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Thunborg C, Wang R, Rosenberg A, Sindi S, Andersen P, Andrieu S, Broersen LM, Coley N, Couderc C, Duval CZ, Faxen-Irving G, Hagman G, Hallikainen M, Håkansson K, Kekkonen E, Lehtisalo J, Levak N, Mangialasche F, Pantel J, Rydström A, Stigsdotter-Neely A, Wimo A, Ngandu T, Soininen H, Hartmann T, Solomon A, Kivipelto M. Integrating a multimodal lifestyle intervention with medical food in prodromal Alzheimer's disease: the MIND-AD mini randomized controlled trial. Alzheimers Res Ther 2024; 16:118. [PMID: 38812047 PMCID: PMC11138035 DOI: 10.1186/s13195-024-01468-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/27/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) showed cognitive benefits from a multidomain lifestyle intervention in at-risk older people. The LipiDiDiet trial highlighted benefits of medical food in prodromal Alzheimer's disease (AD). However, the feasibility and impact of multimodal interventions combining lifestyle with medical food in prodromal AD is unclear. METHODS MIND-ADmini was a 6-month multinational (Sweden, Finland, Germany, France) proof-of-concept randomized controlled trial (RCT). Participants were 60-85 years old, had prodromal AD (International Working Group-1 criteria), and vascular/lifestyle risk factors. The parallel-group RCT had three arms: multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); multimodal lifestyle intervention + medical food (Fortasyn Connect); and regular health advice/care (control). Participants were randomized 1:1:1 (computer-generated allocation at each site). Outcome evaluators were blinded to randomization. Primary outcome was feasibility of the multimodal intervention, evaluated by recruitment rate during a 6-month recruitment phase, overall adherence in each intervention arm, and 6-month retention rate. Successful adherence was pre-specified as attending ≥ 40% of sessions/domain in ≥ 2/4 domains (lifestyle intervention), and consuming ≥ 60% of the medical food (lifestyle intervention + medical food). The secondary outcomes included adherence/participation to each intervention component and overall adherence to healthy lifestyle changes, measured using a composite score for healthy lifestyle. Cognitive assessments were included as exploratory outcomes, e.g. Clinical Dementia Rating scale. RESULTS During September 2017-May 2019, 93 individuals were randomized (32 lifestyle intervention, 31 lifestyle + medical food, and 30 control group). Overall recruitment rate was 76.2% (64.8% during the first 6 months). Overall 6-month retention rate was 91.4% (lifestyle intervention 87.5%; lifestyle + medical food 90.3%; control 96.7%). Domain-specific adherence in the lifestyle intervention group was 71.9% to cognitive training, 78.1% exercise, 68.8% nutritional guidance, and 81.3% vascular risk management; and in the lifestyle + medical food group, 90.3% to cognitive training, 87.1% exercise, 80.7% nutritional guidance, 87.1% vascular risk management, and 87.1% medical food. Compared with control, both intervention arms showed healthy diet improvements (βLifestyle×Time = 1.11, P = 0.038; βLifestyle+medical food×Time = 1.43, P = 0.007); the lifestyle + medical food group also showed vascular risk reduction (P = 0.043) and less cognitive-functional decline (P < 0.05, exploratory analysis). There were 5 serious adverse events (control group: 1; lifestyle intervention: 3; lifestyle + medical food: 1) unrelated to interventions. CONCLUSIONS The multidomain lifestyle intervention, alone or combined with medical food, had good feasibility and adherence in prodromal AD. Longer-term cognitive and other health benefits should be further investigated in a larger-scale trial. TRIAL REGISTRATION ClinicalTrials.gov NCT03249688.
