What if protecting brain health became as routine as protecting heart health?

That question was at the center of a presentation on the U.S. POINTER study at the Heartland Cognitive Care Collective Summit on October 2 in Des Moines. The study provides evidence that lifestyle changes may help protect cognitive function in older adults at risk for cognitive decline and raises an important question for physicians and health systems: How do we operationalize prevention?

Jeff A. Katula, PhD, MA, professor and McDonough Family Faculty Fellow and director of graduate studies in health and exercise science at Wake Forest University School of Medicine, presented findings from U.S. POINTER. Katula chaired the study's intervention oversight committee.

U.S. POINTER enrolled 2,111 cognitively healthy older adults at increased risk for Alzheimer's disease. Participants were assigned to either a structured or self-guided lifestyle intervention focused on four areas: physical activity, nutrition, cognitive and social engagement, and management of cardiovascular health risk factors.

The structured program was intensive. Participants met frequently in small groups, received support and accountability, exercised regularly, followed the MIND diet, participated in cognitive activities, and monitored cardiovascular health.

Importantly, they stuck with it.

Participants in the structured group attended 91% of team meetings and largely met physical activity and nutrition goals. After two years, cognition improved in both groups, but participants receiving the structured intervention experienced significantly greater improvement. The strongest effects were seen in executive function.

The cognitive gains were modest, Katula acknowledged. But modest improvements across a population could have meaningful public health implications.

From research to routine care

For physicians, the question now is how this evidence could translate into everyday practice.

Researchers are now studying how to take an intervention that required considerable support and translate it into something health systems and communities can realistically deliver.

One model being tested would begin in primary care. When a patient reports memory concerns, primary care physicians could initiate a pathway for cognitive assessment, additional diagnostic testing when appropriate, specialist referral for patients with more significant impairment, and lifestyle-based risk reduction for cognitively healthy patients at risk for decline.

The concept is similar to how medicine approaches cardiovascular disease or diabetes: identify risk earlier and intervene before disease progresses. In other words, operationalize prevention for brain health.

But implementation presents significant challenges. Neurologists, neuropsychologists, and other specialists are already in short supply, and referrals can take months. Questions also remain about reimbursement, technology, staffing, and who would provide lifestyle interventions in routine practice.

Those realities may be particularly relevant in Iowa, where rural communities already face health care workforce and access challenges.

An opportunity for Iowa

At the summit, co-organizer Yogesh Shah, MD, MPH, FAAFP, challenged participants to think about how Iowa could become a national leader in brain health by taking emerging science and putting it into practice.

“Brain health starts decades before we see the first symptoms. Earlier detection gives Iowans more time—time for better care, better planning, and now, more treatment options,” said Dr. Shah, medical director of the Broadlawns Memory Clinic. “We have tremendous reasons for hope, but now we need to turn that hope into action.”

That doesn't necessarily mean replicating U.S. POINTER exactly. The study used a community-based approach, bringing together academic medical centers, Alzheimer's Association chapters, and community organizations such as YMCAs and parks and recreation departments. Researchers are now exploring how the approach could be adapted for real-world settings.

Iowa could be well positioned to explore a similar model, but one designed around the realities of our state. That could mean connecting primary care physicians with cognitive assessment, specialists, community-based resources, and evidence-based prevention, while finding ways to reach patients in rural and underserved communities.

It would also require confronting the practical barriers physicians already know well: workforce shortages, long waits for specialty care, reimbursement, and limited resources in some communities.

The science increasingly suggests there are steps patients can take to support brain health. The opportunity for Iowa is to determine how to operationalize that prevention so it becomes part of routine care rather than something patients must navigate on their own.

Doing that will require more than a new program. It will take physicians, health systems, public health leaders, community organizations, and policymakers working together to build a practical pathway from prevention to diagnosis and care.

If Iowa can do that, Shah's vision of making the state a national leader in brain health may be within reach.