Objective:

To examine the effects of a structured multidomain lifestyle intervention on white matter integrity and cerebrovascular health in older adults at risk for cognitive decline.

Approach:

• Study Design: Secondary analysis of the POINTER Imaging ancillary study, part of the US POINTER randomized clinical trial.
• Participants: Older adults aged 60-79 years, cognitively unimpaired but at risk for cognitive decline, were randomized to either a structured multidomain intervention or a self-guided program.
• Imaging Methods: Participants underwent MRI scanning sessions at baseline, 12 months, and 24 months, focusing on diffusion MRI measures.
• Analysis: Longitudinal trajectories of free water (FW), white matter hyperintensity (WMH), peak width of skeletonized mean diffusivity (PSMD), fractional anisotropy (FA), and the ALPS index were analyzed.

Key Findings:

• The structured intervention group showed different trajectories in white matter integrity compared to the self-guided group.
• FW was hypothesized to be sensitive to interventions and may identify individuals at higher risk for progression of brain injury.
• Age-related differences in cerebrovascular injury were noted, particularly for participants aged 70 and older.

Interpretation:

The study aims to clarify the relationship between lifestyle interventions and cerebrovascular health, focusing on white matter integrity.

Limitations:

• The study primarily focuses on imaging outcomes with limited data on cognitive outcomes.
• Small sample sizes in previous studies may affect the generalizability of findings.

Conclusion:

The analysis seeks to provide insights into how lifestyle interventions may influence white matter integrity and cerebrovascular health in older adults at risk for cognitive decline.