A 12-week multidomain intervention versus active control to reduce risk of Alzheimer's disease: study protocol for a randomized controlled trial

Effect of Socialization on Alzheimer's Disease During the COVID-19 Pandemic

Age is the strongest risk factor for Alzheimer's disease, a neurodegenerative disease where beta-amyloid plaques accumulate in the brain. Elderly individuals, especially those in nursing homes, were burdened by social isolation during the COVID-19 pandemic. The purpose of this literature review is to describe the effectiveness of social engagement and how combating isolation can have a neuroprotective effect on individuals at risk for Alzheimer's disease. We conducted a search in PubMed examining articles from 2010 to 2023 that discussed the impact of socialization on Alzheimer's disease, particularly during the COVID-19 pandemic. Our search terms were "Alzheimer's Disease + Socialization," "Social Isolation + Alzheimer's Disease," "Alzheimer's Disease + COVID-19," "COVID-19 + Social Isolation," and "Social Interventions + Alzheimer's Disease." Inclusion criteria consisted of patients ages 60 and older with Alzheimer's disease, mention of social isolation or engagement, and any relationship between COVID-19 and Alzheimer's disease. Exclusion criteria were defined as other dementias, non-social interventions, and the effects of different viruses on Alzheimer's disease. After the screening process, 30 articles were included, along with six articles that were suitable to the topic. Of the 36 total articles, 19 focused on an intervention involving socialization; eight explored the effect of social isolation during COVID-19 on patients with Alzheimer's disease; five articles examined social isolation as a risk factor for dementia; and four articles discussed the effect of socialization on Alzheimer's disease. A few studies reported that having a large social network can improve cognition and mood for patients with Alzheimer's disease. Studies reported that interventions such as volunteering, video calls, group art classes, animal interactions, and others produced positive outcomes in Alzheimer's patients, but not all were statistically significant. Our review found a consistent association between a socially integrated lifestyle and a decreased incidence of early-onset dementia. Although not all interventions were solely social, a strong social structure remained at the core of a healthy aging process.

Validity and reliability of the Turkish version of the Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI)

INTRODUCTION

There is still a requirement for concise, practical scales that can be readily incorporated into everyday schedules and predict the likelihood of dementia onset in individuals without dementia. This study aimed to assess the reliability of the ANU-ADRI (Australian National University Alzheimer's Disease Risk Index)-Short Form in Turkish geriatric patients.

METHODS

This methodological study involved 339 elderly patients attending the geriatric outpatient clinic for various reasons. The known-group validity and divergent validity were assessed. The ANU-ADRI was administered during the baseline test and again within one week for retest purposes. Alongside the ANU-ADRI, all participants underwent a comprehensive geriatric assessment, including Activities of Daily Living (ADL), mobility assessment (Performance-Oriented Mobility Assessment (POMA) and Timed Up and Go Test), nutritional assessment (Mini Nutritional Assessment (MNA)), and global cognition evaluation (Mini-Mental State Examination (MMSE)).

RESULTS

The scale demonstrated satisfactory linguistic validity. A correlation was observed between the mean scores of the ANU-ADRI test and retest (r = 0.997, p < 0.001). Additionally, there existed a moderate negative linear association between the ANU-ADRI and MMSE scores (r = -0.310, p < 0.001), POMA (r = -0.406, p < 0.001), Basic ADL (r = -0.359, p < 0.001), and Instrumental ADL (r = -0.294, p < 0.001). Moreover, a moderate positive linear association was found between the ANU-ADRI and the Timed Up and Go Test duration (r = 0.538, p < 0.001).

CONCLUSION

The ANU-ADRI-Short Form was proved as a valuable tool for clinical practice, facilitating the assessment of Alzheimer's disease risk within the Turkish geriatric population.

Multi-Domain Interventions for Dementia Prevention - A Systematic Review

OBJECTIVES

There is a growing incidence of cognitive decline and dementia associated with the ageing population. Lifestyle factors such as diet, physical activity, and cognitive activities may individually or collectively be undertaken to increase one's odds of preventing cognitive decline and future dementia. This study will examine whether clinical trials using multidomain lifestyle intervention can significantly decrease the risk of cognitive decline and therefore dementia.

