022 through October 2024.
The analysis revealed that after two years, PACC scores increased by 0.2 units in the no exercise group (95% CI 0.1 to 0.3) and by 0.3 units in the exercise group (95% CI 0.2 to 0.4), with no significant differences between groups. For IRVR, scores increased by 0.3 units in the no IRVR group (95% CI 0.2 to 0.4) and 0.2 units in the IRVR group (95% CI 0.1 to 0.3), again with no significant differences between groups.
Clinical Implications for Cognitive Function Strategies
These findings suggest that neither structured aerobic training nor intensive pharmacological reduction of blood pressure and low-density lipoprotein cholesterol meaningfully enhances cognitive function over 24 months in this population. For clinicians, this indicates that while cardiovascular risk management remains essential for overall health, expectations regarding direct cognitive benefits should be tempered. Future research should explore longer follow-up periods and earlier intervention windows. Improved stratification of patients most likely to benefit may also be required, particularly given the heterogeneity of cognitive decline pathways.
Reference
Zhang R et al. Effects of exercise and intensive vascular risk reduction on cognitive function in older adults: a randomized clinical trial. JAMA Neurol. 2026;DOI:10.1001/jamaneurol.2026.0359.
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