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Affiliation(s)
- Charlotta Thunborg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Karolinska Vägen 37 A, Solna, Stockholm, 171 64, Sweden
- Department of Caring Sciences, Faculty of Health and Occupational Studies, Gävle, 801 76, Sweden
| | - Rui Wang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
- Department of Physical Activity and Health, the Swedish School of Sport and Health Sciences, Stockholm, SE-114 86, Sweden
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave J5/1 Mezzanine, Madison, WI, 53792, USA
| | - Anna Rosenberg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 8, Kuopio, 70210, Finland
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
| | - Pia Andersen
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Karolinska Vägen 37 A, Solna, Stockholm, 171 64, Sweden
| | - Sandrine Andrieu
- Department of Clinical Epidemiology and Public Health, CHU de Toulouse, and Aging Research Team, CERPOP Inserm UMR 1295, Jules Guesde, Toulouse, 31000, France
- IHU HealthAge, Toulouse, 31059, France
| | | | - Nicola Coley
- Department of Clinical Epidemiology and Public Health, CHU de Toulouse, and Aging Research Team, CERPOP Inserm UMR 1295, Jules Guesde, Toulouse, 31000, France
- IHU HealthAge, Toulouse, 31059, France
| | - Celine Couderc
- Department of Clinical Epidemiology and Public Health, CHU de Toulouse, and Aging Research Team, CERPOP Inserm UMR 1295, Jules Guesde, Toulouse, 31000, France
| | - Celine Z Duval
- German Institute for Dementia Prevention (DIDP), Saarland University, Homburg, 66424, Germany
- Institute of General Practice, Goethe University Frankfurt a.M, Frankfurt, 60590, Germany
| | - Gerd Faxen-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
| | - Göran Hagman
- Theme Inflammation and Aging, Karolinska University Hospital, Karolinska Vägen 37 A, Solna, Stockholm, 171 64, Sweden
| | - Merja Hallikainen
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
| | - Krister Håkansson
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Karolinska Vägen 37 A, Solna, Stockholm, 171 64, Sweden
- Stockholm Gerontology Research Center, Tomtebodavägen 18a, Solna, 171 65, Sweden
| | - Eija Kekkonen
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
| | - Jenni Lehtisalo
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
| | - Nicholas Levak
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Karolinska Vägen 37 A, Solna, Stockholm, 171 64, Sweden
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
| | - Johannes Pantel
- German Institute for Dementia Prevention (DIDP), Saarland University, Homburg, 66424, Germany
- Institute of General Practice, Goethe University Frankfurt a.M, Frankfurt, 60590, Germany
| | - Anders Rydström
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
| | - Anna Stigsdotter-Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, 651 88, Sweden
- Engineering Psychology, Luleå University of Technology, Luleå, 971 87, Sweden
| | - Anders Wimo
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
| | - Tiia Ngandu
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, Helsinki, Finland
| | - Hilkka Soininen
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
| | - Tobias Hartmann
- German Institute for Dementia Prevention (DIDP), Saarland University, Homburg, 66424, Germany
- Department of Experimental Neurology, Medical Faculty, Saarland University, Homburg, 66424, Germany
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 8, Kuopio, 70210, Finland
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research QA32, Karolinska Institute, Karolinska Vägen 37 A, Solna, 171 64, Sweden.
- Theme Inflammation and Aging, Karolinska University Hospital, Karolinska Vägen 37 A, Solna, Stockholm, 171 64, Sweden.
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 8, Kuopio, 70210, Finland.
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK.
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 8, Kuopio, 70210, Finland.
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Bruinsma J, Visser LNC, Abaci A, Rosenberg A, Diaz A, Hanke S, Crutzen R, Mangialasche F, Kivipelto M, Thunborg C. Social activities in multidomain dementia prevention interventions: insights from practice and a blueprint for the future. Front Psychiatry 2024; 15:1386688. [PMID: 38832328 PMCID: PMC11146203 DOI: 10.3389/fpsyt.2024.1386688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Social activities are important for health and act as a driver of cognitive reserve during aging. In this perspective paper, we describe challenges and outline future (research) endeavors to establish better operationalization of social activities in multidomain interventions to prevent dementia. Body We first address the lack of conceptual clarity, which makes it difficult to measure engagement in social activities. Second, drawing from our experience with the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we discuss social activities in multidomain dementia prevention interventions. Using qualitative data from the Multimodal Preventive Trial for Alzheimer's Disease (MIND-ADmini), we reflect on participant experiences with social activities. Third, we address the potential and challenges of digital solutions in promoting social activities in interventions for dementia prevention. Finally, we share insights from a workshop on digital technology, where we consulted with individuals with and without cognitive impairment who have been involved in three European projects (i.e., EU-FINGERS, Multi-MeMo, and LETHE). Discussion Based on these insights, we advocate for research that strengthens and accelerates the integration of social activities into multidomain interventions for dementia prevention. We propose several ways to achieve this: (a) by conducting mixed methods research to formulate a broadly accepted definition and instructions to measure social activities; (b) by focusing on promoting engagement in social activities beyond the intervention setting; and (c) by exploring the needs and preferences of older adults towards digitally-supported interventions and co-design of new technologies that enrich in-person social activities.
