The FINGER Trial: How Lifestyle Can Protect the Aging Brain

By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living

Alzheimer’s disease and dementia remain some of the most feared conditions of aging — and for good reason. While genetics play a role, mounting evidence shows that lifestyle and vascular health may be even more influential in determining cognitive outcomes.

One of the most important studies to demonstrate this connection is the FINGER trial — the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability. It remains a landmark in longevity medicine because it proved something remarkable:

Cognitive decline is not inevitable — and a structured, multidomain lifestyle program can slow or prevent it.

1. What Was the FINGER Trial?

The FINGER trial was a large, randomized controlled study conducted across multiple centers in Finland.

• Published in: The Lancet (Ngandu et al., 2015)
• Participants: 1,260 adults aged 60–77 years
• Inclusion criteria: At-risk for dementia but without major cognitive impairment (based on CAIDE Dementia Risk Score).
• Study design:
  • Participants were randomized into two groups:
    1. Intervention group: Received intensive, structured lifestyle modification.
    2. Control group: Received standard general health advice.
  • Duration: 2 years.

The trial aimed to determine whether a multidomain intervention — addressing diet, exercise, cognitive training, and vascular risk — could preserve or improve cognitive performance in older adults.

2. What Did the Intervention Include?

The FINGER intervention targeted four lifestyle pillars, reflecting the same integrative principles we emphasize at Beyond Health:

1. Diet:
   • Modeled after a Nordic-Mediterranean style — high in fruits, vegetables, whole grains, fish, and unsaturated fats.
   • Limited refined sugar and processed foods.
   • Focused on omega-3 fatty acids and antioxidant-rich produce.
2. Exercise:
   • Combined aerobic and resistance training (2–5 sessions per week).
   • Individualized intensity, emphasizing functional strength, balance, and endurance.
3. Cognitive Training:
   • Computer-based mental exercises targeting memory, executive function, and processing speed.
   • Group sessions for reinforcement and accountability.
4. Vascular and Metabolic Risk Monitoring:
   • Regular medical assessments for blood pressure, cholesterol, weight, and glucose.
   • Lifestyle coaching and medication optimization as needed.

This comprehensive structure made FINGER the first trial to integrate all major modifiable risk domains into one coordinated protocol.

3. The Results: A Blueprint for Cognitive Longevity

After two years, the results were striking:

• Global cognition: Improved 25% more in the intervention group versus control (p=0.030).
• Executive function: Improved 83% more in the intervention group.
• Processing speed: Improved 150% more in the intervention group.
• Memory: Improved modestly but significantly.

(Ngandu et al., Lancet, 2015)

Importantly, these benefits were seen in adults who already had some risk for dementia — showing that intervention works even after midlife, not just preventatively.

Follow-up studies (Kivipelto et al., Alzheimers Dement, 2020) found that benefits persisted up to 7 years after the study ended, with sustained cognitive and functional advantages.

Other analyses linked the program to improved metabolic health, cardiovascular resilience, and quality of life — reinforcing the interconnectedness of brain and body.

4. Why It Matters

The FINGER trial changed how clinicians and researchers view dementia prevention.

Historically, cognitive decline was treated as a neurological disease — managed primarily through medication. The FINGER results reframed it as a systemic, lifestyle-driven condition influenced by vascular, metabolic, and behavioral health.

This model led to a wave of similar studies across the globe (the “World-Wide FINGERS” network), which are now replicating the findings in diverse populations.

The key message:

Prevention and protection of brain health begin decades before memory symptoms appear.

5. Action Steps: Applying FINGER Principles in Daily Life

The real power of the FINGER trial is that its core strategies are achievable for everyone.
 Here’s how to apply them in the Beyond Health framework:

1. Prioritize Aerobic and Strength Training

• Engage in Zone 2 cardio (moderate intensity, 30–45 min, 3–4 times per week).
• Add resistance training twice weekly to maintain muscle and bone health.
• Even walking 7,000–8,000 steps daily reduces dementia risk by up to 50% (Del Pozo Cruz et al., JAMA Neurol, 2022).

2. Eat for the Brain

• Follow a Mediterranean-style diet: vegetables, olive oil, fish, legumes, nuts, and whole grains.
• Limit added sugars and refined carbohydrates.
• Include omega-3 sources (salmon, sardines, walnuts, flaxseed).

3. Train Cognition

• Learn a new skill, language, or instrument — cognitive novelty builds neuroplasticity.
• Use digital tools or puzzles that challenge working memory and problem-solving.
• Prioritize social engagement; isolation accelerates decline.

4. Control Vascular and Metabolic Health

• Monitor blood pressure, glucose, and cholesterol regularly.
• Manage insulin resistance and inflammation through exercise, sleep, and nutrition.
• Avoid smoking and minimize alcohol.

5. Sleep and Stress Management

• Sleep 7–9 hours per night; prioritize consistent timing.
• Practice mindfulness, meditation, or slow breathing to lower cortisol.
• Poor sleep increases amyloid accumulation — the same protein linked to Alzheimer’s pathology (Ju et al., Ann Neurol, 2014).

6. Beyond Health’s Perspective

The FINGER trial validated what functional and precision medicine have long suggested:
 The brain cannot be separated from the body.

Cognition depends on vascular flow, metabolic stability, and behavioral consistency. There is no single pill that can replace what an integrated lifestyle approach provides.

At Beyond Health, our cognitive longevity protocols build directly from these principles — combining medical monitoring, fitness programming, nutrition, and stress management to protect and optimize brain health.

The takeaway is hopeful: decline is not destiny. The earlier we act, the greater the benefit — but it’s never too late to begin protecting your brain.

Conclusion

The FINGER trial was the first proof that lifestyle medicine can change the trajectory of cognitive aging.

By combining nutrition, exercise, cognitive training, and metabolic control, researchers demonstrated that the brain remains adaptable and resilient — even in later life.

You don’t need to live in Finland to benefit from the same science.
 Start small. Move daily. Eat with purpose. Sleep deeply. Challenge your mind.

Longevity is not found in a supplement bottle — it’s built through daily habits that strengthen the body, brain, and spirit together.

References

1. Ngandu T, et al. A 2-Year Multidomain Intervention of Diet, Exercise, Cognitive Training, and Vascular Risk Monitoring in At-Risk Elderly People (FINGER): Randomised Controlled Trial. Lancet. 2015;385(9984):2255–2263.
2. Kivipelto M, et al. Long-Term Effects of the FINGER Multidomain Intervention on Cognition and Health-Related Quality of Life. Alzheimers Dement. 2020;16(9):1340–1348.
3. Del Pozo Cruz B, et al. Steps per Day and Incident Dementia in 78,430 Adults. JAMA Neurol. 2022;79(10):970–978.
4. Ju YE, et al. Sleep Quality and Amyloid Deposition in Aging. Ann Neurol. 2014;76(5):837–844.
5. Livingston G, et al. Dementia Prevention, Intervention, and Care: 2020 Report of the Lancet Commission. Lancet. 2020;396(10248):413–446.