A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial

Effects of multidomain lifestyle intervention on frailty among older men and women - a secondary analysis of a randomized clinical trial

BACKGROUND

Frailty is a common geriatric syndrome associated with poor clinical outcomes. Effectiveness of lifestyle intervention programmes among frail older people has been examined earlier, but effects of interventions on prevention of frailty have been rarely studied. The aim of this study was to investigate to what extent the multidomain lifestyle intervention in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) affected changes in frailty status among older men and women at risk of cognitive disorders.

METHODS

The 2-year multidomain lifestyle intervention trial including simultaneous nutritional counseling, physical exercise, cognitive training and social activity, and management of metabolic and vascular risk factors, was conducted among 1259 older people (mean age 68.9 years). A modified Fried's frailty phenotype (weight loss, exhaustion, weakness, slowness, and low physical activity) was used to assess frailty at baseline and after the 2-year intervention. Participants with one or more components of the frailty phenotype were classified as pre-frail or frail. A multinomial regression model was applied to investigate efficacy of the intervention on frailty.

RESULTS

We observed a favorable trend in reversing frailty among older men with the intervention. Pre-frail or frail men in the intervention group had higher probability of being non-frail after the intervention (44%) than pre-frail or frail men in the control group (30%) (p = 0.040). Among men, the intervention was especially beneficial in terms of increasing physical activity. Among women, multidomain lifestyle intervention did not affect the frailty status.

CONCLUSION

Modifying lifestyle-related factors may have potential to reverse first signs of frailty among older men. However, the intervention lasted only two years, therefore, research with longer follow-up is needed to see possible long-term effects of lifestyle management on the development of frailty.

Pregnancy as a window of opportunity for dementia prevention: a narrative review

Dementia is a debilitating condition with a disproportionate impact on women. While sex differences in longevity contribute to the disparity, the role of the female sex as a biological variable in disease progression is not yet fully elucidated. Metabolic dysfunctions are drivers of dementia etiology, and cardiometabolic diseases are among the most influential modifiable risk factors. Pregnancy is a time of enhanced vulnerability for metabolic disorders. Many dementia risk factors, such as hypertension or blood glucose dysregulation, often emerge for the first time in pregnancy. While such cardiometabolic complications in pregnancy pose a risk to the health trajectory of a woman, increasing her odds of developing type 2 diabetes or chronic hypertension, it is not fully understood how this relates to her risk for dementia. Furthermore, structural and functional changes in the maternal brain have been reported during pregnancy suggesting it is a time of neuroplasticity for the mother. Therefore, pregnancy may be a window of opportunity to optimize metabolic health and support the maternal brain. Healthy dietary patterns are known to reduce the risk of cardiometabolic diseases and have been linked to dementia prevention, yet interventions targeting cognitive function in late life have largely been unsuccessful. Earlier interventions are needed to address the underlying metabolic dysfunctions and potentially reduce the risk of dementia, and pregnancy offers an ideal opportunity to intervene. This review discusses current evidence regarding maternal brain health and the potential window of opportunity in pregnancy to use diet to address neurological health disparities for women.

A meta-analytic study of complex exercise interventions for cognitive performance in older adults

PURPOSE

To analyze the effect of complex exercise on cognitive ability of the elderly.

STUDY DESIGN

By means of literature screening and quality assessment, high-quality studies were extracted to comprehensively analyze the effects of complex exercise on cognitive ability of the elderly.

METHOD

By searching databases such as Web of Science and CNKI, we integrated experimental studies on the effects of complex exercise on cognitive ability in the elderly, conducted literature quality assessment according to Cochrane bias risk assessment tool, and conducted meta-analysis using Review Manager 5.3.

RESULTS

1) A total of 27 articles of high quality literature were included, containing 1072 subjects; 2) Complex exercise had a positive effect on cognitive abilities of older adults (SMD = 0.56; 95 % CI: 0.34, 0.78, P < 0.00001), with differences in the effects on different cognitive abilities, with the best effect on cognitive inhibition (SMD = 0.79; 95 % CI: 0.17, 1.41, P = 0.01), followed by executive function (SMD = 0.76; 95 % CI: 0.41, 1.11, P < 0.0001) and cognitive speed (SMD = 0.48; 95 % CI: 0.13, 0.84, P = 0.008), and a non-significant effect of memory intervention (SMD = 0.07; 95 % CI: -0.2, 0.33, P = 0.62); 3) The literature publication bias detection was more effective.

CONCLUSION

1) Complex exercise had a moderate effect in promoting cognitive performance in older adults. 2) By subgroup analysis, the order of intervention effect was cognitive inhibition, executive function, and cognitive speed, in descending order. 3) The intervention effect of complex exercise on memory in older adults was not significant.

Policy Actions Required to Improve Nutrition for Brain Health

Brain health is a pressing global concern. Poor diet quality is a recognized major environmental risk factor for brain disorders and one of the few that is modifiable. There is substantial evidence that nutrition impacts brain development and brain health across the life course. So why then is the full potential of nutrition not utilized to improve brain function? This commentary, which is based on discussions of the European Brain Research Area BRAINFOOD cluster, aims to highlight the most urgent research priorities concerning the evidence base in the area of nutrition and brain health and identifies 3 major issues that need to be addressed: (1) increase causal and mechanistic evidence on the link between nutrition and brain health, (2) produce effective messages/education concerning the role of food for brain health, and (3) provide funding to support collaborative working across diverse stakeholders.

Digital Isolation and Dementia Risk in Older Adults: Longitudinal Cohort Study

BACKGROUND

Dementia poses a significant global health challenge, characterized by progressive cognitive decline and functional impairment. With the aging global population, dementia prevalence is projected to surge, reaching an estimated 153 million cases by 2050. While the impact of traditional social isolation on dementia risk has been extensively studied, the influence of digital isolation, a phenomenon unique to the digital age, remains underexplored.

OBJECTIVE

This study aimed to investigate the association between digital isolation and dementia risk among older adults, hypothesizing that higher levels of digital isolation significantly increase the risk of developing dementia.

METHODS

We conducted a longitudinal cohort study using data from the National Health and Aging Trends Study (NHATS), analyzing 8189 participants aged 65 years and older from the 3rd (2013) to the 12th wave (2022). Digital isolation was quantified using a composite digital isolation index, derived from participants' usage of digital devices, electronic communication, internet access, and engagement in online activities. Participants were stratified into low isolation and moderate to high isolation groups. Dementia incidence was assessed using cognitive tests and proxy reports. Cox proportional hazards models were used to estimate the association between digital isolation and dementia risk, adjusting for potential confounders including sociodemographic factors, baseline health conditions, and lifestyle variables.

RESULTS

The moderate to high isolation group demonstrated a significantly elevated risk of dementia compared with the low isolation group. In the discovery cohort, the adjusted hazard ratio (HR) was 1.22 (95% CI 1.01-1.47, P=.04), while the validation cohort showed an HR of 1.62 (95% CI 1.27-2.08, P<.001). The pooled analysis across both cohorts revealed an adjusted HR of 1.36 (95% CI 1.16-1.59, P<.001). Kaplan-Meier curves corroborated a higher incidence of dementia in the moderate to high isolation group.

CONCLUSIONS

Our findings indicate that digital isolation is a significant risk factor for dementia among older adults. This study underscores the importance of digital engagement in mitigating dementia risk and suggests that promoting digital literacy and access to digital resources should be integral components of public health strategies aimed at dementia prevention.

Acceptability and fidelity of the multidomain 'Brain Bootcamp' dementia risk reduction program: a mixed-methods approach

BACKGROUND

Interventions targeting dementia prevention typically lack comprehensive exploration of feasibility, acceptability, and long-term translation factors prior to deployment. Our study aimed to explore the acceptability, fidelity and participants' experiences with Brain Bootcamp, a multi-domain behaviour change intervention targeting reduced dementia risk and increased dementia risk factor awareness for older adults.

METHODS

Conducted in New South Wales, Australia, from January to August 2021, our concurrent single-group mixed-methods feasibility study involved post-intervention surveys and qualitative interviews with community-dwelling older adults. Descriptive statistics were used to assess acceptability of the methods, outcome measures, and fidelity to the program components. Thematic analysis of semi-structured interviews explored participant experiences, preferences, barriers, and recommendations.

RESULTS

Out of 853 enrolled participants, only 355 completed the program (41.6%). Among these participants, 79.1% agreed that the intervention improved their awareness of dementia risk factors, and 92.4% expressed intent to continue maintaining brain healthy behaviours post- program. Participants typically set 2-4 modifiable risk factor lifestyle goals, which were most often related to physical activity (83.7%). A majority (91.5%) successfully achieved at least one brain health goal. Qualitative analyses (n = 195) identified three overarching themes on the role of education on behaviour modification (i.e., the transformative role of the program in enhancing knowledge about dementia prevention and fostering behavioral modifications), psychological considerations (e.g., intrinsic versus extrinsic motivation on their engagement and perception of the program) and future directions (e.g., sustainability concerns and the need for tailored strategies for specific demographics).

CONCLUSIONS

While Brain Bootcamp had low completion rates, those who completed the program reported high acceptability. Future refinements, incorporating targeted strategies and enhanced participant support and communication, will facilitate pragmatic initiatives.

CLINICAL TRIAL NUMBER

ACTRN12621000165886.

Adherence to intervention components: The key to success? Analysis on health-related outcomes of the AgeWell.de intervention to preserve cognition

BACKGROUND

The aim of the study was to analyze the impact of adherence to the intervention components on the effectiveness of AgeWell.de, a multi-domain lifestyle intervention against cognitive decline, on function in everyday activities, quality of life, depressiveness and social isolation.

OBJECTIVE

Studying the effect of adherence on health-related outcomes.

