A new study shows that heart health interventions do not affect older adults’ cognitive function. Exercise and aggressive blood pressure/cholesterol-lowering improved cardiovascular markers, but not measurable cognitive outcomes, over two years.
For clinicians treating older Black patients, who face higher rates of both cardiovascular disease and dementia risk, this study provides insights into how to tailor effective interventions for this population.
Neither exercise nor aggressive cardiovascular risk reduction significantly improves cognitive benefits in older adults at risk for dementia, according to a study published online March 23 in JAMA Neurology.
Rong Zhang, Ph.D., from Texas Health Presbyterian Hospital in Dallas, and colleagues examined whether exercise, intensive pharmacological reduction of blood pressure and serum low-density lipoprotein cholesterol, or the combination of the three, can improve cognitive function in older adults. The analysis included 513 adults (aged 60 to 85 years) with hypertension, a family history of dementia, and/or self-reported subjective cognitive decline who were randomly assigned in a 1:1:1:1 ratio to aerobic exercise training, intensive pharmacological lowering of systolic blood pressure to <130 mmHg and serum low-density lipoprotein cholesterol with atorvastatin, the combination, or usual care.
The researchers found that for global cognitive function at 24 months from baseline, Preclinical Alzheimer Cognitive Composite (PACC) scores increased by 0.2 units in the no-exercise group and by 0.3 units in the exercise group, with no significant group differences observed. Similarly, in the group not receiving intensive pharmacological lowering, PACC scores increased by 0.3 units versus 0.2 units in the intensive reduction group, with no significant group differences noted. Similar results were seen for the National Institutes of Health Toolbox Cognition Battery composite score and individual test scores with each intervention.
“We improved the body, but not the brain,” coauthor Jeffrey N. Keller, Ph.D., from Pennington Biomedical in Baton Rouge, Louisiana, said in a statement. “Addressing a single set of risk factors, even aggressively, may not be sufficient, highlighting the need for more comprehensive approaches to dementia prevention.”
Two authors disclosed ties to the pharmaceutical industry.
Black adults face higher rates of hypertension, stroke, diabetes, and kidney disease, which are all linked to later cognitive decline. They are also more likely to develop dementia — typically more severe presentations — than their white peers.
Structural barriers, such as lower access to preventive care, underdiagnosis, and chronic stress, may compound Black patients’ risk of heart disease and dementia.
Even though the researchers found no cognitive benefit in heart health interventions, aggressive risk-factor control is still critical as these diseases disproportionately harm Black communities.
This study suggests lowering blood pressure and low-density lipoprotein (LDL) cholesterol alone may not be enough to protect cognitive function. Cognitive health is multifactorial, meaning it is influenced by a complex, interacting web of genetic, biological, lifestyle, and social factors rather than by a single cause. Factors like sleep, hearing loss, social isolation, physical activity, nutrition, and education matter. For Black older adults, caregiving stress (especially among the sandwich generation), neighborhood safety, transportation, and food access can also shape outcomes.
For clinicians caring for Black seniors, whole-person dementia strategies will be necessary to protect their cognitive health and reduce the risk of decline.
Here are some practical approaches providers can apply when treating older Black patients:
Protecting heart health will continue to be crucial, but for older Black adults, preserving cognition will likely require broader, equity-focused prevention strategies that go beyond prescriptions and exercise alone. Clinicians must treat the heart and brain simultaneously while also addressing the patient’s social determinants of health (SDOH) to improve outcomes.
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