Effect of a Multidomain Lifestyle Intervention on Estimated Dementia Risk.
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SUBMITTER: Solomon A
PROVIDER: S-EPMC8461663 | biostudies-literature | 2021
REPOSITORIES: biostudies-literature
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Effect of a Multidomain Lifestyle Intervention on Estimated Dementia Risk.
Solomon Alina A Handels Ron R Wimo Anders A Antikainen Riitta R Laatikainen Tiina T Levälahti Esko E Peltonen Markku M Soininen Hilkka H Strandberg Timo T Tuomilehto Jaakko J Kivipelto Miia M Ngandu Tiia T
Journal of Alzheimer's disease : JAD 20210101 4
We investigated the effect of a multidomain lifestyle intervention on the risk of dementia estimated using the validated CAIDE risk score (post-hoc analysis). The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a 2-year randomized controlled trial among 1,260 at-risk older adults (60-77 years). Difference in the estimated mean change in CAIDE score at 2 years in the intervention compared to the control group was -0.16 (95 %CI -0.31 to 0.00) (p = 0. ...[more]
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Project description:BackgroundLittle is known regarding the dose-response function in multidomain interventions for dementia prevention.MethodThe Multidomain Alzheimer Preventive Trial is a 3-year randomized controlled trial comprising cognitive training, physical activity, nutrition, and omega-3 polyunsaturated fatty acids for at-risk older adults. The dose delivered (number of sessions attended) was modeled against global cognition, memory, and fluency in 749 participants. Interaction effects were assessed for age, sex, education, dementia score (CAIDE), frailty score, and apolipoprotein E (APOE) ε4 status.ResultsThe dose-response models were non-linear functions indicating benefits up to about 12 to 14 training hours or 15 to 20 multidomain sessions followed by a plateau. Participants who benefited from a higher dose included women, younger participants, frail individuals, and those with lower education or lower risk of dementia.DiscussionThe non-linear function indicates that a higher dose is not necessarily better in multidomain interventions. The optimal dose was about half of the potentially available sessions.
| S-EPMC9786573 | biostudies-literature
Project description:BackgroundFrailty often precedes and co-occurs with dementia. A multidomain lifestyle intervention has shown favourable effects on cognition. We aimed to investigate if frailty status modifies this intervention effect.MethodsThe Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) recruited 1259 participants aged 60-77 years who were at risk of dementia. They were randomised to receive a multidomain intervention (diet, exercise, cognitive training and vascular risk monitoring) or regular health advice for two years. The outcome was a change in cognition (neuropsychological test battery composite score). Frailty and prefrailty were defined according to the Fried phenotype. Mixed models were used to investigate if frailty status at baseline modified the intervention effect on cognition.ResultsFrailty status (prefrail/frail n = 520, robust n = 625) at baseline did not modify the effect of intervention on global cognition during the 2-year follow-up (P-value for frailty × intervention × time interaction > .05). Concerning cognitive subdomains, similar results were found. Among prefrail/frail persons, within-group analyses suggested a beneficial intervention effect on executive function and processing speed and also on global cognition when frail participants (n = 15) were excluded from the analyses. Being prefrail/frail was related to less improvement in global cognition, memory and executive function domains compared with being robust when intervention was not taken into consideration.ConclusionsA multidomain intervention is likely to be beneficial to cognition regardless of frailty status. Prefrail participants seemed particularly responsive to preventive intervention. Thus, an optimal time for a multidomain lifestyle intervention may be at the prefrailty stage.