DESIGN, SETTING AND PARTICIPANTS

This systematic literature review of multidomain lifestyle interventions for the prevention of cognitive decline and dementia followed the PRISMA guidelines. Clinical trials involving multidomain intervention (i.e., diet and physical activity, or without cognitive training) in older adults (≥ 49 years old) at higher risk of dementia were identified through 5 electronic databases (EMBASE, MEDLINE, CINAHL, Cochrane, and Scopus). A comprehensive search was performed to identify and retrieve publications until 15 November 2022. Trials were published in English.

RESULTS

The included studies (n=15) assessed change in cognition in response to a multidomain lifestyle intervention. However, the cognitive outcome measures used in these studies were heterogeneous. Despite this heterogeneity, two thirds of the studies showed improvement in cognition following a multidomain intervention (n=10 with a total of 9,439 participants). However, five studies reported no improvement in cognition following the multidomain intervention. The most common form of dietary intervention included higher amount of fruit and vegetable intake; whole-grain cereal products instead of refined; low fat options in milk and meat products; and limiting sucrose intake to less than 50 g/day. Most clinical trial studies were powered to examining the effects of multidomain interventions in cognition but were not designed to test the contribution of individual domains (i.e., dietary changes, increased physical activity, or increased cognitive stimulation alone).

CONCLUSION

This systematic review aimed to determine the effect of multimodal lifestyle interventions on cognitive outcomes in older adults at risk of dementia. We found that participants with conditions that may increase the risk of dementia, (e.g., hypertension, cardiovascular fragility) do benefit from multi-modal lifestyle changes including diet, physical activity, and cognitive training. Two thirds of studies using multidomain lifestyle interventions showed improvements in cognitive function. Trials with a focus on cognitive training, dietary improvement, and physical activity may prevent or delay cognitive decline in older adults including those at risk of developing dementia. Future studies should consider longer follow-up periods and adequate power to be able to examine the effects of each lifestyle component in the context of multimodal interventions.

An Internet-Based Intervention Augmented With a Diet and Physical Activity Consultation to Decrease the Risk of Dementia in At-Risk Adults in a Primary Care Setting: Pragmatic Randomized Controlled Trial

BACKGROUND

There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course.

OBJECTIVE

This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care.

METHODS

A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m² or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician-led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF).

RESULTS

Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means -3.86, 95% CI -6.81 to -0.90, P=.01; week 18: difference in means -4.05, 95% CI -6.81 to -1.28, P<.001; week 36: difference in means -4.99, 95% CI -8.04 to -1.94, P<.001; and week 62: difference in means -4.62, 95% CI -7.62 to -1.62, P<.001).

CONCLUSIONS

A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results.

TRIAL REGISTRATION

Australian clinical trials registration number (ACTRN): 12616000868482; https://anzctr.org.au/ACTRN12616000868482.aspx.

Promotion of Healthy Aging Within a Community Center Through Behavior Change: Health and Fitness Findings From the AgeWell Pilot Randomized Controlled Trial

The purpose of this randomized controlled trial was to determine if behavior change through individual goal setting (GS) could promote healthy aging, including health and fitness benefits in older adults who attended a community "AgeWell" Center for 12 months. Seventy-five older adults were randomly allocated to either a control or a GS group. Health outcomes were measured at baseline and after 12 months of the participants' having access to the exception of Agewell Center facilities. The findings demonstrate that participation in the Center in itself was beneficial, with improved body composition and reduced cardiovascular risk in both groups (p < .05), and that this kind of community-based resource offers valuable potential for promoting protective behaviors and reducing health risk. However, a specific focus on identifying individual behavior change goals was required in order to achieve increased activity engagement (p < .05) and to bring about more substantial improvements in a range of health, diet, and physical function measures (p < .05).

The Gray Matters App Targeting Health Behaviors Associated with Alzheimer's Risk: Improvements in Intrinsic Motivation and Impact on Diet Quality and Physical Activity

OBJECTIVE

We examine if the Gray Matters intervention (education and behavioral self-monitoring app targeting lifestyle risks for Alzheimer's disease [AD]) affected participants' motivation for change and whether high motivation predicts improved diet and physical activity over 6 months.