METHODS

Participants were aged 60-77 years at baseline and at risk (Cardiovascular Risk Factors, Ageing and Dementia Score (CAIDE) ≥9). Adherence to the components nutrition, enhancement of physical and social activities and cognitive training was analyzed in two ways, first continual within the intervention group (n = 378, mean age = 69.1 years, 52.7% female) and second as dichotomous split (75% adherence) and in reference to the control group (received infomaterial and regular health advice; n = 441, mean age = 69 years, 53% female). Generalized linear regression models were then run on the health outcomes functioning in everyday activities, quality of life, depressive symptoms, and social inclusion.

RESULTS

Health-related quality of life and depressiveness were improved in participants with better adherence to nutritional counselling and enhancement of physical and social activities. Better adherence to social activities was relevant for function in everyday activities. Effects of high adherence to cognitive training was found for improvements in depressiveness when comparing it to the control group. No effect was found on social inclusion when considering the particular components.

CONCLUSIONS

The extent of adherence to most components influenced health-related outcomes such as health-related quality of life and depressiveness. With this study, the effectiveness of AgeWell.de can be understood in greater depth.

TRIAL REGISTRATION

German Clinical Trial Register (DRKS; ID: DRKS00013555).

Evaluating the feasibility of a community-adapted multi-domain intervention for dementia prevention in older adults

BACKGROUND

Dementia impacts individuals, families, and society, necessitating effective prevention strategies.

OBJECTIVE

To evaluate the feasibility of a community-adapted multi-domain intervention for dementia prevention among older adults in Obu City, Japan and how uncertainties in implementing definitive trials can be reduced.

METHODS

A 12-month one-arm intervention trial was conducted with 80 community-dwelling older adults aged 65-86 years from two district regions. The multi-domain intervention included physical exercise, nutrition guidance, cognitive training, social participation, and vascular risk management. The primary outcome was the continuation rate, defined as the proportion of participants attending >60% of classes from the initial assessment to 6 months. Secondary outcomes, such as fidelity, acceptability, and appropriateness, were assessed through qualitative and quantitative evaluations. Additionally, health outcomes, including cognitive function and overall lifestyle, were evaluated.

RESULTS

The study achieved continuation rates of 75% and 76% at 6 and 12 months, respectively, indicating high feasibility. Participants showed high program acceptability (average acceptance score, 4.4 of 5). Fidelity was high regarding content coverage and duration, although the frequency and coverage varied between study sites. Cognitive function remained stable; food-diversity status improved significantly over the study period, though the absence of a control group limits causal interpretation of these changes.

CONCLUSIONS

The community-adapted multi-domain intervention for dementia prevention demonstrated high feasibility and acceptability among older adults. Our findings can help reduce uncertainties and support planning future definitive trials to evaluate the effectiveness of community-based dementia-prevention programs.

A data-driven cluster analysis to explore cognitive reserve and modifiable risk factors in early phases of cognitive decline

The present study was aimed to cluster sub-groups of patients with varying degrees of cognitive impairment (Subjective Cognitive Decline, mild or Major Neurocognitive Disorder) based on their modifiable risk factors and cognitive reserve with k-means analysis. As a secondary analysis, we described the identified clusters from different perspectives, i.e., socio-demographic characteristics, cognitive functioning, and mental health. The analysis revealed two clusters, which were composed by 27 and 43 patients characterized by protective (Cluster 1) and unprotective (Cluster 2) everyday life habits, respectively. The two groups showed significant differences across all examined dimensions, with Cluster 1 demonstrating a more favourable profile compared to Cluster 2. Specifically, Cluster 1 exhibited advantages in: (1) sociodemographic (education, technological skills, and occupation), (2) cognitive (global cognitive functioning, executive functioning, and working memory), and (3) mental health (mood state and quality of life) characteristics. Such a finding is representative of a more positive individual wellbeing for people who adopt protective behaviours. In the field of dementia prevention, these results support the importance to intervene proactively and simultaneously in the management of multiple risk factors during the entire lifespan.

An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial

Effective, scalable dementia prevention interventions are needed to address modifiable risk factors given global burden of dementia and challenges in developing disease-modifying treatments. A single-blind randomized controlled trial assessed an online multidomain lifestyle intervention to prevent cognitive decline over 3 years. Participants were dementia-free community-dwelling Australians aged 55-77 years with modifiable dementia risk factors. Eligible participants (n = 6,104, 64% female) were randomized 1:1 to a personalized schedule of online coaching in two to four modules (targeting physical activity, nutrition, cognitive activity and depression or anxiety) or a control group that received module-eligible information only. At 3 years, the mean change in a global cognitive composite, the primary outcome, was met. The mean changes in z scores were 0.28 (95% confidence interval (CI): 0.25-0.32) for intervention, 0.10 (95% CI: 0.07-0.13) for control and 0.18 (95% CI: 0.13-0.23, P < 0.001) for the between-group difference. Trial-related adverse events occurred in 19 (0.60%) intervention and 1 (0.03%) control participant. Randomization of this internet-delivered lifestyle intervention tailored to individual dementia risk factors resulted in significantly better cognition in older adults over 3 years. This intervention is scalable with the potential for population-level rollout that may delay cognitive decline in the general community. Australian New Zealand ClinicalTrials.gov registration: ACTRN12618000851268.

Efficacy of a group-based 8-week multicomponent cognitive training on cognition, mood and activities of daily living among healthy older adults: A two-year follow-up of a randomized controlled trial

BACKGROUND

Cognitive training (CT) has been one of the important non-pharmaceutical interventions that could delay cognitive decline. Currently, no definite CT methods are available. Furthermore, little attention has been paid to the effect of CT on mood and instrumental activities of daily living (IADL).

OBJECTIVES

To assess the effectiveness of a multicomponent CT using a training program of executive functions, attention, memory and visuospatial functions (TEAM-V Program) on cognition, mood and instrumental ADL.

DESIGN

A randomized, single-blinded, treatment-as-usual controlled trial.

SETTING

Geriatric clinic in Bangkok, Thailand.

PARTICIPANTS

80 nondemented community-dwelling older adults (mean age 65.7 ± 4.3 years).

INTERVENTION

The CT (TEAM-V) Program or the treatment-as-usual controlled group. The TEAM-V intervention was conducted over 5 sessions, with a 2-week interval between each session. A total of 80 participants were randomized (n = 40 the TEAM-V Program; n = 40 the control group).

MEASUREMENTS

The Thai version of Montreal Cognitive Assessment (MoCA), The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Thai version of Hospital Anxiety and Depression Scale (HADS) and The Chula ADL were used to assess at baseline, 6 months, 1 year and 2 years.

RESULTS

Compared with the control arm (n = 36), the TEAM-V Program (n = 39) was associated with significantly improved general cognition (MoCA, P = 0.02) at 2 years. Compared with baseline, participants receiving the TEAM-V Program were associated with significantly improved immediate recall (word recall task, P < 0.001), retrieval and retention of memory processes (word recognition task, P = 0.01) and attention (number cancellation part A, P = 0.01) at 2 years. No training effects on anxiety (P = 0.94), depression (P = 0.093) and IADL (P = 0.48) were detected.

CONCLUSIONS

The TEAM-V Program was effective in improving global cognitive function. Even though, the program did not significantly improve anxiety, depression and IADL compared with the control group, memory and attention improved in the intervention group compared with baseline. Further studies incorporating a larger sample size, longitudinal follow-up and higher-intensity CT should be conducted.

Enhancing dementia prediction: A 19-year validation of the CAIDE risk score with insulin resistance and APOE ε4 integration in a population-based cohort

BACKGROUND

Dementia is a significant cause of disability and dependency. Persons with high dementia risk but intact cognition will benefit from preventive interventions.

OBJECTIVES

The aim was to validate dementia risk score Cardiovascular Risk Factors, Aging and Incidence of Dementia (CAIDE) in a national population-based cohort with data on age, education, hypertension, obesity, hyperlipidemia and physical activity. Secondly, we examined if substituting obesity item with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) would improve predictive value of CAIDE risk score.

DESIGN

Longitudinal, population-based cohort study.

SETTING

General population, Finland PARTICIPANTS: Representative sample of Finnish adult population aged over 30 years from Health 2000 Survey (n = 5,806).

MEASUREMENTS

CAIDE dementia risk score and substituting BMI with HOMA-IR.

RESULTS

Dementia was diagnosed in 571 (9.8 %) participants during the 19 years follow-up. CAIDE risk score predicted dementia well: AUC (area under curve) ROC (receiver-operating characteristic) was 0.78 (95 % CI from 0.76 to 0.79). Secondly, replacing obesity with HOMA-IR in CAIDE risk score generated similar results: ROC AUC 0.78 (95 % CI from 0.76 to 0.80). Adding APOE ε4 status further improved predictive value of risk score: ROC AUC 0.81 (95 % CI from 0.80 to 0.83).

CONCLUSIONS

CAIDE dementia risk score predicts dementia well in a national population-based cohort. Adding APOE ε4 genotype improved predictive value of risk score. Insulin resistance measured by HOMA-IR is comparable to obesity as part of CAIDE risk score. These findings imply that CAIDE risk score is applicable for assessing risk of dementia and highlight importance of modifiable risk factors of dementia.

White matter hyperintensities regress at a high rate at three months after minor ischemic stroke or transient ischemic attack

BACKGROUND

The potential for early white matter hyperintensities(WMH) regression and associated contributory factors remains uncertain. The purpose of this study is to investigate whether WMH regress at early time of three months after minor ischemic stroke (MIS) or transient ischemic attack (TIA), while also identifying factors that may influence this outcome.

METHODS

A retrospective analysis of a prospective subcohort from the CHANCE trial comprising individuals with MIS and TIA was conducted. All patients underwent brain MRI at the onset and at three months. Deep learning algorithms were employed for the automatic segmentation of WMH volumes in four distinct regions. Scores for lacunes, cerebral microbleeds (CMB), perivascular spaces (PVS), WMH, and overall cerebral small vessel disease (CSVD) burden were quantified. Patients were divided into the stable, regression and progression groups according to change in WMH volume. The demographic, clinical, and imaging data of the participants in the three groups were collected and statistically analyzed.

