The Lancet July 13, 2026

Multidomain lifestyle intervention for the prevention of cognitive decline in at-risk older adults in Latin America (LatAm-FINGERS): a single-blind, multicentre, randomised controlled trial

Lucia Crivelli, Claudia Kimie Suemoto, Ana Luisa Sosa, Francisco Lopera, David Aguillón, Ricardo Francisco Allegri, Ricardo Nitrini, et al.

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Bottom Line

The LatAm-FINGERS trial demonstrated that a culturally tailored, 2-year multidomain lifestyle intervention significantly improved global cognition compared to standard health advice in at-risk older adults across 11 Latin American countries.

Key Findings

1. Global cognitive composite scores increased over time in both groups, but the structured lifestyle intervention (SLI) group showed a significantly greater mean annual change of 0.31 SD (95% CI, 0.28–0.34) compared to 0.20 SD (95% CI, 0.17–0.23) in the flexible lifestyle intervention (FLI) control group.

2. The SLI group achieved a mean between-group difference of 0.11 SD per year (95% CI, 0.06–0.15; p<0.0001), representing approximately a 55% greater improvement in global cognitive scores over the control arm.

3. The multidomain intervention proved highly feasible with an 82% overall retention rate; dropouts were significantly higher in the FLI control group (20.2%) than in the SLI group (15.2%, p=0.042).

4. Adverse events were generally mild and expected; musculoskeletal symptoms occurred in 21% (n=113) of the SLI group versus 2% (n=13) of the FLI group, and no serious adverse events (9% SLI vs 5% FLI) or deaths were related to the intervention.

Study Design

Design

RCT

Single-Blind

Sample

1,065

Patients

Duration

2 yr

Median

Setting

11 Latin American countries

Population Adults aged 60-77 years at high risk for dementia (indicated by cardiovascular risk factors, aging, and a dementia risk score ≥6) with suboptimal cognitive performance.

Intervention A 2-year structured lifestyle intervention (SLI) combining supervised physical activity, MIND diet dietary counselling, computerised cognitive training, cardiovascular risk management, and regular social engagement, adapted to local cultures.

Comparator A flexible lifestyle intervention (FLI) providing periodic, flexible health advice.

Outcome Trial feasibility (assessed via RE-AIM measures) and the intervention's effect on global cognitive composite scores.

Study Limitations

• The single-blind design (only outcome assessors were masked) means participants and staff were aware of group assignments, which could introduce expectation and performance biases.

• Higher dropout rates in the control group might reflect participant disappointment over not receiving the intensive intervention, potentially introducing attrition bias.

• The rigorous 2-year intervention requires substantial participant motivation, which may limit generalizability and real-world adherence in broader, less motivated, or frailer populations.

• While statistically significant, the long-term clinical magnitude of a 0.11 SD/year cognitive difference in definitively delaying or preventing dementia incidence requires further longitudinal follow-up.

Clinical Significance

LatAm-FINGERS establishes that non-pharmacological, multidomain lifestyle interventions can be successfully adapted to culturally diverse and low-to-middle-income settings. By demonstrating substantial cognitive benefits from structured exercise, MIND diet counselling, cognitive training, and vascular risk management, it offers a scalable, evidence-based strategy to counter the rapidly growing dementia burden in populations historically underrepresented in clinical trials.

Historical Context

With the limitations, high costs, and systemic challenges of emerging pharmacological therapies for Alzheimer's disease, global focus has increasingly turned to modifiable risk factors. The landmark 2015 FINGER trial in Finland first established the efficacy of a multidomain lifestyle intervention in preserving cognition. To validate this model globally, the World-Wide FINGERS network was created. LatAm-FINGERS represents a major global milestone in this effort, proving that culturally tailored lifestyle interventions can succeed across the diverse socioeconomic and healthcare landscapes of Latin America.

Guided Discussion

High-yield insights from every perspective

Med Student

Medical Student

What are the primary pathophysiological mechanisms by which a multidomain lifestyle intervention, such as addressing vascular risk, diet, and exercise, protects against cognitive decline in older adults?

Key Response

This question focuses on foundational basic science and pathophysiology. Students should understand that managing vascular risk reduces microvascular ischemic damage and neuroinflammation, while exercise and cognitive stimulation promote neurogenesis, increase brain-derived neurotrophic factor (BDNF), and build cognitive reserve, which collectively delay the clinical manifestation of neurodegenerative changes.