| S-EPMC11878527 | biostudies-literature
Project description:BackgroundGOIZ ZAINDU ("caring early" in Basque) is a pilot study to adapt the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) methodology to the Basque population and evaluate the feasibility and adherence to a FINGER-like multidomain intervention program. Additional aims included the assessment of efficacy on cognition and data collection to design a large efficacy trial.MethodGOIZ ZAINDU is a 1-year, randomized, controlled trial of a multidomain intervention in persons aged 60+ years, with Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score ≥ 6, no diagnosis of dementia, and below-than-expected performance in at least one of three cognitive screening tests. Randomization to a multidomain intervention (MD-Int) or regular health advice (RHA) was stratified by sex, age (>/≤ 75), and cognitive status (mild cognitive impairment (MCI)/normal cognition). MD-Int included cardiovascular risk factor control, nutritional counseling, physical activity, and cognitive training. The primary outcomes were retention rate and adherence to the intervention program. Exploratory cognitive outcomes included changes in the Neuropsychological Test Battery z-scores. Analyses were performed according to the intention to treat.ResultsOne hundred twenty-five participants were recruited (mean age: 75.64 (± 6.46); 58% women). The MD-Int (n = 61) and RHA (n = 64) groups were balanced in terms of their demographics and cognition. Fifty-two (85%) participants from the RHA group and 56 (88%) from the MD-Int group completed the study. More than 70% of the participants had high overall adherence to the intervention activities. The risk of cognitive decline was higher in the RHA group than in the MD-Int group in terms of executive function (p =.019) and processing speed scores (p =.026).ConclusionsThe GOIZ-ZAINDU study proved that the FINGER methodology is adaptable and feasible in a different socio-cultural environment. The exploratory efficacy results showed a lower risk of decline in executive function and processing speed in the intervention group. These results support the design of a large-scale efficacy trial.Trial registrationGOIZ ZAINDU feasibility trial was approved and registered by the Euskadi Drug Research Ethics Committee (ID: PI2017134) on 23 January 2018. Retrospectively registered in ClinicalTrials.gov (NCT06163716) on 8 December 2023.
| S-EPMC10898038 | biostudies-literature
Project description:In the SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention in at-risk elderly people (SUPERBRAIN), we evaluated the impact of multidomain lifestyle intervention on regional homogeneity (ReHo) in resting-state functional brain magnetic resonance imaging (MRI) data. Of 152 participants aged 60-79 years without dementia assigned to either facility-based multidomain intervention (FMI), home-based MI, or controls, we analyzed 56 scanned MRIs at baseline and 24 weeks. ReHo values from regions with significant longitudinal changes were compared between the intervention and control groups and their correlations with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) or serum brain-derived neurotrophic factor (BDNF) were evaluated. ReHo values in the left medial orbitofrontal gyrus and right superior parietal lobule were increased [p = 0.021, correlated positively with serum BDNF changes (r = 0.504, p = 0.047)] and decreased [p = 0.021, correlated negatively with changes in the total (r = -0.509, p = 0.044) and attention (r = -0.562, p = 0.023). RBANS], respectively, in the participants assigned to the FMI group than those of the controls. Our results suggest that facility-based group preventive strategies may have cognitive benefits through neuroplastic changes in functional processing circuits in the brain areas which play a crucial role in the adaptive learning and internally directed cognition.
| S-EPMC9366741 | biostudies-literature
Project description:IntroductionDementia risk scores constitute promising surrogate outcomes for lifestyle interventions targeting cognitive function. We investigated whether dementia risk, assessed using the LIfestyle for BRAin health (LIBRA) index, was reduced by the AgeWell.de intervention.MethodsSecondary analyses of the AgeWell trial, testing a multicomponent intervention (including optimization of nutrition, medication, and physical, social, and cognitive activity) in older adults with increased dementia risk. We analyzed data from n = 461 participants with complete information on risk/protective factors comprised by LIBRA at the 24-month follow-up. Intervention effects on LIBRA and LIBRA components were assessed using generalized linear models.ResultsThe intervention reduced LIBRA scores, indicating decreased dementia risk at follow-up (b = -0.63, 95% confidence interval [CI]: -1.14, -0.12). Intervention effects were particularly due to improvements in diet (odds ratio [OR]: 1.60, 95% CI: 1.16, 2.22) and hypertension (OR: 1.61, 95% CI: 1.19, 2.18).DiscussionThe AgeWell.de intervention reduced dementia risk. However, several risk factors did not improve, possibly requiring more intensive interventions.HighlightsThe AgeWell.de intervention reduced dementia risk according to LIfestyle for BRAin health (LIBRA) scores. Beneficial effects on LIBRA are mainly due to changes in diet and blood pressure. A pragmatic lifestyle intervention is apt to reduce dementia risk in an at-risk population.