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Affiliation(s)
- Jeroen Bruinsma
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Leonie N. C. Visser
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Public Health Research Institute, Quality of Care/Personalized Medicine, Amsterdam, Netherlands
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Alara Abaci
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rosenberg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ana Diaz
- Alzheimer Europe, Senningerberg, Luxembourg
| | - Sten Hanke
- Department of Applied Informatics, Institute of eHealth, FH Joanneum - University of Applied Sciences, Graz, Austria
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Charlotta Thunborg
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Stockholm, Sweden
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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McEvoy CT, Regan-Moriarty J, Dolan C, Bradshaw C, Mortland V, McCallion M, McCarthy G, Kennelly SP, Kelly J, Heffernan M, Kee F, McGuinness B, Passmore P. A qualitative study to inform adaptations to a brain health intervention for older adults with type 2 diabetes living in rural regions of Ireland. Diabet Med 2023; 40:e15034. [PMID: 36572988 DOI: 10.1111/dme.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/10/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
AIMS Type 2 diabetes is a risk factor for late-life dementia, but dementia prevention strategies have yet to be comprehensively evaluated in people with diabetes. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated cognitive benefits of a 2-year multidomain lifestyle intervention. However, given the intensive nature of FINGER, there is uncertainty about whether it can be implemented in other high-risk populations. Our aim was to explore attitudes towards dementia risk, and barriers to an intervention based on the FINGER model in older adults with type 2 diabetes living in rural areas of Ireland. METHODS Focus groups were conducted with 21 adults (11 men and 10 women) aged 60+ years with type 2 diabetes living in border regions of north and south Ireland. Data were analysed using thematic analysis. RESULTS There was limited understanding of diabetes as a risk factor for late-life dementia. The main barriers to engagement with the multidomain intervention were eating foods that were not compatible with cultural norms, time and travel constraints, and perceived lack of self-efficacy and self-motivation for adopting the desired diet, exercise and computerised cognitive training (CCT) behaviours. Facilitators for intervention acceptability included the provision of culturally tailored and personalised education, support from a trusted source, and inclusion of goal setting and self-monitoring behavioural strategies. CONCLUSIONS While there was high acceptability for a brain health intervention, several barriers including cultural food norms and low self-efficacy for adopting the diet, exercise and CCT components would need to be considered in the intervention design. Findings from this study will be used to inform local decisions regarding the adaptation of FINGER for people with type 2 diabetes. The feasibility of the adapted multidomain intervention will then be evaluated in a future pilot trial.
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Affiliation(s)
- Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Joanne Regan-Moriarty
- Department of Health and Nutritional Sciences, Atlantic Technological University, Sligo, Ireland
| | - Catherine Dolan
- Galway and Sligo Leitrim Mental Health Services, National University of Ireland, Sligo, Ireland
| | - Caroline Bradshaw
- Galway and Sligo Leitrim Mental Health Services, National University of Ireland, Sligo, Ireland
| | - Valerie Mortland
- Department of Geriatric Medicine, South West Acute Hospital, Enniskillen, UK
| | - Maire McCallion
- Department of Health and Nutritional Sciences, Atlantic Technological University, Sligo, Ireland
| | - Geraldine McCarthy
- Galway and Sligo Leitrim Mental Health Services, National University of Ireland, Sligo, Ireland
| | - Seán P Kennelly
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Jim Kelly
- Department of Geriatric Medicine, South West Acute Hospital, Enniskillen, UK
| | - Margaret Heffernan
- Galway and Sligo Leitrim Mental Health Services, National University of Ireland, Sligo, Ireland
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Fallahpour M, Fritz H, Thunborg C, Akenine U, Kivipelto M. Experiences of Active Everyday Life Among Persons with Prodromal Alzheimer's Disease: A Qualitative Study. J Multidiscip Healthc 2022; 15:1921-1932. [PMID: 36068878 PMCID: PMC9441142 DOI: 10.2147/jmdh.s369878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Identifying strategies to prevent or delay cognitive decline among the rising numbers of elderly is acknowledged as a global public health priority. Research suggests that an active lifestyle in terms of participation in activities has the potential to reduce the risk of later-life cognitive decline. The concept of "active everyday life", however, needs to be further explored. Aim The study aimed to explore and describe the active everyday lives of persons with prodromal Alzheimer's disease (AD) in terms of quality of participation in activities and perceived restrictions. Methods This qualitative study was part of a larger project, the MIND-ADMINI trial. Nine in-depth interviews were conducted with seven participants (2 males, 5 females; mean age of 72.3) at baseline before the intervention. The data were collected from January to October 2018 and analyzed using the grounded theory approach. Results Four categories emerged from the analysis: (i) active body and mind; (ii) doing desired meaningful activities to feel engaged, contented, and satisfied; (iii) doing in the context of being connected to others; (iv) ability in making decisions and taking actions. From these categories, which presented the key elements of an active everyday life, a core category was identified: Living a complete life in flow. Conclusion The findings suggest key elements of participation quality that contribute to an active life. The identified elements are important to be considered in rehabilitation to provide opportunities and possibilities for participation to enable and improve the quality of participation among persons with cognitive impairments.
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Affiliation(s)
- Mandana Fallahpour
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Heather Fritz
- School of Occupational Therapy, Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - Charlotta Thunborg
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- School of Health, Care and Social Welfare, Department of Physiotherapy, Mälardalen University, Västerås, Sweden
| | - Ulrika Akenine
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
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