DESIGN

In this 6-month randomized controlled trial (treatment n=104; control n=42; assessed pre/post intervention) amotivation, external regulation, identified regulation, and intrinsic motivation were assessed via the Situational Motivation Scale (SIMS). Diet quality was assessed via adherence to the DASH diet, and physical activity was assessed in minutes.

PARTICIPANTS

Eligibility criteria included not having significant cognitive impairment. Participants were aged 39-64 (M = 54.17, SD = 6.9), 66% female, 81% married, 90% White, and 80% had a college degree.

INTERVENTION

Treatment included an activity tracker, Gray Matters app, access to booster sessions, contact with a student health coach, and study website.

SETTING

Participants were in the general community.

RESULTS

Independent samples t-tests determined that intrinsic motivation (IM) increased significantly for the treatment group (M = 2.09 SD = 4.82), compared to the control group (M = 1.00 SD = 5.52; t (130) = -3.04, p = .003). Comparing subgroups of people with High vs Low IM we found that High IM males increased vigorous physical activity more than Lower IM males (F(1,42)=5.053, p=.030). Comparing persons aged 58-64 years with High vs Lower IM, High IM persons had less improvement in diet quality F(1,48)=4.538; p=0.038).

CONCLUSION

RCT results support that the Gray Matters AD-focused intervention increased IM, and IM was associated with improved physical activity and diet quality for some subgroups.

Face-to-Face and Digital Multidomain Lifestyle Interventions to Enhance Cognitive Reserve and Reduce Risk of Alzheimer's Disease and Related Dementias: A Review of Completed and Prospective Studies

BACKGROUND

Currently, there is no pharmaceutical intervention to treat or delay pathological cognitive decline or Alzheimer's disease and related dementias (ADRD). Multidomain lifestyle interventions are increasingly being studied as a non-pharmacological solution to enhance cognitive reserve, maintain cognition, and reduce the risk of or delay ADRD. Review of completed and prospective face-to-face (FTF) and digital multidomain interventions provides an opportunity to compare studies and informs future interventions and study design.

METHODS

Electronic databases (PubMed, PsycINFO, clinicaltrials.gov and NIH RePORTER) were searched for multidomain lifestyle programs. Studies were included if the program (1) included a control group, (2) included at least 3 interventions, (3) were at least 6 months in duration, and (4) included measurement of cognitive performance as an outcome.

RESULTS

In total, 17 multidomain lifestyle programs aimed at enhancing cognitive reserve and reducing risk of ADRD were found. Thirteen programs are FTF in intervention delivery, with 3 FTF programs replicating the FINGER protocol as part of the World Wide Fingers Consortium. Four programs are delivered digitally (website, Web application, or mobile app). Program characteristics (e.g., target population, duration, frequency, outcomes, and availability) and results of completed and prospective studies are reviewed and discussed.

CONCLUSION

This review updates and discusses completed and current multidomain lifestyle interventions aimed at enhancing cognitive reserve and reducing risk of ADRD. A growing number of international studies are investigating the efficacy and utility of these programs in both FTF and digital contexts. While a diversity of study designs and interventions exist, FTF and digital programs that build upon the foundational work of the FINGER protocol have significant potential to enhance cognitive reserve and reduce risk of ADRD.

Dementia Stigma Reduction (DESeRvE): Study protocol for a randomized controlled trial of an online intervention program to reduce dementia-related public stigma

Background

Dementia is considered to be a highly stigmatized condition leading to significant negative effects on the health and well-being of people with dementia and people supporting someone living with dementia. Even though there has been an increasing amount of research on dementia-related stigma over the past two decades, research on effective, evidence-based approaches to reduce dementia-related public stigma is still lacking.