| S-EPMC11350131 | biostudies-literature
Project description:IntroductionThe Finnish Geriatric Intervention Study (FINGER) led to the global dementia risk reduction initiative: World-Wide FINGERS (WW-FINGERS). As part of WW-FINGERS, the Australian AU-ARROW study mirrors aspects of FINGER, as well as US-POINTER.MethodAU-ARROW is a randomized, single-blind, multisite, 2-year clinical trial (n = 600; aged 55-79). The multimodal lifestyle intervention group will engage in aerobic exercise, resistance training and stretching, dietary advice to encourage MIND diet adherence, BrainHQ cognitive training, and medical monitoring and health education. The Health Education and Coaching group will receive occasional health education sessions. The primary outcome measure is the change in a global composite cognitive score. Extra value will emanate from blood biomarker analysis, positron emission tomography (PET) imaging, brain magnetic resonance imaging (MRI), and retinal biomarker tests.DiscussionThe finalized AU-ARROW protocol is expected to allow development of an evidence-based innovative treatment plan to reduce cognitive decline and dementia risk, and effective transfer of research outcomes into Australian health policy.HighlightsStudy protocol for a single-blind, randomized controlled trial, the AU-ARROW Study.The AU-ARROW Study is a member of the World-Wide FINGERS (WW-FINGERS) initiative.AU-ARROW's primary outcome measure is change in a global composite cognitive score.Extra significance from amyloid PET imaging, brain MRI, and retinal biomarker tests.Leading to development of an innovative treatment plan to reduce cognitive decline.
| S-EPMC11002765 | biostudies-literature
Project description:Importance/Objective: To describe the feasibility and acceptability of a 6-month web-based multidomain lifestyle training intervention for community-dwelling older people and to test the effects of the intervention on both function- and lifestyle-related outcomes.Design6-month, parallel-group, randomized controlled trial (RCT).SettingToulouse area, South-West, France.ParticipantsCommunity-dwelling men and women, ≥ 65 years-old, presenting subjective memory complaint, without dementia.InterventionThe web-based multidomain intervention group (MIG) received a tablet to access the multidomain platform and a wrist-worn accelerometer measuring step counts; the control group (CG) received only the wrist-worn accelerometer. The multidomain platform was composed of nutritional advices, personalized exercise training, and cognitive training. Main outcomes and measures: Feasibility, defined as the proportion of people connecting to ≥75% of the prescribed sessions, and acceptability, investigated through content analysis from recorded semi-structured interviews. Secondary outcomes included clinical (eg, cognitive function, mobility, health-related quality of life (HRQOL)) and lifestyle (eg, step count, food intake) measurements.ResultsAmong the 120 subjects (74.2 ±5.6 years-old; 57.5% women), 109 completed the study (n=54, MIG; n=55, CG). 58 MIG subjects connected to the multidomain platform at least once; among them, adherers of ≥75% of sessions varied across multidomain components: 37 people (63.8% of 58 participants) for cognitive training, 35 (60.3%) for nutrition, and three (5.2%) for exercise; these three persons adhered to all multidomain components. Participants considered study procedures and multidomain content in a positive way; the most cited weaknesses were related to exercise: too easy, repetitive, and slow progression. Compared to controls, the intervention had a positive effect on HRQOL; no significant effects were observed across the other clinical and lifestyle outcomes.Conclusions and relevanceProviding multidomain lifestyle training through a web-platform is feasible and well-accepted, but the training should be challenging enough and adequately progress according to participants' capabilities to increase adherence. Recommendations for a larger on-line multidomain lifestyle training RCT are provided.
| S-EPMC7754697 | biostudies-literature
Project description:This study aimed to investigate the effects of a multidomain intervention on gene expression profile of older adults with cognitive frailty in Selangor, Malaysia, using mRNA gene sequencing. The intervention included a combination of dietary changes, exercise, and psychosocial support. By analyzing gene expression profile in both groups, this study explores how multidomain interventions may influence mrna in older adults. The findings could provide insights into the role of lifestyle factors on the CF in aging populations.