RESULTS

A total of 98 patients with minor ischemic stroke or TIA were included. There were 22 patients in the stable group, 41 patients in the regression group and 35 patients in the progression group. Age and hypertension status were significantly different among the three groups. The lacunes, CMB,WMH, and total CSVD burden scores differed notably among groups, with all the CSVD markers being severely elevated in the progression group, moderately elevated in the regression group, and subtly elevated in the stable group.

CONCLUSION

The findings suggest that WMH could exhibit regression within three months following minor ischemic stroke or TIA. Patients under the age of 65, without a hypertension history, and with a low CSVD burden are more likely to experience WMH regression.

Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer's disease: the need for rigor

We consider the recent publication by Ornish and colleagues and the rigor expected for interventional clinical trials. We contend that lifestyle intervention trials should strive for the same rigor as drug trials and highlight opportunities to improve rigor in this example, particularly in design, data analysis, and publication of results for this and other lifestyle intervention studies.

Costs of Care in Relation to Alzheimer's Disease Severity in Sweden: A National Registry-Based Cohort Study

BACKGROUND

The advancement of diagnostic and therapeutic interventions in early Alzheimer's disease (AD) has demanded the economic evaluation of such interventions. Resource utilization and cost estimates in early AD and, more specifically, the amyloid-positive population are still lacking. We aimed to provide cost estimates in AD in relation to disease severity and compare these with the control population. We also aimed to provide cost estimates for a subset of the AD population with both clinical diagnosis and amyloid-positive confirmation.

MATERIALS AND METHODS

This was a retrospective longitudinal analysis of resource utilization using data from national registries. A cohort from the national Swedish registry for cognitive/dementia disorders (SveDem) includes all clinically diagnosed AD between 2013 and 2020. The study population included 31,951 people with AD and 63,902 age- and sex-matched controls (1:2). The population was followed until death, the end of December 2020, or 2 years from the last clinic visit. Direct medical and social costs were estimated from other national registries. Direct medical costs include costs for medications and inpatient and outpatient clinical visits. Direct social costs include costs for institutionalization, home care, short-term care, support for daytime activities, and housing support. Mean annual costs and 95% confidence intervals were obtained by bootstrapping, presented in 2021 Swedish Krona (SEK) (1 SEK = 0.117 USD, 1 SEK = 0.0985 EUR in 2021), and disaggregated by AD severity, cost component, sex, age group, and care setting.

RESULTS

Mean annual costs for individuals with clinically diagnosed AD were SEK 99,906, SEK 290,972, SEK 479,524, and SEK 795,617 in mild cognitive impairment (MCI), mild, moderate, and severe AD. The mean annual costs for the population with both clinical diagnosis and amyloid-positive AD confirmation (N = 5610) were SEK 57,625, SEK 179,153, SEK 333,095, and SEK 668,073 in MCI, mild, moderate, and severe AD, respectively. The mean annual costs were higher in institutionalized than non-institutionalized patients, females than males, and older than younger age groups. Inpatient and drug costs were similar in all AD severity stages, but outpatient costs decreased with AD severity. Costs for institutionalization, home care, support for daytime activities, and short-term care increased with AD severity, whereas the cost of housing support decreased with AD severity.

CONCLUSIONS

This is the first study estimating annual costs in people with AD from MCI to severe AD, including those for the amyloid-positive population. The study provides cost estimates by AD severity, cost components, care settings, sex, and age groups, allowing health economic modelers to apply the costs based on different model structures and populations.

Brain health is a human right: Implications for policy and research

The call to synergize brain health with mental health has major ramifications for research and policy. Mental health has been recognized as a universal human right, but no such declaration exists for brain health. Here, I defend the right to lifelong brain health as a derived, intermediary, and generative right. It is derived from the right to physical health because it is reducible to facts about the health of the body. This grounds brain health in the right to physical health, a long-standing right with hard legal status, while avoiding "rights inflation." It is intermediary because it bridges the gap between physical and mental health, since the brain is an organ that is central to both physical and mental health. It is generative because it provides impetus to downstream actions including the creation of health-based "neurorights" and bolstering the right to a healthy environment to protect collective cognitive health. Thus, the right to lifelong brain health would guarantee the right of citizens to live and grow in a brain health-promoting environment. A rights-based approach to brain health also has important consequences for research. It would help to move research away from the disease paradigm that focuses on individual risk and responsibility to the study of deeper contributions to brain health and disease through a population neuroscience approach to public brain health. Until the right to brain health is recognized alongside mental health, their synergy will remain incomplete, and brain health promotion will lack unity.

Comparison of 3 Aging Metrics in Dual Declines to Capture All-Cause Dementia and Mortality Risk: Cohort Study

Background

The utility of aging metrics that incorporate cognitive and physical function is not fully understood.

Objective

We aim to compare the predictive capacities of 3 distinct aging metrics-motoric cognitive risk syndrome (MCR), physio-cognitive decline syndrome (PCDS), and cognitive frailty (CF)-for incident dementia and all-cause mortality among community-dwelling older adults.

Methods

We used longitudinal data from waves 10-15 of the Health and Retirement Study. Cox proportional hazards regression analysis was employed to evaluate the effects of MCR, PCDS, and CF on incident all-cause dementia and mortality, controlling for socioeconomic and lifestyle factors, as well as medical comorbidities. Discrimination analysis was conducted to assess and compare the predictive accuracy of the 3 aging metrics.

Results

A total of 2367 older individuals aged 65 years and older, with no baseline prevalence of dementia or disability, were ultimately included. The prevalence rates of MCR, PCDS, and CF were 5.4%, 6.3%, and 1.3%, respectively. Over a decade-long follow-up period, 341 cases of dementia and 573 deaths were recorded. All 3 metrics were predictive of incident all-cause dementia and mortality when adjusting for multiple confounders, with variations in the strength of their associations (incident dementia: MCR odds ratio [OR] 1.90, 95% CI 1.30-2.78; CF 5.06, 95% CI 2.87-8.92; PCDS 3.35, 95% CI 2.44-4.58; mortality: MCR 1.60, 95% CI 1.17-2.19; CF 3.26, 95% CI 1.99-5.33; and PCDS 1.58, 95% CI 1.17-2.13). The C-index indicated that PCDS and MCR had the highest discriminatory accuracy for all-cause dementia and mortality, respectively.

Conclusions

Despite the inherent differences among the aging metrics that integrate cognitive and physical functions, they consistently identified risks of dementia and mortality. This underscores the importance of implementing targeted preventive strategies and intervention programs based on these metrics to enhance the overall quality of life and reduce premature deaths in aging populations.

Prevention and Mitigation of Frailty Syndrome in Institutionalised Older Adults Through Physical Activity: A Systematic Review

Background/Objectives: Frailty syndrome significantly impacts the health and quality of life of institutionalised older adults, increasing the risk of adverse outcomes such as disability and mortality. This systematic review aimed to evaluate the effectiveness of physical activity interventions in preventing and mitigating frailty syndrome among institutionalised older adults and to identify key intervention characteristics influencing their effectiveness. Methods: A systematic search following PRISMA guidelines was conducted in the Web of Science, PubMed, and Cochrane databases to identify randomised controlled trials published from 2001 to June 2024. Studies involving institutionalised adults aged 60 or older, assessing the impact of physical activity interventions on frailty using validated measures, were included. A narrative synthesis approach was employed to analyse the findings due to the heterogeneity of interventions and settings. Results: Twelve randomised controlled trials comprising 1223 participants were included. Multicomponent exercise programmes-combining resistance exercises, balance, and aerobic training-consistently improved frailty indicators, including muscle strength, gait speed, and balance, among others parameters. Frailty reversal occurred in 36% of participants, with interventions showing a reduction in frailty criteria and improved functional autonomy. Programmes integrating physical activity with cognitive or nutritional components demonstrated high efficacy. The control groups showed minimal improvement, highlighting the unique impact of tailored interventions. Despite variability in intervention design, frailty was consistently shown to be reversible in pre-frail and frail individuals, where the benefits were evident including for individuals over 85 years old. Conclusions: Physical activity interventions, particularly multicomponent exercise programmes, are effective in reducing frailty and improving health outcomes in institutionalised older adults. Future research should focus on optimising intervention characteristics and exploring the long-term sustainability of benefits in diverse populations. These findings reinforce the importance of exercise as a cornerstone in frailty management.

A review of the application of exercise intervention on improving cognition in patients with Alzheimer's disease: mechanisms and clinical studies

Alzheimer's disease (AD) is the most common form of dementia, leading to sustained cognitive decline. An increasing number of studies suggest that exercise is an effective strategy to promote the improvement of cognition in AD. Mechanisms of the benefits of exercise intervention on cognitive function may include modulation of vascular factors by affecting cardiovascular risk factors, regulating cardiorespiratory health, and enhancing cerebral blood flow. Exercise also promotes neurogenesis by stimulating neurotrophic factors, affecting neuroplasticity in the brain. Additionally, regular exercise improves the neuropathological characteristics of AD by improving mitochondrial function, and the brain redox status. More and more attention has been paid to the effect of Aβ and tau pathology as well as sleep disorders on cognitive function in persons diagnosed with AD. Besides, there are various forms of exercise intervention in cognitive improvement in patients with AD, including aerobic exercise, resistance exercise, and multi-component exercise. Consequently, the purpose of this review is to summarize the findings of the mechanisms of exercise intervention on cognitive function in patients with AD, and also discuss the application of different exercise interventions in cognitive impairment in AD to provide a theoretical basis and reference for the selection of exercise intervention in cognitive rehabilitation in AD.