Resident

When evaluating an older adult with mild cognitive impairment in a busy primary care setting, how can you practically implement the components of the LatAm-FINGERS intervention given typical time and resource constraints?

Key Response

This tests practical clinical application. Residents must learn to transition from simply prescribing medications to coordinating lifestyle changes, utilizing multidisciplinary teams (dietitians, physical therapists), leveraging community resources, and establishing structured follow-up for vascular risk factors like hypertension and diabetes in real-world settings.

Fellow

How does the cultural tailoring of the LatAm-FINGERS intervention impact its efficacy compared to the original FINGER trial, and what does this imply for designing neuroprotective interventions for diverse populations globally?

Key Response

Requires advanced understanding of landmark trials and evidence integration. The fellow must synthesize how adapting dietary recommendations (e.g., culturally relevant foods instead of standard Nordic diets), cognitive tools, and exercise modalities to local socioeconomic contexts improves adherence, internal validity, and generalizability in non-European populations.

Attending

Given the positive results of LatAm-FINGERS in a resource-diverse, multi-country setting, how should healthcare systems restructure primary care and geriatrics clinics to sustainably deliver and reimburse these multidomain preventive strategies on a population level?

Key Response

Focuses on systems-level thinking, healthcare economics, and broad practice change. It challenges attendings to think beyond individual patient encounters to how interdisciplinary lifestyle interventions can be operationalized, incentivized, and funded to prevent dementia at scale.

Scholarly Review

Critical appraisal through the lens of expert reviewers and guideline development

PhD

In a single-blind behavioral intervention trial spanning 11 diverse countries, what are the primary statistical and methodological challenges in harmonizing the measurement of 'global cognition,' and how can researchers adequately control for varying levels of baseline education and cultural test bias?

Key Response

Targets advanced methodology. Highlights the difficulty of cross-cultural neuropsychological assessment, the need for robust harmonization of outcome measures, handling missing data, and accounting for the Hawthorne effect or practice effects in non-pharmacological trials across heterogeneous populations.

Journal Editor

As a peer reviewer, how would you evaluate the risk of detection bias and performance bias in this single-blind trial, and what specific adherence metrics would you demand to see to ensure the intervention's effect size is not driven by the placebo effect or unequal attrition?

Key Response

Emphasizes rigorous peer review. In single-blind behavioral trials, participants know their assignment, potentially altering their behavior outside the protocol or increasing dropout in the control arm. Editors must look for objective adherence data, rigorous blinding of cognitive raters, and strict intention-to-treat analyses to validate the findings.

Guideline Committee

How do the findings from the LatAm-FINGERS trial influence the strength of recommendation for multidomain lifestyle interventions in the WHO Guidelines on risk reduction of cognitive decline and dementia, specifically regarding applicability in low- and middle-income countries (LMICs)?

Key Response

Directly addresses guideline formulation. The WHO currently offers a conditional recommendation for multidomain interventions based on moderate-to-low certainty evidence primarily from high-income countries. LatAm-FINGERS provides crucial high-quality evidence from LMICs, potentially upgrading the certainty of evidence and prompting stronger, globally applicable recommendations for culturally tailored lifestyle interventions.

Clinical Landscape

Noteworthy Related Trials

2015

FINGER Trial

n = 1,260 · Lancet

Tested

Multidomain lifestyle intervention (diet, exercise, cognitive training, vascular risk monitoring)

Population

At-risk older adults (aged 60-77 years)

Comparator

General health advice

Endpoint

Cognitive function measured by comprehensive neuropsychological test battery (NTB)

Key result: The multidomain lifestyle intervention improved or maintained cognitive functioning and reduced the risk of cognitive decline compared to general health advice.

2016

PreDIVA Trial

n = 3,526 · Lancet

Tested

Nurse-led intensive vascular care and lifestyle advice

Population

Unselected community-dwelling older adults aged 70-78 years

Comparator

Standard care

Endpoint

Cumulative incidence of dementia over 6 years

Key result: The intervention did not significantly reduce the overall incidence of dementia, but showed potential benefit in a subgroup with untreated baseline hypertension.

2017

MAPT Trial

n = 1,680 · Lancet Neurol

Tested

Multidomain lifestyle intervention plus omega-3 polyunsaturated fatty acids

Population

Older adults (aged 70 and older) with subjective memory complaints

Comparator

Placebo and routine care

Endpoint

Change in composite cognitive score at 3 years

Key result: There was no significant difference in overall cognitive decline between groups, though post-hoc analyses suggested potential benefits for those with higher baseline dementia risk.

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