Methods

A 2 × 2 factorial randomized controlled trial (RCT) is being conducted to evaluate the feasibility and short-term efficacy of an online intervention program. It compares different approaches to reduce dementia-related public stigma: 1) Education (ED) that is designed to provide written information on dementia; 2) Contact (CT) that is designed to offer indirect virtual contact with people with dementia and/or people supporting someone with dementia; 3) Education plus contact (ED + CT) that is designed to provide both written information on dementia and indirect virtual contact with people with dementia and/or people supporting someone living with dementia; and 4) an active control condition receiving written information on general health. We aim to recruit 500 lay persons aged 40 and over, to complete a questionnaire measuring the level of dementia-related public stigma, assessed with a modified Attribution Questionnaire and dementia knowledge, assessed with the Dementia Knowledge Assessment Scale version 2 at baseline and follow-up assessments (immediately after the intervention and 12 weeks post-intervention).

Discussion

Results from this trial will provide evidence on the most effective approach in reducing dementia-related public stigma. The results are also likely to form an evidence base for the feasibility of dementia-related public stigma campaigns to educate the general public.

Web-Based Multidomain Lifestyle Programs for Brain Health: Comprehensive Overview and Meta-Analysis

BACKGROUND

The number of people living with dementia is increasing worldwide, mainly because of aging of the population. To date, there is no pharmaceutical intervention to delay or treat cognitive decline or dementia. As an estimated one-third of dementia cases might be attributable to modifiable lifestyle factors (such as cognitive and physical activity), multidomain lifestyle interventions are a promising way to maintain or improve brain health. Offering programs online would enable large-scale implementation. An overview of multidomain Web-based lifestyle programs for brain health would facilitate comparison and improvement of such programs to develop effective and sustainable interventions.

OBJECTIVE

This study aimed to (1) provide a comprehensive overview of Web-based multidomain lifestyle programs aimed at optimizing brain health in healthy adult populations and (2) describe the programs and targeted lifestyle factors, availability, and evaluation of adherence and user experience. In addition, a meta-analysis was performed to evaluate the effectiveness of these programs.

METHODS

Electronic databases (PubMed, EMBASE, and PsycINFO) were searched for Web-based lifestyle programs that were included when the program (1) aimed to optimize brain health, (2) focused on multiple lifestyle factors, (3) was completely Web-based (website, Web application or mobile app), (4) consisted of multiple sessions, and (5) focused on a healthy adult population. Program characteristics (target population, duration, frequency, tailoring, platform, and availability) and results of program evaluations (effectiveness, user evaluations, and adherence) were extracted and compared. Studies using a controlled design were included in a random-effects meta-analysis on the effectiveness on brain health outcomes. Study quality was assessed using the physiotherapy evidence database (PEDro) scale.

RESULTS

The electronic searches yielded 44 documents describing 14 Web-based lifestyle programs; physical and cognitive activities were targeted in all programs. Four programs (4/14, 29%) were publicly available and free of charge, whereas others were restricted to research settings (5/14, 36%), available after payment (1/14, 7%), or not available at all (2/14, 14%). User evaluations were reported for 8 (57%) of the 14 programs. Reported dropout of the intervention groups ranged from 2% to 52%. Overall, 3 studies evaluated the effectiveness of a program using a controlled design and were included in the meta-analysis (moderate-to-high quality). Pooled results showed a significant small-to-medium effect of the Web-based multidomain lifestyle interventions on outcome measures for brain health (global cognition score, subjective cognitive score, and lifestyle risk score; standard mean difference=0.45; 95% CI 0.12-0.78), with a high degree heterogeneity across studies (I²=75%; P=.02).

CONCLUSIONS

In total, 14 Web-based multidomain lifestyle programs aimed at optimizing brain health were found. The programs showed heterogeneity in both characteristics and effectiveness evaluation. Despite this heterogeneity, this meta-analysis suggests that Web-based lifestyle programs can positively influence brain health outcomes and have the potential to contribute to the prevention of dementia.

Dementia Stigma Reduction (DESeRvE): Study protocol for a randomized controlled trial of an online intervention program to reduce dementia-related public stigma

Background

Dementia is considered to be a highly stigmatized condition leading to significant negative effects on the health and well-being of people with dementia and people supporting someone living with dementia. Even though there has been an increasing amount of research on dementia-related stigma over the past two decades, research on effective, evidence-based approaches to reduce dementia-related public stigma is still lacking.