Cognitive dysfunction in diabetes - the 'forgotten' diabetes complication: a narrative review

BACKGROUND

In addition to peripheral neuropathy of various kinds, diabetes can also cause central neuropathy, which among other things can manifest itself as premature cognitive dysfunction, often linked to vascular dysfunction. Although the link between diabetes and cognitive dysfunction was discovered more than 100 years ago and has important clinical implications, this diabetes complication remains relatively unknown. Recent years have seen research that has clarified cerebral insulin resistance and defective insulin signaling as examples of pathogenic factors behind this cognitive impairment in diabetes.

METHOD

We provide a narrative review of select and contemporary publications with relevance for the interface between diabetes/prediabetes and cognitive function.

RESULTS

Recently published studies show that physical activity can reverse insulin resistance in the brain as well as cognitive impairment and pathological appetite regulation. Pharmacological interventions with, for example, nasal insulin, GLP-1 receptor agonists, SGLT-2 inhibitors, or PPAR-γ agonists have also shown promising results.

CONCLUSION

Optimization of lifestyle factors (e.g. physical activity), as well as several pharmaceutical agents already in clinical use against diabetes, have shown promising results in improving cognitive function in diabetic patients. An important task for primary health care, where most patients with type 2 diabetes are diagnosed, treated, and followed, is to increase awareness and early detection of cognitive dysfunction in these patients for optimizing risk factor control.

Evaluating the Effectiveness of a Culturally Adapted Dementia Prevention Animation on Ethnically Diverse participants' Knowledge of Dementia Prevention

OBJECTIVES

To determine whether culturally adapted dementia prevention animations increased dementia prevention knowledge in ethnically diverse communities.

METHODS

A before-and after survey conducted online and in-person between 1 February and 5 June 2022. Participants viewed the animation in Arabic, Hindi, Tamil, Cantonese, Mandarin, Greek, Italian, Spanish, Vietnamese or English. Dementia knowledge was measured using two subscales from the dementia risk reduction knowledge instrument (KoDeRR), measuring knowledge of dementia risk factor mitigation strategies and appraisal of dementia risk factors (misconceptions).

RESULTS

Among the 318 respondents there was a significant increase in dementia knowledge in most languages after viewing the animation (ps < 05; except for English). Mean performance on knowledge of dementia risk factor mitigation strategies significantly increased after viewing the animation (p < .001), with a clinically meaningful effect (mean change = 3.63). Appraisal of dementia risk factor misconceptions significantly increased in the Spanish group (mean change = 1.29, p < .001), but significantly decreased in the English group (mean change = -1.09, p < .001).

CONCLUSIONS

Viewing the animation in a language other than English was associated with an increase in KoDeRR scores for both the recognition of mitigation strategies and identification of misconceptions subscales.

CLINICAL IMPLICATIONS

Codesigned, culturally adapted in-language dementia prevention animations improve dementia prevention awareness in ethnically diverse communities.

Internet-Based Dementia Prevention Intervention (DementiaRisk): Protocol for a Randomized Controlled Trial and Knowledge Translation

BACKGROUND

Research has shown that engaging in a range of healthy lifestyles or behavioral factors can help reduce the risk of developing dementia. Improved knowledge of modifiable risk factors for dementia may help engage people to reduce their risk, with beneficial impacts on individual and public health. Moreover, many guidelines emphasize the importance of providing education and web-based resources for dementia prevention. Internet-based interventions may be effective, but few have been studied rigorously or widely disseminated. We created DementiaRisk, an award-winning, web- and email-based education platform for the public focused on modifiable risk factors, featuring multimedia e-learning and email "microlearning" content, to help raise awareness and improve knowledge of actions to reduce dementia risk.

OBJECTIVE

This protocol describes a randomized controlled trial to (1) evaluate whether exposure to DementiaRisk changes knowledge of dementia risk factors, intention to engage in risk reduction activities, and health behaviors related to dementia risk reduction and to (2) explore qualitative aspects including participants' engagement and satisfaction with the intervention and barriers and facilitators to use.

METHODS

Using a sequential explanatory mixed methods design, this study conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. In total, 485 participants will be recruited on the web and randomly assigned to 2 groups: one accessing DementiaRisk and the other receiving alternative e-learning on mild cognitive impairment. Assessments will be delivered on the web at baseline (T1), at 4 weeks (T2), and at 2 months after the intervention (T3). Knowledge will be assessed using items from the Dementia Knowledge Assessment Scale, intentions to engage in risk reduction activities will be assessed using items in line with current evidence, and health behaviors related to dementia risk reduction will be assessed using items from the Godin-Shephard Leisure Time Physical Activity Questionnaire along with additional questions related to a range of health status domains. Outcomes and feasibility will be assessed using the Information Assessment Method for patients and consumers. A linear mixed effects model will be used to examine the relationship between each outcome score by group and time point.

RESULTS

This study was approved by the Hamilton Integrated Research Ethics Board on August 24, 2022 (project ID 14886) and received funding in February 2023. Recruitment took place from March 28, 2023, to April 28, 2023, with the final participants completing the intervention by August 18, 2023. Analyses and interpretation of data are ongoing.

CONCLUSIONS

DementiaRisk is a readily scalable, technology-enhanced solution for dementia prevention education. It has been designed using evidence-based principles of multimedia learning. It has the potential to scale and spread widely using the open internet, so it may be able to reach a wider audience than traditional in-person educational interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05383118; https://clinicaltrials.gov/study/NCT05383118.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64718.

Mediation of modifiable risk factors in two multidomain dementia prevention trials

INTRODUCTION

We explored which dementia risk factors in two multidomain prevention trials mediate beneficial, neutral, or counteracting effects on dementia incidence.

METHODS

We 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.

RESULTS

We 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.

DISCUSSION

In 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.

HIGHLIGHTS

There 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.

Association between apolipoprotein E ε4 status and the risk of Alzheimer's disease: a meta-analysis

BACKGROUND

The apolipoprotein E ε4 (APOE ε4) status has a controversial role in predicting Alzheimer's disease (AD) factors. This meta-analysis assessed AD event risk in patients with APOE ε4 status.

MATERIALS AND METHODS

The relevant English-language articles were identified by searching the Cochrane Library, EMBASE, and PubMed databases. The prognostic significance of APOE ε4 status in AD patients was examined on the basis of pooled hazard ratios (HRs).

RESULTS

A total of 22 studies published after 1987, including 571,800 patients, were included. Consequently, APOE ε4 status was a risk factor for disease-free survival (DFS, HR = 2.033; 95% confidence interval [CI] = 1.589-2.602; P = 0.000; I 2 = 93.1%) in patients with AD. Additionally, subgroup analysis suggested that the ROC curve was the main risk factor among patients with AD.

CONCLUSIONS

AD patients with different events are managed via different methods; however, the present meta-analysis suggests an increased risk of AD events in patients with different APOE ε4 statuses.

Exploring sex differences in Alzheimer's disease: a comprehensive analysis of a large patient cohort from a memory unit

BACKGROUND

Alzheimer's disease (AD) stands as the leading cause of dementia worldwide, and projections estimate over 150 million patients by 2050. AD prevalence is notably higher in women, nearly twice that of men, with discernible sex differences in certain risk factors. To enhance our understanding of how sex influences the characteristics of AD patients and its potential impact on the disease trajectory, we conducted a comprehensive analysis of demographic, clinical, cognitive, and genetic data from a sizable and well-characterized cohort of AD dementia patients at a memory clinic in Barcelona, Spain.

METHODS

The study cohort comprised individuals with probable and possible AD dementia with a Clinical Dementia Rating (CDR) score between 1 and 3 diagnosed at the Memory Unit from Ace Alzheimer Center Barcelona, Spain, between 2008 and 2018. We obtained cognitive baseline data and follow up scores for the Mini-Mental State Examination (MMSE), the CDR scale, and the neuropsychological battery used in our center (NBACE). We employed various statistical techniques to assess the impact of sex on cognitive evolution in these dementia patients, accounting for other sex-related risk factors identified through Machine Learning methods.

RESULTS

The study cohort comprised a total of 6108 individuals diagnosed with AD dementia during the study period (28.4% males and 71.6% females). MMSE scores exhibited an average decline of approximately two units per year, unaffected by sex. Similarly, the decline in most neuropsychological functions assessed by NBACE did not exhibit significant differences between males and females. However, we observed that women diagnosed with mild AD dementia progressed more rapidly based on their CDR score (HR = 2.57, 95%CI:2.33-2.84) than men (HR = 2.03, 95%CI: 1.71-2.41) (p-interaction = 0.01).

CONCLUSIONS

Our findings do not strongly support the notion that sex significantly modifies the clinical progression of AD dementia based on cognitive data. Further research is essential to validate whether women with mild AD dementia indeed progress more rapidly than men at a similar stage and to delve into the potential underlying reasons for this finding.

Development of an Evidence-Based Cognitive Training Application for Elderly Individuals with Cognitive Dysfunction

BACKGROUND

Early cognitive training is important to prevent cognitive decline in patients with mild cognitive impairment (MCI) or dementia. Therefore, developing an application that can provide evidence-based cognitive training is necessary for patients with MCI or dementia.

METHOD

This study aimed to develop and evaluate Smart Brain, an evidence-based application that provides comprehensive cognitive training tailored to this population. The application was developed using an ADDIE (analysis, design, development, implementation, and evaluation) model. A systematic review of databases, including Ovid-MEDLINE, Ovid-EMBASE, Cochrane Library, and CINAHL, was conducted up to April 15, 2021, to identify key content areas. Additionally, a survey of 100 participants highlighted the need for features such as cognitive games, health notes, social networking services, and goal achievement.

RESULT

The application was developed with distinct user and administrator interfaces to support engagement and monitoring. Usability testing involved 7 experts and 11 elderly individuals with MCI or dementia from a daycare center. Based on usability feedback, features such as the time limits for cognitive games were refined. The final application integrates cognitive games, physical exercises, emotional support, and health management tools to address user needs comprehensively.

