Overcoming Brain Healthism: Providing Support for Healthy Lifestyles

“Brain healthism” is a moralizing bias in dementia research and policy that places the onus for responsibility for brain health on individuals to live healthy lifestyles, while overlooking environmental drivers of poor brain health such as poverty, pollution and privation [1]. It is a highly present and misleading narrative [2], as evidenced by skewed interpretations of a recent high-impact study, the “US POINTER” supported by the Alzheimer's Association and Worldwide FINGERS international research initiative studying lifestyle interventions for brain health in older adults [3]. In US POINTER, 2111 participants at risk of cognitive decline aged 60 to 79 years with a sedentary lifestyle, suboptimal diet, and at least two additional criteria (family history of memory impairment, cardiometabolic risk, race and ethnicity, older age, and sex) were randomized into two groups: two years of a structured versus self-guided multidomain lifestyle interventions for brain health [3]. Global cognition increased from baseline over time in both groups, but crucially, the mean rate of increase per year was statistically significantly greater for the structured group than the self-guided group [3]. Healthist interpretations limit the public health value of this study. The Alzheimer's Association lists the “US POINTER Brain Health Recipe” (https://www.alz.org/getmedia/5d1826c1-1ddd-49ca-badc-44deed8eee40/uspointerbrainhealthrecipe.pdf; Accessed 9th December 2025) on its website consisting of physical exercise, cognitive exercise, health monitoring, and nutrition. According to the Cambridge dictionary, a recipe is “a set of instructions telling you how to prepare and cook food.” This “recipe” framing places responsibility at an individual level (“you”) and is instruction-based, that is, brain healthism. The structured group received “38 facilitated peer team meetings over 2 years, with education, goal-setting, and accountability to support the health behaviors,” whereas the self-guided group received “6 facilitated peer team meetings over 2 years to provide the support” (p. 3, [3]). So the entire variable of the structured, supported multi-domain intervention (32 extra meetings; exercise in a community center; the MIND diet; supported cognitive and social stimulation; twice-yearly medical advisor appointments) was the randomized factor causally responsible for group differences. It is incorrect to isolate the multi-domain intervention “recipe” as the active component. The POINTER study group differences provide an analogy of social advantage and empirically confirm that more advantaged people (e.g., with more social support) would gain the most from lifestyle-only approaches, worsening pre-existing brain health inequalities [4]. Therefore, policy makers and dementia researchers have to choose between brain healthism and a public health approach [4]. I argue in favor of the latter, with a focus on what is called primordial prevention, that is, improving social and environmental conditions (see Table 1). A whole-population approach would make people less exposed to environmental sources of dementia risk, and provide them with more autonomy to make healthy choices easier [4]. To avoid brain healthism, lifestyle changes should always be accompanied by support or “enablement,” that is, “providing the conditions, resources, and opportunities that make a given action possible” [5]. Immediately actionable Easy to understand Politically palatable Likely to be limited in impact [1, 4] Reinforces pre-existing inequalities [4] Timothy Daly undertook all aspects of the article: conceptualization, writing, editing, validation. The author has nothing to report. The author has nothing to report. The author declares no conflicts of interest.