A secondary MRI analysis of the US POINTER randomized clinical trial found that a structured multidomain lifestyle intervention slowed the progression of cerebral small-vessel disease–related injury, as measured by white matter free water (FW), in adults aged 60–69 years, but not in those aged 70 years or older, suggesting greater benefit when intensive lifestyle changes begin earlier in late life. The study included 959 adults aged 60–79 years at increased risk of cognitive decline who underwent annual brain MRI scans over 24 months while participating in either a structured program combining supervised exercise, dietary counseling, cognitive and social engagement, and health coaching or a self-guided educational program. No significant intervention effects were observed for other MRI markers, including white matter hyperintensity volume, fractional anisotropy, peak width of skeletonized mean diffusivity (PSMD), or the ALPS index. In addition, higher baseline FW and PSMD were associated with a greater risk of developing new cerebral microbleeds, while higher baseline FW and lower fractional anisotropy predicted greater progression of white matter hyperintensities. These findings identify FW as the cerebrovascular MRI marker most responsive to lifestyle intervention and suggest that implementing intensive multidomain lifestyle programs earlier in late life may provide greater protection against cerebral microvascular injury. Source: https://jamanetwork.com/