CONCLUSION

Smart Brain holds significant potential to improve the quality of life and cognitive health of elderly individuals with MCI or dementia. Its usability and functionality make it a promising tool for community-based interventions.

Proof-of-concept for integrating multimodal digital health assessments into lifestyle interventions for older adults with dementia risk factors

Multimodal digital health assessments overcome the limitations of patient-reported outcomes by allowing for continuous and passive monitoring but remain underutilized in older adult lifestyle interventions for brain health. Therefore, we aim to (1) report ecological momentary assessment (EMA) and ActiGraph adherence among older adults during a lifestyle intervention; and (2) use dynamic data collected via EMA and ActiGraph to examine person-specific patterns of mindfulness, steps, and sleep throughout the intervention. We analyzed EMA and ActiGraph data from a pilot study of the 8-week My Healthy Brain program (N = 10) lifestyle group for older adults (60+) with subjective cognitive decline. EMA adherence metrics included proportion of EMA completed and the proportion of days with at least 10 mindfulness minutes. ActiGraph GT9X adherence metrics included the number of valid wear days (≥ 7 h) and the number of days participants achieved their step goal. We used linear mixed-effects models to examine person-specific patterns of step count, sleep efficiency, and mindfulness practice. On average, participants completed 39 of the 49 possible EMAs (80%) during the program. ActiGraph adherence was slightly higher than EMA (M = 61.40 days, 87.71%). Participants achieved the daily mindfulness goal (10 min/day) and step goal on 46.32% and 55.10% of days, respectively. Dynamic data revealed that on average, participant step counts increased by approximately 16.5 steps per day (b = 16.495, p = 0.002). However, some participants exhibited no changes while improvements made by other participants returned to baseline levels of activity. There was substantial heterogeneity in trajectories of mindfulness practice and sleep efficiency. EMA and ActiGraph are feasible for older adults enrolled in dementia risk reduction lifestyle interventions. Future studies are needed to better understand how mechanisms of lifestyle behaviors captured by EMA and ActiGraph are related to cognitive outcomes in older adults.

A mobile-based multidomain lifestyle intervention using Cognitive Evergreenland for older adults with subjective cognitive decline: a feasibility study

BACKGROUND

Dementia is a growing public health issue. Non-drug interventions targeting individuals before the onset of overt cognitive decline may be effective. Subjective cognitive decline (SCD) is present in > 50% of older adults and associated with progression to dementia. Here, we tested the compliance and effectiveness of a Multidomain Lifestyle Intervention Program using the mini-program, Cognitive Evergreenland, (MLIP-CE), based on the Health Action Process Approach model to support home-based intervention in older adults with SCD.

METHODS

Cognitive Evergreenland was designed to improve cognitive reserve and maintain brain function in people at high risk of dementia and included: cognitive stimulation, cognitive training, health education, vascular risk monitoring, social support, and functional assessment, among other features. This was an exploratory trial designed to examine participant compliance with the mobile lifestyle intervention and its effectiveness, as well as changes in health-related indicators and cognitive function of older adults with SCD from baseline to 12 and 24 weeks post-intervention.

RESULTS

The retention rate for MLIP-CE was 90.2% (37/41). Mean participant age was 70.93 ± 6.91 years, 73.2% of participants were female, and mean Montreal Cognitive Assessment score was 24.51 ± 2.87. Throughout the 24 weeks of the prescribed intervention, app usage remained consistently high, with over 92% of participants using the mini-program at least once a week and successfully completing corresponding health management tasks. In terms of average usage, cognitive training emerged as the most frequently used functional module (95.73%), closely followed by health education (95.02%). The health behavior levels of older adults with SCD, measured in terms of ability, opportunity, and motivation, were significantly increased relative to baseline (p < 0.001). Regarding cognitive function, Mini-Mental State Examination scores were significantly improved post-intervention, with a moderate effect size (Hedges' g = 0.60).

CONCLUSIONS

These findings suggest that MLIP-CE, which was designed based on a theoretical framework, has potential for implementation, and support ongoing research into use of MLIP-CE for individuals at high risk of SCD or other dementia conditions.

TRIAL REGISTRATION

The trial was prospectively registered at the Chinese Clinical Trials Registry with the registration number ChiCTR2200058665 on 13 April 2022.

Motivation, barriers and preferences of lifestyle changes among older adults with frailty and mild cognitive impairments: A scoping review of qualitative analysis

Lifestyle intervention has proven effective in managing older adults' frailty and mild cognitive impairment issues. What remains unclear is how best to encourage lifestyle changes among older adults with frailty and Mild Cognitive Impairment (MCI). We conducted searches in electronic literature searches such as PubMed, Scopus, Cochrane Reviews, ProQuest, and grey resources to find articles published in English between January 2010 and October 2023. This review focused on research using a qualitative study design. We extracted data on publication year, location, the aim of the study, study population, involved intervention, barriers, motivations, and preferences reported in the articles. Out of 5226 retrieved, 253 articles were selected after the deletion of duplicates, title, abstract screening, and. We included fourteen articles for final analysis at the end of the review process. The two main themes generated from this review are intrinsic and extrinsic factors in motivations and barriers to lifestyle changes. The most reported motivators were the perceived benefits of lifestyle intervention and self-efficacy. Among the obstacles participants face are perceived adverse effects of intervention, lack of knowledge, existing impairment (physical or mental), and social support. Lifestyle change motivations and barriers among older adults mainly were intrinsic factors such as the perceived benefit of the intervention, self-efficacy, knowledge, familial commitment, and existing impairments. There is a need to empower older adults to overcome the barriers with support from healthcare professionals, the community, and the family.

Searching for responders to multidomain dementia prevention in late life: A pooled analysis of individual participant data from the MAPT and preDIVA trials

INTRODUCTION

It is unknown in which, if any, subgroups of older adults multidomain interventions are effective at reducing long-term dementia incidence.

METHODS

We pooled up to 12 years of follow-up data from 5205 participants aged > 70 from the Multidomain Alzheimer Preventive Trial (MAPT) and Prevention of Dementia by Intensive Vascular Care (preDIVA) studies. The primary outcome was incident all-cause dementia. Pre-specified subgroups were defined by dementia risk factors (age, sex, education, apolipoprotein E [APOE] genotype, cognitive status, and cardiovascular risk factors).

RESULTS

Four hundred eighty-six participants developed dementia during 37,782 person-years of follow-up. Higher incidence was associated with baseline age, APOE ε4 genotype, physical inactivity, Mini-Mental State Examination, and blood pressure. Multidomain intervention had no effect on incident dementia overall (hazard ratio = 0.98, 95% confidence interval 0.80-1.21), or in any pre-specified subgroup. A recursive partitioning algorithm also did not detect any subgroups, defined by single or multiple risk factors, showing a differential intervention effect.

DISCUSSION

We did not identify any subgroups of older adults in whom multidomain interventions significantly reduced incident dementia.

CLINICAL TRIAL REGISTRATION

MAPT: NCT00672685 (clinicaltrials.gov); PreDIVA: ISRCTN29711771 (ISRCTN registry) HIGHLIGHTS: We pooled up to 12 years of follow-up data from two multidomain prevention trials. Five thousand two hundred five participants aged ≥ 70 were included. Subgroups were pre-defined by modifiable and non-modifiable dementia risk factors. A data-driven recursive partitioning algorithm was also used. Multidomain intervention did not lower incident dementia overall or in any subgroup.

Association between inflammatory biomarkers and the cognitive response to a multidomain intervention: secondary longitudinal analyses from the MAPT study

The aim of this study is to evaluate the association of systemic inflammation measured by plasma biomarkers with the change in cognitive function among participants from the Multidomain Alzheimer Preventive Trial (MAPT) exposed to the multidomain intervention (MI). Secondary analysis of the MAPT longitudinal data. MAPT is a randomized, placebo-controlled trial with 3 interventional groups (omega-3 only, MI only, omega-3 plus MI) and a control group. We tested the association of the change in cognitive function with inflammatory biomarkers (tumoral necrosis factor receptor-1 (TNFR1), monocyte chemoattractant protein-1 (MCP1), Growth Differentiation Factor-15 (GDF15), Interleukin-6 (IL6) and C reactive protein (CRP)) using mixed-effects models. A subgroup analysis was performed in those exposed to the MI. The response to the MI was defined as the change in the composite cognitive score over the 2-year clinical follow-up period. by modeling the response to the intervention and identifying "good responders", i.e., those in the 5th quintile of response at the end of the intervention period (2 years after the measurement of inflammatory markers). We included 1,527 participants (mean age 75.3, SD = 4.4; 64% female). Higher levels of GDF15 and TNFR1 were associated with a worse trajectory in the cognitive composite score in adjusted models. "Good responders" had an estimated mean change in the composite score of 0.051 (SD 0.062) over two years of intervention, compared to -0.136 (SD = 0.111) for the "not-good responders". Higher IL6 levels were associated with a decreased likelihood of being a "good responder" (OR = 0.22, p = 0.018, 95% CI 0.06; 0.78), with similar results for CRP (OR = 0.48, p = 0.009, 95% CI 0.28; 0.84). Higher inflammation was associated with a worse cognitive trajectory among nondemented participants and a lower likelihood of being classified as a "good responder" in those receiving a MI. Further confirmation of these findings could lead to the use of systemic inflammation as inclusion or stratification criteria in prevention trials.

