There are some things Mario Tardif knows for sure. He’s a procrastinator. He should exercise more. And he should not have a bowl of ice cream every night, as much as he would like to.
But what the 68-year-old North Attleborough grandfather doesn’t know is perhaps the thing that most haunts him — whether he will spend the last years of his life lost in a fog of Alzheimer’s dementia, staring out the window and crying, as his mother did.
That specter prompted Tardif to volunteer for a first-of-its kind US trial, known as the POINTER study, which is examining whether computer-based brain exercises similar to video games, in combination with a healthy diet, physical exercise, and social interaction can ward off dementia for those thought to be most at risk.
Butler Hospital and The Miriam Hospital, both in Providence, are jointly running one of five POINTER study sites nationally, and are recruiting volunteers from Greater Boston and Rhode Island.
“Maybe I can do something to reduce my chances of getting it,” Tardif said. “Or if [researchers] get something from me that could help somebody else, that’s terrific.”
An estimated 5.8 million Americans are living with Alzheimer’s — a number that is expected to rise sharply with aging baby boomers. But with diminishing hopes for an imminent, effective Alzheimer’s medication, studies testing the protective power of computer-based brain exercises, as well as lifestyle interventions, have taken on new urgency.
“We are not going to get a blockbuster treatment that will come through and vanquish Alzheimer’s any time soon,” said Dr. Stephen Salloway, a neurology and psychiatry professor at Brown University’s Warren Alpert Medical School and co-leader of the Rhode Island trial site.
The POINTER trial aims to enroll 2,000 people across the country, including about 400 in New England. Volunteers must be age 60-79, generally exercise less than three times a week, and have slightly high blood pressure, cholesterol, or blood sugar, or some family history of memory problems.
Participants are assigned to one of two groups: a structured group that receives instructions and regular coaching for adopting a Mediterranean-style diet with more fruits and vegetables, and for increasing social interactions, approaches that may be helpful in warding off cognitive decline.
“If we can control the risk factors for heart disease and stroke, we are going to keep your brain healthier,” Salloway said.
They also are expected to adhere to specific computerized brain-training exercises and prescribed aerobics, strength-training, and stretching.
The other group receives more general information about exercise, good nutrition, and the benefits of engaging in socially and mentally stimulating activities, such as learning a new skill or hobby.
Researchers will evaluate both groups of volunteers every six months for two years, measuring changes in cognition and physical health.
The brain exercises include a computer software program, known as BrainHQ, that is designed to be challenging in very specific ways. Using a video game-like approach, it tests and strengthens participants’ attention, brain processing speed, memory, spatial navigation, and people skills.
The POINTER study, with $35 million from the Alzheimer’s Association to recruit and run the trial sites, is expected to receive up to $47 million more from the National Institute on Aging to perform brain scans of participants. The scans, it is hoped, will provide important clues about why the interventions are, or are not, effective.
“There’s the possibility that by exercising our brain ... maybe that does change some of the biology, but we just don’t have the evidence to be able to make firm statements about that,” said Dr. Dana Plude, deputy director in the Division of Behavioral and Social Research at the National Institute on Aging, who oversees many of the institute’s dementia-related studies. “So we need this kind of research in order to answer those kinds of questions.”
Over the years, evidence has been mixed on whether certain forms of cognitive training may be more effective than others in forestalling cognitive decline. Some studies, for example, have suggested doing crosswords or other problem-solving puzzles may help, while others found little effect.
But results from a landmark study, known as the ACTIVE trial, found that healthy older adults who received specific brain-training, called speed of processing, had a 29 percent lower risk of dementia after 10 years than an untreated control group.
(Speed of processing requires participants to spot a target in the middle of the screen while simultaneously noticing a target in the periphery — even when they flash on screen very briefly.)
Various brain exercises may help with everyday activities, such as in driving, recalling people’s names, and finding your car keys.
Plude, from the aging institute, said his agency is funding trials that take different approaches to uncover which activities might be most effective.
“Some people who want to do these sorts of things may prefer to do them individually, and they would be uncomfortable in a group, and other people won’t do it unless they’re in a group,” he said.
“Let’s try to do these kinds of training activities in various ways and see which ones have traction,” Plude said. ”And it’s probably not going to be one-size-fits-all.”
Working on that theory, Plude’s division also recently funded a small, one-year study in California that tests whether brain exercises embedded into an already-popular community-based physical fitness program are effective at consistently drawing people to participate.
It awarded $465,000 to Posit Science, the company that created BrainHQ, to develop a brain-boosting program with the YMCA of San Francisco that also includes training in better nutrition, physical fitness, stress reduction, and improvements in sleep and social interactions.
“The goal of this grant is, let’s take the known science of dementia risk reduction and let’s build a curriculum that can be run at any YMCA, or in church basements, or network of any health-based community centers across the country,” said Henry Mahncke, Posit Science’s chief executive.
Another new trial the aging institute is funding is called PACT, underway in Florida. The $44 million, five-year trial will enroll 7,600 people and study whether computerized brain-training exercises can reduce the risk of mild cognitive impairment and dementias including Alzheimer’s disease.
All told, the the National Institute on Aging is supporting 423 active clinical trials on Alzheimer’s disease and related dementias, with nearly twice as many involving nonpharmaceutical interventions, such as the ones at the YMCA and in Rhode Island, compared to those involving medications.
Heather Snyder, vice president of medical and scientific relations at the Alzheimer’s Association, said both approaches may prove to be effective.
“Anyone who has lived with someone in their family with Alzheimer’s, you understand the challenges a family faces, to improve the quality of life but also to get ahead of it, so people have more time to do things with their families and to have the best quality of life they can,” she said.
That sentiment resonates with Tardif, the North Attleborough grandfather who lost his mother to Alzheimer’s and is participating in the Rhode Island POINTER trial.
His favorite part of the trial, he said, is group conversations with the other volunteers, who offer healthy recipe tips, such as adding spinach to fruit smoothies, as well as encouragement to stick with the program when he is tempted to skip some activities.
“I am trying to get better to avoid Alzheimer’s, and having these people will help me in that journey,” he said. “I am hopeful it will help my brain.”