Methods

A 2 × 2 factorial randomized controlled trial (RCT) is being conducted to evaluate the feasibility and short-term efficacy of an online intervention program. It compares different approaches to reduce dementia-related public stigma: 1) Education (ED) that is designed to provide written information on dementia; 2) Contact (CT) that is designed to offer indirect virtual contact with people with dementia and/or people supporting someone with dementia; 3) Education plus contact (ED + CT) that is designed to provide both written information on dementia and indirect virtual contact with people with dementia and/or people supporting someone living with dementia; and 4) an active control condition receiving written information on general health. We aim to recruit 500 lay persons aged 40 and over, to complete a questionnaire measuring the level of dementia-related public stigma, assessed with a modified Attribution Questionnaire and dementia knowledge, assessed with the Dementia Knowledge Assessment Scale version 2 at baseline and follow-up assessments (immediately after the intervention and 12 weeks post-intervention).

Discussion

Results from this trial will provide evidence on the most effective approach in reducing dementia-related public stigma. The results are also likely to form an evidence base for the feasibility of dementia-related public stigma campaigns to educate the general public.

Alzheimer's Biomarkers From Multiple Modalities Selectively Discriminate Clinical Status: Relative Importance of Salivary Metabolomics Panels, Genetic, Lifestyle, Cognitive, Functional Health and Demographic Risk Markers

Background: Among the neurodegenerative diseases of aging, sporadic Alzheimer’s disease (AD) is the most prevalent and perhaps the most feared. With virtually no success at finding pharmaceutical therapeutics for altering progressive AD after diagnosis, research attention is increasingly directed at discovering biological and other markers that detect AD risk in the long asymptomatic phase. Both early detection and precision preclinical intervention require systematic investigation of multiple modalities and combinations of AD-related biomarkers and risk factors. We extend recent unbiased metabolomics research that produced a set of metabolite biomarker panels tailored to the discrimination of cognitively normal (CN), cognitively impaired and AD patients. Specifically, we compare the prediction importance of these panels with five other sets of modifiable and non-modifiable AD risk factors (genetic, lifestyle, cognitive, functional health and bio-demographic) in three clinical groups.

Method: The three groups were: CN (n = 35), mild cognitive impairment (MCI; n = 25), and AD (n = 22). In a series of three pairwise comparisons, we used machine learning technology random forest analysis (RFA) to test relative predictive importance of up to 19 risk biomarkers from the six AD risk domains.

Results: The three RFA multimodal prediction analyses produced significant discriminating risk factors. First, discriminating AD from CN was the AD metabolite panel and two cognitive markers. Second, discriminating AD from MCI was the AD/MCI metabolite panel and two cognitive markers. Third, discriminating MCI from CN was the MCI metabolite panel and seven markers from four other risk modalities: genetic, lifestyle, cognition and functional health.

Conclusions: Salivary metabolomics biomarker panels, supplemented by other risk markers, were robust predictors of: (1) clinical differences in impairment and dementia and even; (2) subtle differences between CN and MCI. For the latter, the metabolite panel was supplemented by biomarkers that were both modifiable (e.g., functional) and non-modifiable (e.g., genetic). Comparing, integrating and identifying important multi-modal predictors may lead to novel combinations of complex risk profiles potentially indicative of neuropathological changes in asymptomatic or preclinical AD.

Development and assessment of a web-based intervention for educating older people on strategies promoting healthy cognition

Background

The increase in the population of aging people has increased the occurrence of cognitive decline leading to predemented stage of dementia, ie, mild cognitive impairment (MCI). The cognitive tools that are web-based have been proven to be useful in decreasing the risk of MCI. Thus, in the present study, an education tool that is web-based, called WESIHAT 2.0^©, had been created to educate elderly people about precautionary strategies against MCI.

Methodology

WESIHAT 2.0 was devised in a senior-friendly style, which includes touch screen, greater font size, larger icons, and employed multimedia components of text, images, and videos. The components employed in WESIHAT 2.0 were a screening tool called TUA-WELLNESS, 10 guides for memory improvement, health diary, and guide for a healthy menu. This application assessed a group of 73 candidates consisting of elderly people, health professionals, caregivers, and information technology (IT) professionals for 1 month.