Complex interactions and composite burden of risk factors in vascular cognitive impairment

Vascular cognitive impairment (VCI) stresses the vascular contributions to cognitive decline, ranging from mild to major forms. Except for symptomatic treatment for relevant vascular diseases, the other recommended strategy is to intervene in key vascular risk factors (VRFs) as early as possible. A considerable amount of previous research delineated the association of a specific factor with dementia, involving each risk factor discussed in the present review. However, due to the heterogeneity and complexity of VCI, managing a single factor is insufficient to reduce its incidence and prevalence. Ongoing studies suggest differences in the impact of various combinations of risk factors on dementia. Here in this review, we aimed to provide an updated overview of clinical evidence and implications of complex interactions among various risk factors of VCI, including common VRFs and modifiable dementia-related risk factors. Understating the effect of comorbid risk factors on VCI and underlying mechanisms of them during VCI progression is essential for identifying high-risk population and developing preventive strategies. Furthermore, we summarized common composite risk scores and models used for risk evaluation and prediction of VCI, involving conventional risk scores, subclinical vascular composites, and novel risk models driven by intelligent algorithms. Lastly, we discussed potential gaps and research directions on searching specific clinical risk profiles, constructing effective risk scores, and implementing targeted risk interventions.

Accelerated aging as a mediator of the association between co-exposure to multiple air pollutants and risk of chronic kidney disease

BACKGROUND

The association between co-exposure to multiple air pollutants and the occurrence of chronic kidney disease (CKD) was not well-established, and the mediating role of accelerated aging in this association remained uncertain.

METHODS

Using a cohort of 313,908 participants without CKD at baseline from the UK Biobank, we examined the potential association between co-exposure to multiple air pollutants, including PM2.5, PM10, PM2.5-10, NO2 and NOx, and the incidence of CKD by calculating an air pollution score. Mediation analyses were performed to examine the mediating role of accelerated aging (PhenoAgeAccel or KDM-BioAgeAccel) in this association.

RESULTS

During the median follow-up time of 12.9 years, 11,117 participants developed CKD. The results showed that per interquartile range (IQR) increment in air pollution score led to an approximately 9.0 % (6.6-11.4 %) elevated risk of occurring CKD. Compared to the first quartile (Q1) of air pollution score, those in the highest quartile (Q4) had a 21.2 % (14.8-27.9 %) higher risk of developing CKD (Ptrend<0.001). Mediation analyses suggested that PhenoAgeAccel and KDM-BioAgeAccel significantly mediated 1.5 % and 5.7 % of the association between air pollution score and incident CKD, respectively.

CONCLUSION

Co-exposure to multiple air pollutants could increase the risk of developing CKD, with accelerated aging serving as a partial mechanism in the relationship between air pollution and CKD. These findings highlight the importance of reducing air pollution, and suggest a possible mechanism from air pollution to CKD through accelerated aging.

Lifetime risk and projected burden of dementia

Understanding the lifetime risk of dementia can inform public health planning and improve patient engagement in prevention. Using data from a community-based, prospective cohort study (n = 15,043; 26.9% Black race, 55.1% women and 30.8% with at least one apolipoprotein E4 (APOE ε4) allele), we estimated the lifetime risk of dementia (from age 55 years to 95 years), with mortality treated as a competing event. We applied lifetime risk estimates to US Census projections to evaluate the annual number of incident dementia cases from 2020 to 2060. The lifetime risk of dementia after age 55 years was 42% (95% confidence interval: 41-43). Rates were substantially higher in women, Black adults and APOE ε4 carriers, with lifetime risks ranging from approximately 45% to 60% in these populations. The number of US adults who will develop dementia each year was projected to increase from approximately 514,000 in 2020 to approximately 1 million in 2060. The relative growth in new dementia cases was especially pronounced for Black adults. These results highlight the urgent need for policies that enhance healthy aging, with a focus on health equity.

Time to consider health services dedicated for adults living with cerebral small vessel disease: Report of a ESO scientific seminar

PURPOSE

Cerebral small vessel disease (cSVD) is a highly prevalent disorder leading to physical, cognitive and functional decline. We report key barriers in the management of individuals with cSVD, the potential benefit of cSVD-dedicated health services, and evidence from existing models of care for adults with cSVD.

METHODS

We examined information from a scientific seminar developed between seven experts in cSVD during the eighth European Stroke Organisation Conference that discussed the optimal health care for adults with cSVD and what health services dedicated to cSVD should include.

FINDINGS

Barriers in cSVD care include unrecognised symptoms and modifiable risk factors, heterogeneity of clinical presentations, inefficient inter/intra-clinical services communication/organisation, and uncertainties regarding what assessments/treatments should be routinely done, when and by whom. However, existing health services and research studies suggest models of care in cSVD. Multi-step approaches can be used for identification and aetiological workup in individuals with cSVD, including basic and selected advanced evaluations, for example, monogenic cSVD testing. Although current guidelines for management of cSVD illlustrate limitations, there are recommendations on risk factors and lifestyle considerations, as well as pharmacological and non-pharmacological interventions for people with cSVD.

DISCUSSION AND CONCLUSION

Existing healthcare models do not provide optimal care for individuals with cSVD. Lack of awareness of heterogeneous clinical presentations and uncertainty in threshold of cSVD 'burden' for referral to specialist multidisciplinary services, are key challenges for health services to overcome. Creating cSVD-dedicated services may prevent underdiagnosing and achieve standardised holistic management to improve outcomes in people with cSVD. However, adequate prevention and early management should be offered at all levels of care.

The health and economic burden of brain disorders: Consequences for investment in diagnosis, treatment, prevention and R&D

Brain disorders are prevalent across all age groups but particularly in the elderly, highlighting the importance of preserving brain health in ageing populations. There have been few previous studies to address the complete scope of burden of brain disorders, including direct and indirect costs as well as intangible costs from morbidity and mortality. We seek to illustrate the full health and economic impact of brain disorders by leveraging data from previous large-scale epidemiological and health economic studies to estimate the total direct, indirect and intangible cost of brain disorders in 2019. Two alternative methods were used to estimate indirect costs: the human capital (HC) method (data from the CBDE2010 study), and the willingness-to-pay (WTP) per DALY method (data from GBD2019). Less than 10% of the costs of Alzheimer's disease (AD) and other dementias are incurred by the health care system, while Alzheimer's disease and other dementias is the costliest condition using the HC approach and stroke is the costliest condition due to the large number of life-years lost, followed by AD using the WTP approach. Using per-capita GDP as a proxy for WTP, the indirect costs were nearly four times higher compared to the conventional HC approach. We found that Indirect costs of brain disorders outweigh the direct costs for diagnosis, treatment and care even in high-income countries with advanced, universally accessible systems in Europe. There is likely underinvestment in R&D for brain disorders, and health care systems may lack sufficient incentives to invest in their treatment and prevention.

Consuming a modified Mediterranean ketogenic diet reverses the peripheral lipid signature of Alzheimer's disease in humans

BACKGROUND

Alzheimer's disease (AD) is a major neurodegenerative disorder with significant environmental factors, including diet and lifestyle, influencing its onset and progression. Although previous studies have suggested that certain diets may reduce the incidence of AD, the underlying mechanisms remain unclear.

METHOD

In this post-hoc analysis of a randomized crossover study of 20 elderly adults, we investigated the effects of a modified Mediterranean ketogenic diet (MMKD) on the plasma lipidome in the context of AD biomarkers, analyzing 784 lipid species across 47 classes using a targeted lipidomics platform.

RESULTS

Here we identified substantial changes in response to MMKD intervention, aside from metabolic changes associated with a ketogenic diet, we identified a a global elevation across all plasmanyl and plasmenyl ether lipid species, with many changes linked to clinical and biochemical markers of AD. We further validated our findings by leveraging our prior clinical studies into lipid related changeswith AD (n = 1912), and found that the lipidomic signature with MMKD was inversely associated with the lipidomic signature of prevalent and incident AD.

CONCLUSIONS

Intervention with a MMKD was able to alter the plasma lipidome in ways that contrast with AD-associated patterns. Given its low risk and cost, MMKD could be a promising approach for prevention or early symptomatic treatment of AD.

Threshold effects of sleep duration and cognitive function in older adults with BMI ≥ 25 kg/m2

Background

It has been demonstrated that older adults' cognitive capacities can be improved with sleep duration. However, the relationship between overweight, obesity, and cognitive decline remains a subject of debate. The impact of sleep duration on cognitive performance in seniors with a body mass index (BMI) ≥ 25 kg/m2 is largely unknown. This makes it an intriguing subject to explore further.

Methods

This study used data from the National Health and Nutrition Examination Survey (NHANES) (2011-2014) with 2,243 participants. Weighted multivariate linear regression and smooth curve fitting were employed to investigate linear and non-linear relationships. A two-part linear regression model was used to determine the threshold effects. Additionally, subgroup analysis and interaction tests were conducted.

Results

Results showed that a negative association was found between sleep duration and scores in the fully adjusted model in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, the Animal Fluency test (AFT), and the Digit Symbol Substitution test (DSST). A two-piecewise linear regression model was then applied to explore the threshold effect of sleep duration on cognitive performance. When sleep duration was less than 5 and 6 h per day, sleep duration was positively correlated with CERAD test scores [ß (95% CI): 2.11 (1.17, 3.05), p < 0.0001], AFT scores [β (95% CI): 0.25 (-0.17, 0.67), p = 0.2376], and DSST scores [ß (95% CI): 0.49 (-0.57, 1.56), p = 0.3654]. However, there was a threshold effect where sleep duration reached the three inflection points.

Conclusion

In overweight and obese older adults, there is a clear inverted U-shaped relationship between sleep duration and cognitive function, with consistent results across different subgroups. Sleep durations of around 5-6 h may help prevent cognitive decline in older adults with a BMI ≥ 25 kg/m2.

A qualitative study on the impact and participation in the AGELESS multidomain intervention: Insights from older adults with cognitive frailty and their caregivers

BACKGROUND

Cognitive frailty (CF) is a major precursor to dementia, and multidomain interventions have the potential to delay, prevent or reverse its early onset. However, the successful translation and sustainability of such interventions in real-life settings remain uncertain. In this study, we aimed to explore the insights of older adults with CF and their caregivers regarding the impact and participation in the AGELESS multidomain intervention.

