A structured lifestyle programme beat health advice for cognition in Latin America

A structured, two-year lifestyle programme improved thinking scores more than flexible health advice in older Latin Americans at high risk of dementia, in the largest dementia-prevention trial yet run in the region [s1]. The difference between the two groups was small, and cognitive scores rose in both — but the result extends a body of evidence built almost entirely in wealthy countries to a population that has been largely absent from it [s1].

The trial, LatAm-FINGERS, was published in The Lancet and funded by the Alzheimer's Association, not by a drug company [s1]. It is the Latin American arm of a growing family of trials modelled on Finland's FINGER study, which a decade ago first showed that a bundle of lifestyle changes could slow cognitive decline [s2].

How the trial was built

LatAm-FINGERS was a single-blind, multicentre randomised trial run in 11 countries — Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, the Dominican Republic, Ecuador, Mexico, Peru and Uruguay [s1]. It enrolled adults aged 60 to 77 who were at high risk of dementia, defined by a dementia-risk score of 6 or higher, and who already showed suboptimal cognitive performance [s1]. Participants were randomly assigned in equal numbers to a structured lifestyle intervention, with supervised support and monitoring, or to a flexible intervention offering health advice [s1]. Outcome assessors were masked even though participants and staff could not be [s1].

Of 1,719 people assessed, 1,065 formed the analytic sample: 539 in the structured group and 526 in the flexible group [s1]. Their mean age was 67.5 years, and 795 (75%) were women [s1]. The trial, registered before it began, ran to completion, with the last participant finishing follow-up on 7 November 2025, and 877 participants (82.3%) completed the two-year assessment [s1][s3].

What the numbers showed

Cognition improved in both arms — a familiar pattern in these trials, where repeated testing, attention and general health advice lift everyone's scores. The global cognitive composite rose by a mean of 0.31 standard deviations per year in the structured group (95% confidence interval, 0.28 to 0.34) and 0.20 per year in the flexible group (0.17 to 0.23) [s1]. The between-group difference was 0.11 standard deviations per year (0.06 to 0.15; P<0.0001) — statistically clear, but modest in absolute terms [s1].

The trial's other primary aim was simply to show the programme could be delivered. On that count it largely succeeded: recruitment reached 62.0% of the target, and adherence to the structured programme averaged 71.6% over the trial [s1]. Dropout was actually higher in the flexible-advice group than in the structured group (20.2% versus 15.2%; P=0.042), suggesting the hands-on programme kept people engaged [s1].

Harms were mostly the aches of an exercise programme. Of 478 adverse events, 412 occurred in the structured group, the most common being musculoskeletal symptoms (21% of that group, versus 2% of the flexible group) [s1]. Serious adverse events occurred in 50 participants (9%) in the structured group and 24 (5%) in the flexible group, none judged related to the intervention, and of eight deaths — three in the structured group, five in the flexible — none were related either [s1].

What it adds to FINGER

The original FINGER trial, reported in The Lancet in 2015, randomised at-risk older Finns to a multidomain package of diet, exercise, cognitive training and vascular monitoring or to general health advice, and found better cognitive trajectories in the intervention group [s2]. That design has since been exported worldwide through the World-Wide FINGERS network.

LatAm-FINGERS matters because Latin America carries a heavy and fast-growing dementia burden, with a high prevalence of the risk factors that drive cognitive decline, yet its populations have been under-represented in prevention research [s1]. Showing that a culturally adapted version of the programme is both feasible and beneficial across 11 middle- and low-income countries is the finding, as much as the size of the cognitive gap itself [s1].

What it does and does not settle

The trial establishes that structured lifestyle coaching can be delivered at scale in Latin America and produced better two-year cognitive trajectories than flexible advice [s1]. What it cannot yet show is whether that difference translates into fewer diagnoses of dementia — the outcome people care about — because cognitive-composite scores over two years are a surrogate, not a count of prevented cases [s1]. Both groups improved, the comparison was against active health advice rather than no intervention, and the gap was small [s1]. Longer follow-up would be needed to learn whether an early separation in test scores becomes a difference in who develops dementia. This article describes trial findings and is not medical advice.

Sources

• Multidomain lifestyle intervention for the prevention of cognitive decline in at-risk older adults in Latin America (LatAm-FINGERS) — The Lancet, 2026-07-13
• FINGER: a 2 year multidomain intervention to prevent cognitive decline — The Lancet, 2015-06-06
• LatAm-FINGERS trial registration (NCT06492967) — ClinicalTrials.gov