Results

All the elderly people, caregivers, and 75% of IT and health professionals were satisfied with the subject matter of WESIHAT 2.0. About more than half of the elderly people, caregivers, and IT and health professionals had given a consensus on the comprehensive ease of the terminologies, sentences, images, table, and advice related to diet included in the web application. Proposals for improvements of the web portal included suggestions such as using smaller sentences, using greater font size, adding more images, and avoiding the use of unfamiliar terminologies.

Conclusion

WESIHAT 2.0 is a suitable tool for educating older people about the lifestyle modification strategies to slower progression to cognitive impairment, with regard to the significance of expert advice.

Wishes and preferences for an online lifestyle program for brain health-A mixed methods study

Introduction

Individuals with subjective cognitive decline (SCD) are at increased risk of Alzheimer's disease and could benefit from a prevention strategy targeting lifestyle factors. Making a program available through the Internet gives a widespread reach at low cost, but suboptimal adherence is a major threat to effectiveness. As a first step in developing an online lifestyle program (OLP), we aimed to identify factors that are barriers and/or facilitators for the use of an OLP in individuals with SCD in three European countries.

Methods

As part of the Euro-SCD project, SCD subjects were recruited at memory clinics in the Netherlands, Germany, and Spain. We combined quantitative and qualitative methods, using a mixed methods approach. We conducted an online 18-item survey on the preferences of SCD patients for an OLP (N = 238). In addition, we held semi-structured interviews (N = 22) to gain in-depth understanding of factors acting as a facilitator and/or barrier for intended use of an OLP. Audio recordings were transcribed verbatim. Content analysis was performed.

Results

One hundred seventy-six individuals completed the survey (response rate 74%). Almost all participants regularly use the Internet (97%). Participants reported trustworthiness (93%), user-friendliness (91%), and up-to-date information (88%) as main facilitators, whereas having contact with other users (26%), needing an account (21%), and assignments (16%) were reported as barriers. Barriers differed slightly between countries, but facilitators were largely similar. In-depth interviews revealed that both program characteristics (e.g., trustworthiness, user-friendliness, and personalization) and personal factors (e.g., expectancy to receive negative feedback) are likely to influence the intended use of an OLP.

Discussion

Involving users provided in-depth understanding of factors associated with the intended use of an OLP for brain health. Both program characteristics and personal factors are likely to influence the use of an OLP. Based on this input from the end-users, we will develop an OLP for individuals with SCD.

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Almost all participants believe that healthy lifestyle contributes to brain health.

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Almost all participants use the Internet daily, on all types of devices.

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Barriers or facilitators can be program characteristics as well as personal factors.

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Trustworthiness, user-friendliness, and personalization are important facilitators.

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One online lifestyle program for different European countries seems feasible.

Protocol for a pragmatic randomised controlled trial of Body Brain Life-General Practice and a Lifestyle Modification Programme to decrease dementia risk exposure in a primary care setting

INTRODUCTION

It has been estimated that a 10%-25% reduction in seven key risk factors could potentially prevent 1.1-3.0 million Alzheimer's disease cases globally. In addition, as dementia is preceded by more subtle cognitive deficits which have substantial social and economic impact, effective preventative interventions would likely have more extensive benefits. The current study evaluates in primary care a multidomain risk-reduction intervention targeting adults with high risk of developing dementia.

METHODS AND ANALYSIS

A randomised controlled trial (RCT) is being conducted to evaluate three intervention programmes using a pragmatic approach suitable to the clinic: (1) a 12-week online and face-to-face dementia risk-reduction intervention (Body Brain Life-General Practice (BBL-GP)); (2) a 6-week face-to-face group lifestyle modification programme (LMP); and (3) a 12-week email-only programme providing general health information. We aim to recruit 240 participants, aged 18 and over, to undergo a comprehensive cognitive and physical assessment at baseline and follow-ups (postintervention, 18, 36 and 62 weeks). The primary outcome is dementia risk measured with the modified version of the Australian National University-Alzheimer's Disease Risk Index Short Form. Secondary outcomes are cognitive function measured with Trails A and B, and the Digit Symbol Modalities Test; physical activity with moderate-vigorous physical activity and the International Physical Activity Questionnaire; depression with the Centre for Epidemiological Studies Depression; cost evaluation with the 12-item Short Form Health Survey, Framingham Coronary Heart Disease Risk Score and Australian Type 2 Diabetes Risk Assessment Tool; diet quality with the Australian Recommended Food Score; and sleep quality with the Pittsburgh Sleep Quality Index.