METHODS

This qualitative study was conducted following the completion of AGELESS multidomain intervention. Semi-structured interviews covering domains such as perceptions, benefits, barriers, facilitators, and program preferences were conducted among 17 older adults with CF and 10 caregivers following the completion of the intervention. The data obtained were transcribed verbatim and analyzed using thematic analysis. Each transcript was reviewed and coded to identify prevailing themes derived from the interview data.

RESULTS

The analysis revealed five distinct themes: (1) impact of the program, (2) facilitators enhancing participation, (3) barriers hindering participation, (4) suggestions for improving participation and (5) challenges to adopt digital platforms. Based on the findings, the AGELESS multidomain intervention had a positive impact on the participants and their caregivers. It was noted that they showed preference for in-person sessions over virtual ones. The study highlighted key factors critical for successful participation, including diversity and inclusivity. It emphasized incorporating a multi-component, group-based approach with social aspects. The intervention should be people-centered, dignified, affordable, and customized to meet the unique needs of each participant.

CONCLUSIONS

The AGELESS multidomain intervention was well received by older adults with CF and their caregivers who participated in this study. Moving forward, it is recommended that future initiatives focus on identifying opportunities to implement existing evidence-based programs on a larger scale for the prevention of dementia in older adults.

The Beneficial Effects of Lactobacillus Strains on Gut Microbiome in Alzheimer's Disease: A Systematic Review

BACKGROUND/OBJECTIVES

Growing evidence suggests that the gut-brain axis influences brain function, particularly the role of intestinal microbiota in modulating cognitive processes. Probiotics may alter brain function and behavior by modulating gut microbiota, with implications for neurodegenerative diseases like Alzheimer's disease (AD). The purpose of this review is to systematically review the current literature exploring the effects of probiotic supplementation on gut microbiota and cognitive function in AD and mild cognitive impairment (MCI).

METHODS

A comprehensive literature search was conducted across PubMed/Medline, Embase, and Scopus to identify relevant randomized controlled trials (RCTs) from inception to 20 August 2024. The search focused on comparing outcomes between intervention and control/placebo groups. Data searches, article selection, data extraction, and risk of bias assessment were performed in accordance with Cochrane guidelines.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no: CRD42023446796.

RESULTS

Data from four RCTs involving 293 Individuals (AD and MCI patients) receiving mainly Lactobacillus and Bifidobacterium strains showed some beneficial effects on cognitive function, altered gut microbiota composition, and positively affected metabolic biomarkers. However, variability in microbiota assessment across studies limits the interpretation of results. The limited number and quality of the existing studies make it difficult to draw definitive conclusions from the data. Additional high-quality research is clearly needed.

CONCLUSIONS

Probiotics show promise as an adjunctive intervention for cognitive decline, but larger, long-term trials are needed to confirm their efficacy and clinical applicability in neurodegenerative diseases like AD.

Flavonoids and Alzheimer's disease: reviewing the evidence for neuroprotective potential

Neurodegeneration, which manifests as several chronic and incurable diseases, is an age-related condition that affects the central nervous system (CNS) and poses a significant threat to the public's health for the elderly. Recent decades have experienced an alarming increase in the incidence of neurodegenerative disorders (NDDs), a severe public health issue due to the ongoing development of people living in modern civilizations. Alzheimer's disease (AD) is a leading trigger of age-related dementia. Currently, there are no efficient therapeutics to delay, stop, or reverse the disease's course development. Several studies found that dietary bioactive phytochemicals, primarily flavonoids, influence the pathophysiological processes underlying AD. Flavonoids work well as a supplement to manufactured therapies for NDDs. Flavonoids are effective in complementing synthetic approaches to treat NDDs. They are biologically active phytochemicals with promising pharmacological activities, for instance, antiviral, anti-allergic, antiplatelet, anti-inflammatory, antitumor, anti-apoptotic, and antioxidant effects. The production of nitric oxide (NO), tumor necrosis factor (TNF-α), and oxidative stress (OS) are downregulated by flavonoids, which slow the course of AD. Hence, this research turned from preclinical evidence to feasible clinical applications to develop newer therapeutics, focusing on the therapeutic potential of flavonoids against AD.

Role of nurse practitioners in comprehensive Alzheimer's disease care: Barriers and opportunities for timely diagnosis

Alzheimer's disease (AD) is a progressive neurodegenerative disease. Treatments include disease-modifying therapies (DMTs), which studies showed are most effective when initiated during the early disease stages. Timely AD diagnosis is therefore important, as DMTs can potentially extend an acceptable quality of life for people with this condition. This scoping review presents the current role of nurse practitioners (NPs) in AD care and describe the current and potential future role NPs can play in timely AD diagnosis and management. A systematic search of the PubMed and CINAHL databases identified 15 relevant articles. The literature review revealed that NPs play an active role in the initial assessment of cognitive disorders; however, there is a lack of evidence for NPs acting autonomously to diagnose and treat AD. Several opportunities to increase the autonomous role of NPs are described, which could reduce barriers to timely AD diagnosis and management.

Cost-effectiveness of a multicomponent intervention against cognitive decline

INTRODUCTION

The societal costs of dementia and cognitive decline are substantial and likely to increase during the next decades due to the increasing number of people in older age groups. The aim of this multicenter cluster-randomized controlled trial was to assess the cost-effectiveness of a multi-domain intervention to prevent cognitive decline in older people who are at risk for dementia.

METHODS

We used data from a multi-centric, two-armed, cluster-randomized controlled trial (AgeWell.de trial, ID: DRKS00013555). Eligible participants with increased dementia risk at baseline (Cardiovascular Risk Factors, Aging, and Incidence of Dementia/CAIDE Dementia Risk Score ≥ 9), 60-77 years of age, were recruited by their general practitioners, and assigned randomly to a multi-domain lifestyle intervention or general health advice. We performed a cost-effectiveness analysis from the societal perspective. The time horizon was 2 years. Health care utilization was measured using the "Questionnaire for Health-Related Resource Use in Older Populations." As effect measure, we used quality-adjusted life-years (QALYs) based on the 5-level EQ-5D version (EQ-5D-5L). We calculated the incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves (CEAC) using the net-benefit approach. Exploratory analyses considering women and the EQ visual analogue scale (EQ VAS) were conducted.

RESULTS

Data were available for 819 participants (mean age 69.0 [standard deviation (SD)5-level EQ-5D version 4.9]); 378 were treated in the intervention group and 441 in the control group. The participants in the intervention group caused higher costs (+€445.88 [SD: €1,244.52]) and gained additional effects (+0.026 QALY [SD: 0.020]) compared to the participants in the control group (the difference was statistically significant). The ICER was €17,149.23/QALY. The CEAC showed that the probability of the intervention being cost-effective was moderate, reaching 59% at a willingness-to-pay (WTP) of €50,000/QALY. The exploratory analyses showed promising results, especially in the female subsample.

DISCUSSION

Considering aspects like the WTP and the limited time horizon, the multi-domain intervention was cost-effective compared to general health advice.

Highlights

The first German randomized controlled trial (RCT) evaluating a multicomponent approach against cognitive decline.We found a favorable incremental cost-effectiveness ratio.The probability of cost-effectiveness reached 78.6%.Women could be an important target group.A longer time horizon is needed.

KaiXinSan improves learning and memory impairment by regulating cholesterol homeostasis in mice overloaded with 27-OHC

Cholesterol and its oxidative products-oxysterols homeostasis- play a crucial role in maintaining cognitive function. Chinese medicine KaiXinSan (KXS) has demonstrated effectiveness in treating mental illness and regulating cognitive dysfunction of Alzheimer's disease (AD). The purpose of this article is to explore whether the KXS can enhance cognitive function by regulating cholesterol homeostasis. Employing the 27-hydroxy cholesterol (27-OHC) induced mice model of cognitive dysfunction and coculture model of assessment neurocyte damage, we investigated learning and memory abilities while concurrently addressing the reduction of neuronal cell damage through the regulation of cholesterol metabolism. 21 days of KXS treatment improved the learning and memory ability in mice 27-OHC-overloading by alleviating the exacerbated deposition of amyloid-β (Aβ), reducing inflammatory reactions, and mitigating synaptic plasticity damage. Additionally, it repaired myelin sheath function. More importantly, KXS significantly affects the metabolism of central cholesterol by substantially inhibiting the expression of liver X receptor (LXR), ATP-binding cassette transporter (ABCA1, ABCG1), apolipoprotein E (ApoE) and upregulated cytochrome P450 46A1(CYP46A1). Furthermore, KXS may alleviate 27-OHC-induced neuronal inflammation and apoptosis by promoting the conversion of cholesterol to 24-hydroxycholesterol (24-OHC) via CYP46A1 and suppressing cholesterol release from astrocyte cells. Altogether, our results demonstrate that KXS can prevent learning and memory impairments induced by 27-OHC loading. This effect may be related to its multitarget capability in promoting the conversion of excessive cholesterol to 24-OHC and maintaining a balance in cholesterol homeostasis and metabolism between neurons and astrocyte cells.

Slowing Cognitive Decline in Major Depressive Disorder and Mild Cognitive Impairment: A Randomized Clinical Trial

Importance

Older adults with major depressive disorder (MDD) or mild cognitive impairment (MCI) are at high risk for cognitive decline.

Objective

To assess the efficacy of cognitive remediation (CR) plus transcranial direct current stimulation (tDCS) targeting the prefrontal cortex in slowing cognitive decline, acutely improving cognition, and reducing progression to MCI or dementia in older adults with remitted MDD (rMDD), MCI, or both.

