LONDON — A structured, culturally adapted lifestyle intervention significantly improved global cognition over 2 years in older adults at increased risk for dementia across 11 Latin American countries, extending evidence that multidomain dementia prevention programs can be successfully adapted beyond high-income settings.

In the LatAm-FINGERS trial, older adults who received a structured multidomain lifestyle intervention experienced a 55% greater improvement in global cognition over 2 years than peers who received general lifestyle advice alone.

The intervention combined supervised exercise, dietary counseling, cognitive training, vascular risk management, and regular social support and coaching, while the comparison group received periodic health education and general lifestyle recommendations.

“The study is important because it shows that dementia risk reduction strategies can be implemented beyond high-income countries, when they are culturally adapted and delivered in a structured way,” lead investigator Lucia Crivelli, PhD, head of Neuropsychology at Fleni-CONICET in Buenos Aires, Argentina, told Medscape Medical News.

“It also reinforces the idea that lifestyle-related risk factors are not marginal: They are central to brain health and may represent a major opportunity for prevention, particularly in regions such as Latin America, where the burden of modifiable risk factors is high,” Crivelli added.

The study was presented on July 13 at the Alzheimer’s Association International Conference (AAIC) 2026 and simultaneously published in The Lancet.

Latin America’s Growing Dementia Burden

These findings extend positive results from the Finnish FINGER trial and the US POINTER study to Latin America, a region facing a disproportionate and rapidly growing burden of dementia but has historically been underrepresented in prevention research.

The need for effective prevention strategies is underscored by a separate study that was also presented at AAIC and published simultaneously in JAMA Neurology.

It showed that dementia prevalence across five sites in Latin America and the Caribbean increased from 10.6% in 2003-2006 to 16.9% in 2016-2020. The increase was driven largely by rising rates in Mexico, Peru, and Puerto Rico, in contrast to the stable or declining dementia prevalence reported in many high-income countries.

Latin America faces high rates of hypertension, diabetes, obesity, and other modifiable dementia risk factors, yet relatively little evidence exists regarding whether multidomain prevention strategies developed in wealthier countries can be implemented effectively in the region.

To address this gap, LatAm-FINGERS enrolled 1065 adults (mean age, 67.5 years; 75% women) at an increased risk for dementia and suboptimal cognitive performance across 11 Latin American countries. Participants were randomly assigned (1:1) to one of the two intervention groups, which differed in structure, intensity, and level of support.

The systematic lifestyle intervention provided ongoing coaching and support, including supervised exercise, nutrition counseling based on an adapted MIND diet, computerized cognitive training, cardiovascular risk monitoring, and 38 group meetings for social connection and accountability.

The flexible lifestyle intervention provided periodic health education and general lifestyle recommendations, plus four group meetings to discuss diet, physical activity, cognitive and social engagement, and vascular risk management without ongoing coaching or supervision.

“We did not simply translate the US POINTER model into Spanish and Portuguese. We adapted it to local cultures and habits while preserving its core elements,” Crivelli said.

For example, activities such as salsa and tango were incorporated into exercise programs, and the MIND diet was adapted to include regional foods including avocado, quinoa, açaí, chia, and pumpkin seeds.

Improved Cognitive Function

Over 2 years, both groups experienced improvements in memory, thinking and overall cognitive function over time, but the gains were consistently greater in the structured intervention group.

Participants in this group improved by 0.31 SD annually on the global cognitive composite compared with 0.20 SD annually in the flexible lifestyle intervention group, for an adjusted between-group difference of 0.11 SD per year (P < .0001) — corresponding to about a 55% greater annual improvement in global cognition in the structured intervention group.

The benefits also extended across multiple cognitive domains. Compared with the flexible intervention, the structured program led to significantly greater improvements in episodic memory (between-group difference, 0.14 SD/year; P < .0001), executive function (0.04 SD/year; P = .006), and processing speed (0.04 SD/year; P = .020).

However, no significant between-group difference emerged on the Clinical Dementia Rating-Sum of Boxes, likely because participants had minimal functional impairment at baseline, the investigators noted.

Exploratory subgroup analyses suggested women may have derived greater benefit than men, although the investigators cautioned that these analyses were not adjusted for multiple comparisons and should be interpreted cautiously. No meaningful heterogeneity was seen by age, education, baseline cognition, cardiovascular risk, depressive symptoms, or APOE epsilon 4 status.

Because LatAm-FINGERS was designed as a multidomain intervention, the investigators could not isolate any single component as responsible for the effect.

“The strength of the program was the combination of components: physical activity, nutritional guidance, cardiovascular risk monitoring, cognitive training, and social interaction,” Crivelli told Medscape Medical News. 

Equally important was the intensity of structured support.

“Regular contact with the study team, group-based activities, coaching, monitoring, and accountability likely helped participants maintain behavioral changes over time,” she added.

In her view, one of the study’s major clinical messages is that counseling alone may not be sufficient.

“Telling patients to ‘exercise more,’ ‘eat better,’ or ‘stay mentally active’ is important, but advice alone is often not enough to produce sustained change. Patients need support, follow-up, feasible goals, and interventions that fit their cultural and social context,” she said. 

‘Landmark’ Research

Experts said the findings strengthen the case for structured, socially supported lifestyle interventions, while also highlighting important unanswered questions about how the benefits are achieved and whether they will translate into delayed cognitive impairment or dementia.

Heather M. Snyder, PhD, senior vice president of medical and scientific relations at the Alzheimer’s Association, emphasized the importance of the intervention’s structure.

“A key message from this study is that structure and social support matter,” Snyder said in a conference statement.

Maria Carrillo, PhD, chief science officer of the Alzheimer’s Association, told Medscape Medical News that the results are “exciting” because they show that multidomain lifestyle prevention programs can be implemented successfully in lower-resource settings and still produce meaningful cognitive benefits.

In an accompanying Lancet Comment, Juan Fortea, MD, PhD, of the Sant Pau Memory Unit at Hospital de la Santa Creu i Sant Pau in Barcelona, Spain, and colleagues described LatAm-FINGERS as “a landmark” trial because it changes “where, how, and by whom” dementia prevention research can be conducted.

The Comment authors also cautioned that several key questions remain unanswered, including whether the intervention alters Alzheimer’s disease pathology or instead improves cognitive resilience through other mechanisms.

They include whether the intervention modifies Alzheimer’s disease pathology or improves cognitive resilience through other mechanisms. 

“Mechanistic understanding will become crucial in multidomain interventions. If we know what these interventions are doing biologically, we can improve designs: which component is essential, which component can be simplified, who benefits most, and which risk factors should be prioritized in each patient,” they wrote.

It also remains unclear whether the cognitive gains observed over 2 years will ultimately delay the onset of mild cognitive impairment or dementia, they added.

Funding for the LatAm-FINGERS study was provided by the Alzheimer’s Association. Disclosure information for the authors is available with the published article. Fortea disclosed having various relationships with Roche, Novo Nordisk, Esteve, Biogen, Laboratorios Carnot, Adamed, Life Molecular Imaging, Novartis, Lundbeck, AC Immune, Alzheon, Zambon, and Lilly.