A small pilot study hints that personalized interventions have a powerful potential for boosting cognitive health in older people at risk of Alzheimer's.

Dementias, including Alzheimer's, are among the most feared illnesses affecting older adults, and it's clear why. Globally, tens of millions of people are living with dementia, and there are limited effective treatments.

So University of California, San Francisco neurologist Kristine Yaffe and colleagues have taken a new approach.

"This is the first personalized intervention, focusing on multiple areas of cognition, in which risk factor targets are based on a participant's risk profile, preferences and priorities," explains Yaffe.

The researchers provided personal, customized coaching for 82 experimental group participants.

This involved each volunteer working with a coach to identify goals based on risk factors and tailor activities to suit each individual's abilities, interests, and preferences across diet, medication, exercise, social, psychological, sleep, and education programs.

From food logging to fitness trackers, video chats to volunteering, and medication to mindfulness, each program had many available approaches.

Another 90 participants in the control group were mailed education materials every three months. These included information on the same dementia risk reduction factors targeted by the experiment group.

The volunteers were predominantly white, all between the ages of 70 and 89, and had at least two of eight risk factors for dementia: poor sleep, depression, social isolation, smoking, prescription medications associated with cognitive decline, hypertension, diabetes, and physical inactivity.

Over two years, the experiment group continued their tailored activities. Their progress was tracked and motivational barriers addressed with weekly case review recommendations from clinical support teams.

As a result, the treatment group experienced a boost in their cognitive and physiological tests, amounting to a 74 percent improvement over the control participants.

Perhaps the best part is that most participants expressed a high level of satisfaction with the interventions. While knowing what you need to do is one thing, being able to keep it up is probably the most challenging aspect of lifestyle changes, as anyone who has tried to diet or quit a bad habit finds all too familiar.

As this is an extremely small and early clinical trial, there are several caveats and limitations.

For starters, the number of participants was too low to detect risk factor changes for individuals. The team also points out there are practical challenges for implementing such involved treatments in the broader communities, especially in the US.

"The trial was conducted at one site and within an integrated health care system, which differs from how many US patients receive health care," they note.

But the strength of the group-level findings suggests this tactic warrants further consideration.

"Hopefully in the future, treatment of Alzheimer's and related dementias will be like cardiovascular disease management, with a combination of risk-reduction and specific drugs targeted for disease mechanisms," Yaffe concludes.

This research was published in JAMA Internal Medicine.