Design, Setting, and Participants

This randomized clinical trial was conducted at 5 academic hospitals in Toronto, Ontario, Canada. Participants were older adults who had rMDD (with or without MCI, age ≥65 y) or MCI without rMDD (age ≥60 y). Assessments were made at baseline, month 2, and yearly from baseline for 3 to 7 years.

Interventions

CR plus tDCS (hereafter, active) or sham plus sham 5 days a week for 8 weeks followed by twice-a-year 5-day boosters and daily at-home CR or sham CR.

Main Outcomes and Measures

The primary outcome was change in global composite cognitive score. Secondary outcomes included changes in 6 cognitive domains, moderating effect of the diagnosis, moderating effect of APOE ε4 status, change in composite score at month 2, and progression to MCI or dementia over time.

Results

Of 486 older adults who provided consent, 375 (with rMDD, MCI, or both) received at least 1 intervention session (mean [SD] age, 72.2 [6.4] years; 232 women [62%] and 143 men [38%]). Over a median follow-up of 48.3 months (range, 2.1-85.9), CR and tDCS slowed cognitive decline in older adults with rMDD or MCI (adjusted z score difference [active - sham] at month 60, 0.21; 95% CI, 0.07 to 0.35; likelihood ratio test [LRT] P = .006). In the preplanned primary analysis, CR and tDCS did not improve cognition acutely (adjusted z score difference [active - sham] at month 2, 0.06, 95% CI, -0.006 to 0.12). Similarly, the effect of CR and tDCS on delaying progression from normal cognition to MCI or MCI to dementia was weak and not significant (hazard ratio, 0.66; 95% CI, 0.40 to 1.08; P = .10). Preplanned analyses showed treatment effects for executive function (LRT P = .04) and verbal memory (LRT P = .02) and interactions with diagnosis (P = .01) and APOE ε4 (P < .001) demonstrating a larger effect among those with rMDD and in noncarriers of APOE ε4.

Conclusions and Relevance

The study showed that CR and tDCS, both targeting the prefrontal cortex, is efficacious in slowing cognitive decline in older adults at risk of cognitive decline, particularly those with rMDD (with or without MCI) and in those at low genetic risk for Alzheimer disease.

Trial Registration

ClinicalTrials.gov Identifier: NCT02386670.

Dementia health matters: Influence of literacy, fears, and endorsements on dementia risk mitigation and screening among community-dwelling older adults

BACKGROUND

Up to one-third of dementia cases may be preventable, with evidence suggesting that modifying lifestyle and health behaviors can significantly lower the risk of developing dementia. However, motivating older adults to adopt and sustain these changes poses a considerable challenge, particularly when facing the specter of dementia.

AIM

To explore the interaction effect between dementia fear and dementia literacy on the perceived ability of community-dwelling older adults to reduce dementia risk and engage in dementia screening.

METHOD

A cross-sectional study involving 1,067 community-dwelling older adults was conducted from August 2022 to December 2023. Participants completed surveys assessing their dementia literacy, personal dementia fear, motivation to change lifestyle and health behaviors, and willingness to engage in investigational screening for memory in primary care.

FINDINGS

Personal dementia fear exhibited significant positive correlations with motivation to change lifestyle and health behavior (r = 0.621, p < 0.001) and investigational screening for memory in primary care (r = 0.559, p < 0.001), indicating that higher levels of fear are associated with increased motivation. Second, dementia literacy demonstrated positive correlations with motivation to change lifestyle and health behavior (r = 0.349, p < 0.001) and investigational screening (r = 0.269, p < 0.001), suggesting that more excellent knowledge enhances perceived ability. Lastly, both dementia literacy and personal dementia fear were positively correlated with motivation to change health behaviors, with respective effects of β = 0.266 and β = 0.595, highlighting their interactive role in shaping perceptions of risk reduction and screening.

IMPLICATION

The significant contributions of dementia literacy, personal dementia fear, and their interaction highlight the importance of these factors in accepting investigational screening for memory in primary care.

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational aspect of geroscience. Thus, PA serves both as preventive medicine and therapeutic agent in pathological states. Sub-optimal PA levels correlate with increased disease prevalence in aging populations. Structured exercise prescriptions should therefore be customized and monitored like any other medical treatment, considering the dose-response relationships and specific adaptations necessary for intended outcomes. Current guidelines recommend a multifaceted exercise regimen that includes aerobic, resistance, balance, and flexibility training through structured and incidental (integrated lifestyle) activities. Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Particularly important are anabolic exercises, such as Progressive resistance training (PRT), which are indispensable for maintaining or improving functional capacity in older adults, particularly those with frailty, sarcopenia or osteoporosis, or those hospitalized or in residential aged care. Multicomponent exercise interventions that include cognitive tasks significantly enhance the hallmarks of frailty (low body mass, strength, mobility, PA level, and energy) and cognitive function, thus preventing falls and optimizing functional capacity during aging. Importantly, PA/exercise displays dose-response characteristics and varies between individuals, necessitating personalized modalities tailored to specific medical conditions. Precision in exercise prescriptions remains a significant area of further research, given the global impact of aging and broad effects of PA. Economic analyses underscore the cost benefits of exercise programs, justifying broader integration into health care for older adults. However, despite these benefits, exercise is far from fully integrated into medical practice for older people. Many healthcare professionals, including geriatricians, need more training to incorporate exercise directly into patient care, whether in settings including hospitals, outpatient clinics, or residential care. Education about the use of exercise as isolated or adjunctive treatment for geriatric syndromes and chronic diseases would do much to ease the problems of polypharmacy and widespread prescription of potentially inappropriate medications. This intersection of prescriptive practices and PA/exercise offers a promising approach to enhance the well-being of older adults. An integrated strategy that combines exercise prescriptions with pharmacotherapy would optimize the vitality and functional independence of older people whilst minimizing adverse drug reactions. This consensus provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults. Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided. The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine as it applies to exercise and geroscience, given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts. Overall, this consensus provides a foundation for applying and extending the current knowledge base of exercise as medicine for an aging population to optimize health span and quality of life.

Systematic evaluation and meta-analysis of the effects of major dietary patterns on cognitive function in healthy adults

PURPOSE

Evidence shows diet promotes brain health. Combining foods and nutrients may have beneficial synergistic effects, but the effects on cognitive function interventions are inconsistent. So, a meta-analysis of RCTs was conducted to examine the specific effects on cognitive function.

METHODS

We searched four databases from creation to April 2023. Eligible randomized controlled trials were identified. A random-effects meta-analysis was used to combine standardized mean differences (SMD) (95% confidence intervals [CI]), and homogeneity tests for a variance were calculated.

RESULTS

A total of 19 studies involving 12,119 participants were included in this systematic review. The dietary intervention group had a positive effect on overall cognitive functioning compared to the control group (SMD = 0.14, 95% CI [0.08, 0.20], P < 0.00001). The dietary intervention improved executive function, processing speed and language skills (SMD = -0.10, 95% CI [-0.17,-0.04], P = 0.002, I2 = 0%), (SMD = -0.16, 95% CI [-0.23,-0.09], P < 0.00001, I2 = 0%), (SMD = 0.10, 95% CI [0.01, 0.20], P = 0.03, I2 = 0%). The dietary intervention had no effect on delayed memory and spatial ability (SMD = 0.04, 95% CI [-0.02, 0.09], P = 0.20, I2 = 0%), (SMD = 0.08, 95% CI [-0.01, 0.16], P = 0.08, I2 = 0%).

CONCLUSION

The Mediterranean diet, a diet with restricted caloric intake, a diet incorporating aerobic exercise, a low-carbohydrate diet, and a healthy lifestyle diet (increased intake of fruits and vegetables, and weight and blood pressure management) appear to have positive effects on cognitively healthy adults, as reflected in their overall cognitive, processing speed, executive, and language functions.

PROSPERO REGISTRATION NUMBER

CRD42023414704.

Disease-modifying therapies for Alzheimer's disease: Clinical trial progress and opportunity

The U.S. Food and Drug Administration (FDA) recently approved lecanemab and donanemab for the treatment of early symptomatic Alzheimer's disease (AD) after their phase III trials reached endpoints. These two anti-amyloid β monoclonal antibodies represent the latest promise of disease-modifying therapy (DMT) for AD, which undoubtedly reignites new hope for DMTs to combat the staggering financial and human costs of AD. However, in addition to these two successful antibodies, there have been enormous efforts to develop DMTs in various aspects to meet the therapeutic requirement of AD. In this review, we delineate the core principles and methodologies of diverse DMTs, covering the advances in clinical trials of drug candidates that either have been discontinued, completed, or are ongoing, as well as brain stimulation and lifestyle interventions. In addition, by overseeing the fate of various candidate molecules, we hope to provide references and ideas for prospective approaches and promising applications of DTMs for AD, particularly in terms of universality and clinical application economics, to optimize efficacy and maximize AD patient benefits in the future.

Cognitive interventions for healthy older adults: A systematic meta-review

Objectives

With increasing global life expectancy, cognitive interventions hold promise in mitigating cognitive decline and fostering healthy aging. Despite the demand for evidence-based interventions, there have been few attempts to summarize existing evidence. This study aims to assess the effectiveness and feasibility of unimodal and multimodal cognitive interventions for cognitively healthy older adults.

Method

Systematic meta-review, selecting articles from four databases: PubMed, Web of Science, Embase, and Cochrane Library. Quality assessment carried out with AMSTAR2. Findings were summarized and discussed narratively.

Results

Thirty-nine articles were included, with 21 meta-analyses and 18 qualitative systematic reviews. The total number of reviews was 38 for cognitive training, 4 for cognitive stimulation, and 1 for multicomponent interventions. Most reviews had low or critically low quality.

Conclusions

The prevailing evidence supports cognitive training. Continued research into cognitive stimulation and multicomponent protocols is encouraged. Longer follow-ups are important for identifying combined and clinically significant results. Rigorous risk of bias and quality assessment is necessary to enhance the evidence base.