ETHICS AND DISSEMINATION

This RCT is a novel pragmatic intervention applied in a primary care setting to reduce the dementia risk exposure in adults at high risk. If successful, BBL-GP and LMP will provide a versatile, evidence-based package that can be easily and quickly rolled out to other primary care settings and which can be scaled up at relatively low cost compared with other strategies involving intensive interventions.

TRIAL REGISTRATION NUMBER

ACTRN12616000868482.

Perceptions of Brain Health and Cognition in Older African Americans and Caucasians With HIV: A Focus Group Study

As people age with HIV, cognitive problems may become more prevalent and severe, but lifestyle behaviors (i.e., physical activity) have been shown to protect brain health and cognition. We examined the perceptions that older adults living with HIV have about protecting and improving brain health and cognition through lifestyle behaviors. Qualitative data were analyzed from four focus groups (N = 30) of African Americans and Caucasians living with HIV and at least 50 years of age. An open-coding scheme using conventional content analysis was employed. Two results were found. First, many older adults with HIV in our study expressed a variety of cognitive complaints that interfered with daily function. Second, these participants reported few specific ideas about how such health behaviors were important to their own brain health and cognition. Education interventions may help older adults with HIV learn to improve and protect brain health and cognition as they age.

Assessing reliability of short and tick box forms of the ANU-ADRI: Convenient alternatives of a self-report Alzheimer's disease risk assessment

Introduction

To assess the reliability of short versions of the Australian National University Alzheimer's Disease Risk Index (ANU-ADRI).

Methods

A short form of the ANU-ADRI (ANU-ADRI-SF) was developed by assessing risk and protective factors with single questions where possible and with short forms of sub-questionnaires where available. The tick box form of the ANU-ADRI (ANU-ADRI-TB) was developed with unique questions for each risk and protective factor for Alzheimer's disease. The short versions were evaluated in an independent community sample of 504 participants with a mean age of 45.01 (SD = 14.85, range = 18–81).

Results

The short versions demonstrated high reliabilities when compared with the ANU-ADRI. However, the proportion of misclassification was high for some risk factors and particularly for the ANU-ADRI-TB.

Discussion

The ANU-ADRI-SF may be considered if less reliable questions from the ANU-ADRI-SF can be replaced with more reliable questions from the ANU-ADRI for risk/protective factors with high misclassification.

Bridging the Translation Gap: From Dementia Risk Assessment to Advice on Risk Reduction

Dementia risk reduction is a global health and fiscal priority given the current lack of effective treatments and the projected increased number of dementia cases due to population ageing. There are often gaps among academic research, clinical practice, and public policy. We present information on the evidence for dementia risk reduction and evaluate the progress required to formulate this evidence into clinical practice guidelines. This narrative review provides capsule summaries of current evidence for 25 risk and protective factors associated with AD and dementia according to domains including biomarkers, demographic, lifestyle, medical, and environment. We identify the factors for which evidence is strong and thereby especially useful for risk assessment with the goal of personalising recommendations for risk reduction. We also note gaps in knowledge, and discuss how the field may progress towards clinical practice guidelines for dementia risk reduction.

Body brain life: A randomized controlled trial of an online dementia risk reduction intervention in middle-aged adults at risk of Alzheimer's disease

Objective

To examine the efficacy of body brain life (BBL), a 12-week online dementia risk reduction intervention.

Methods

BBL was evaluated in a randomized controlled trial in 176 middle-aged adults with >2 risk factors and <2 protective factors for Alzheimer's disease (AD) assessed on a brief screening instrument. Participants were randomized to BBL, BBL plus face-to-face group sessions (BBL + FF) or active control (control). Score on the Australian National University-Alzheimer's disease risk index (ANU-ADRI), a validated index of AD risk, was the primary outcome measure assessed at baseline, 12, and 26 weeks.