2025-05-31 | GSE298126 | GEO
Project description:IntroductionWe explored which dementia risk factors in two multidomain prevention trials mediate beneficial, neutral, or counteracting effects on dementia incidence.MethodsWe pooled data from the multidomain MAPT (Multidomain Alzheimer Preventive Trial; n = 1679, up to 5-year follow-up) and preDIVA trials (Prevention of Dementia by Intensive Vascular Care; n = 3526, up to 12-year follow-up) in adults aged 70+. We used multiple mediation analysis to quantify the role of 2-year changes in body mass index, systolic blood pressure, total cholesterol, and physical activity in the intervention effects on dementia incidence. Mixed linear and Cox proportional hazard models were used to explore pathways.ResultsWe observed no mediation of individual risk factors in the effect of the interventions on dementia incidence. The interventions slightly lowered only blood pressure, but this did not translate into an effect on dementia incidence.DiscussionIn older populations, multidomain interventions may not sufficiently affect dementia risk factors to lower dementia incidence, particularly in settings where cardiovascular risk factor management is well implemented.HighlightsThere is no mediating role of risk factor change in the effects of multidomain interventions on dementia incidence in two large dementia prevention randomized controlled trials. The lack of effect of the interventions on risk factors explains the absence of impact on dementia. Counteracting mediators do not explain the lack of effect of the interventions on dementia. A small effect of the interventions on blood pressure did not translate into a lower dementia incidence.
| S-EPMC11851128 | biostudies-literature
Project description:Importance:The role of the apolipoprotein E (APOE) ε4 allele as an effect modifier in lifestyle interventions to prevent cognitive impairment is still unclear. Objective:To examine whether the APOE ε4 allele modifies the previously reported significant cognitive benefits of a multidomain lifestyle intervention (prespecified subgroup analysis). Design, Setting, and Participants:The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was a randomized clinical trial in 6 centers across Finland (screening and randomization performed from September 7, 2009, through November 24, 2011; intervention duration, 2 years). Data analysis was performed from August 1, 2015, to March 31, 2016. The study population was at-risk older individuals from the general population. Inclusion criteria were age of 60 to 77 years; Cardiovascular Risk Factors, Aging, and Dementia risk score of at least 6 points; and cognition at a mean level or slightly lower than expected for age. Individuals with dementia or substantial cognitive impairment and conditions that prevented cooperation or safe engagement in the intervention were excluded. APOE genotype data were available for 1175 of the 1260 participants. Interventions:Participants were randomly assigned in a 1:1 ratio to a multidomain intervention group (diet, exercise, cognitive training, and vascular risk management) or a control group (general health advice). Group allocation was not actively disclosed to participants, and outcome assessors were masked to group allocation. Main Outcomes and Measures:Primary outcome was change in cognition measured through a comprehensive neuropsychological test battery. Analysis was based on modified intention to treat (participants with at least 1 postbaseline assessment). Results:A total of 1109 participants (mean [SD] age, 69.3 [4.7] years; 514 [46.3%] female) were included in the analysis: 362 APOE ε4 allele carriers (173 intervention and 189 control) and 747 noncarriers (380 intervention and 367 control). The APOE ε4 carriers and noncarriers were not significantly different at baseline (except for serum cholesterol level). The difference between the intervention and control groups in annual neuropsychological test battery total score change was 0.037 (95% CI, 0.001 to 0.073) among carriers and 0.014 (95% CI, -0.011 to 0.039) among noncarriers. Intervention effect was not significantly different between carriers and noncarriers (0.023; 95% CI, -0.021 to 0.067). Conclusions and Relevance:Healthy lifestyle changes may be beneficial for cognition in older at-risk individuals even in the presence of APOE-related genetic susceptibility to dementia. Whether such benefits are more pronounced in APOE ε4 carriers compared with noncarriers should be further investigated. The findings also emphasize the importance of early prevention strategies that target multiple modifiable risk factors simultaneously. Trial Registration:ClinicalTrials.gov Identifier: NCT01041989.
| S-EPMC5885273 | biostudies-literature