Results

A group by time interaction at 26 weeks showed a significant reduction in ANU-ADRI score for BBL compared with control. Planned contrasts showed the BBL and BBL + FF groups had improvement in ANU-ADRI scores at 12 weeks (BBL + FF: z = -0.25; P = .021; BBL: z = -0.25; P = .008) and 26 weeks (BBL + FF: z = -0.48; P < .001; BBL: z = -0.28; P = .004) due to increase in protective factors.

Conclusions

This short intervention resulted in dementia risk reduction. Online dementia risk reduction interventions show promise for reducing the overall dementia risk in middle-aged adults with multiple risk factors.Clinical Trial Registration: The study is registered under Trial Registration: Reg. # ACTRN12612000147886.

The design and progress of a multidomain lifestyle intervention to improve brain health in middle-aged persons to reduce later Alzheimer's disease risk: The Gray Matters randomized trial

Introduction

Most Alzheimer's disease (AD) prevention studies focus on older adults or persons with existing cognitive impairment. This study describes the design and progress of a novel pilot intervention, the Gray Matters study.

Methods

This proof-of-concept randomized controlled trial tests an evidence-based multidomain lifestyle intervention in 146 persons aged 40 to 64 years, in northern Utah. Data collectors were blinded to participants' randomization to treatment (n = 104) or control (n = 42). Intervention targeted physical activity, food choices, social engagement, cognitive simulation, sleep quality, and stress management, and uses a custom smartphone application, activity monitor, and educational materials. Secondary outcomes include biomarkers, body mass index, cognitive testing, and psychological surveys.

Results

Midway through the study, achievements include a 98.7% retention rate, a 96% rate of compliance with app data entry, and positive trends in behavioral change.

Discussion

Participants were empowered, learning that lifestyle might impact AD risk, exhibiting positive behavioral changes thus far.

The Agewell trial: a pilot randomised controlled trial of a behaviour change intervention to promote healthy ageing and reduce risk of dementia in later life

BACKGROUND

Lifestyle factors represent prime targets for behaviour change interventions to promote healthy ageing and reduce dementia risk. We evaluated a goal-setting intervention aimed at promoting increased cognitive and physical activity and improving mental and physical fitness, diet and health.

METHODS

This was a pilot randomised controlled trial designed to guide planning for a larger-scale investigation, provide preliminary evidence regarding efficacy, and explore feasibility and acceptability. Primary outcomes were engagement in physical and cognitive activity. Participants aged over 50 living independently in the community were recruited through a community Agewell Centre. Following baseline assessment participants were randomly allocated to one of three conditions: control (IC) had an interview in which information about activities and health was discussed; goal-setting (GS n = 24) had an interview in which they set behaviour change goals relating to physical, cognitive and social activity, health and nutrition; and goal-setting with mentoring (GM, n = 24) had the goal-setting interview followed by bi-monthly telephone mentoring. Participants and researchers were blinded to group assignment. Participants were reassessed after 12 months.

RESULTS

Seventy-five participants were randomised (IC n = 27, GS n = 24, GM n = 24). At 12-month follow-up, the two goal-setting groups, taken together (GS n = 21, GM n = 22), increased their level of physical (effect size 0.37) and cognitive (effect size 0.15) activity relative to controls (IC n = 27). In secondary outcomes, the two goal-setting groups taken together achieved additional benefits compared to control (effect sizes ≥ 0.2) in memory, executive function, cholesterol level, aerobic capacity, flexibility, balance, grip strength, and agility. Adding follow-up mentoring produced further benefits compared to goal-setting alone (effect sizes ≥ 0.2) in physical activity, body composition, global cognition and memory, but not in other domains. Implementation of the recruitment procedure, assessment and intervention was found to be feasible and the approach taken was acceptable to participants, with no adverse effects.

CONCLUSIONS

A brief, low-cost goal-setting intervention is feasible and acceptable, and has the potential to achieve increased activity engagement.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN30080637.