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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
Abstract
Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a proof-of-concept randomised controlled trial, we aimed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population.
In a double-blind randomised controlled trial we enrolled individuals aged 60-77 years recruited from previous national surveys. Inclusion criteria were CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age. We randomly assigned participants in a 1:1 ratio to a 2 year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), or a control group (general health advice). Computer-generated allocation was done in blocks of four (two individuals randomly allocated to each group) at each site. Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation. The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery (NTB) Z score. Analysis was by modified intention to treat (all participants with at least one post-baseline observation). This trial is registered at ClinicalTrials.gov, number NCT01041989.
Between Sept 7, 2009, and Nov 24, 2011, we screened 2654 individuals and randomly assigned 1260 to the intervention group (n=631) or control group (n=629). 591 (94%) participants in the intervention group and 599 (95%) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis. Estimated mean change in NTB total Z score at 2 years was 0·20 (SE 0·02, SD 0·51) in the intervention group and 0·16 (0·01, 0·51) in the control group. Between-group difference in the change of NTB total score per year was 0·022 (95% CI 0·002-0·042, p=0·030). 153 (12%) individuals dropped out overall. Adverse events occurred in 46 (7%) participants in the intervention group compared with six (1%) participants in the control group; the most common adverse event was musculoskeletal pain (32 [5%] individuals for intervention vs no individuals for control).
Findings from this large, long-term, randomised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population.
Academy of Finland, La Carita Foundation, Alzheimer Association, Alzheimer's Research and Prevention Foundation, Juho Vainio Foundation, Novo Nordisk Foundation, Finnish Social Insurance Institution, Ministry of Education and Culture, Salama bint Hamdan Al Nahyan Foundation, Axa Research Fund, EVO funding for University Hospitals of Kuopio, Oulu, and Turku and for Seinäjoki Central Hospital and Oulu City Hospital, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and af Jochnick Foundation.
Copyright © 2015 Elsevier Ltd. All rights reserved.
... Multidomain lifestyle interventions including exercise are increasingly recognised as a promising dementia risk reduction strategy [5,31]. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was the first large-scale longterm randomized controlled trial to show that a 2-year multidomain lifestyle intervention -combining exercise, diet, cognitive training and vascular risk factor management could improve or maintain cognition in older adults at risk for dementia [31]. ...
... Multidomain lifestyle interventions including exercise are increasingly recognised as a promising dementia risk reduction strategy [5,31]. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was the first large-scale longterm randomized controlled trial to show that a 2-year multidomain lifestyle intervention -combining exercise, diet, cognitive training and vascular risk factor management could improve or maintain cognition in older adults at risk for dementia [31]. Cognitive benefits were also associated with better adherence to the intervention [32]. ...
... The detailed protocol and primary results have been previously published [33]. Participants were aged 60-77 years, had a Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score of ≥ 6 points -indicating higher dementia risk, and cognitive performance around the mean level or slightly lower than expected for age according to Finnish population norms [31]. Participants with dementia or conditions affecting safe participation were excluded. ...
Background
Physical activity (PA) and exercise interventions offer health benefits can reduce dementia risk. However, there might be barriers to engage in PA, such as sleep problems, depressive symptoms and pain, which are common complaints with older adults. We investigated sleep duration, sleep quality, depressive symptoms, and pain at baseline as potential determinants of: (i) adherence to the exercise intervention component of a 2-year multidomain lifestyle intervention; (ii) intervention’s effect on PA after 2 years; and (iii) overall PA after 2 years (exploratory analyses).
Methods
The FINGER trial included 1259 individuals at risk for dementia, aged 60–77 years who were randomized (1:1) to a multidomain lifestyle intervention (exercise, diet, cognitive training, vascular risk factor management) or a control (regular health advice) group. Logistic regression analyses were used with exercise adherence (adherent: ≥66% participation) or self-reported PA (active: ≥2 times/week) as outcomes, adjusted for relevant baseline characteristics. Data on PA at baseline and at 2-years were available for 1100 participants.
Results
Adherence to the exercise intervention was less likely with sleep duration < 6 h or ≥ 9 h per night compared with 7–8 h. OR (95% CI) were 0.46 (0.21–0.99) and 0.38 (0.20–0.74), respectively. The intervention group was more likely to be physically active than the control group at two years (OR 1.87, 95% CI 1.36–2.55). This intervention benefit did not significantly vary by baseline sleep duration, depressive symptoms, or pain (p > 0.3 for all interactions). Regardless of randomization group, those sleeping < 6 h were less likely to be physically active at two years, compared with participants sleeping 7–8 h (OR 0.36, 95% CI 0.18–0.72). Depressive symptoms or pain were not related to PA at two years.
Conclusions
Older adults with sleep problems, depressive symptoms, or pain may benefit from lifestyle interventions. However, both short and long sleep duration can pose barriers to engaging in exercise intervention and should be carefully considered when designing strategies to promote PA among older populations at risk for dementia.
Trial registration
The FINGER trial was registered at ClinicalTrials.gov with identifier NCT01041989 on 04/01/2010.
... As a possible mechanistic model for the MIND diet-cognitive relationship, the healthy diet components are supposed to decrease brain inflammation and brain oxidative stress by their anti-inflammatory and anti-oxidant properties. In the FINGER study [3], in which general lifestyle changes in regard to physical and cognitive activity also included the MIND diet as a specific brain-protective nutritional intervention, participants showed improvements in several cognitive domains after two years, whereas the most recent MIND diet single intervention trial for prevention in cognitive decline among older persons did not reveal any cognitive benefits after three years [4]. Not surprisingly, the MIND diet as a single intervention for preservation of cognitive health seems significantly empowered when combined with other healthy interventions such as exercise, cognitive training and strict monitoring of vascular risk factors. ...
... This weight loss is mainly due to a decrease in lean body mass possibly leading to sarcopenia. The most recent data confirm that intramuscular adipose tissue [3] -often seen in sarcopenia -may predict cognitive decline over the next six years, independent of overall adiposity or muscle health [10]. This disease-related muscle loss underlines the increased protein need among patients with dementia [11], which seems to be best prevented early on by leucine-enriched whey protein supplementation [12]. ...
... Among people referred to memory clinics, about one third report subjective cognitive complaints, i.e. complaints without objective cognitive impairment in neuropsychological tests. These people have an increased risk of developing a neurodegenerative disease and there is growing evidence that targeted interventions can have a positive influence on the ageing cognitive functions of these individuals [3]. Relying on modifiable lifestyle factors [14] currently appears to be an excellent and largely available opportunity for seniors and especially for those with subjective cognitive complaints. ...
Dementia diseases represent a major burden for the directly affected people, their relatives and modern society. Despite considerable efforts in recent years, early and accurate disease diagnosis and monitoring is still a challenge while no cure is available in most cases. New drugs, in particular disease-modifying therapies, and recent technological advancements offer promising perspectives. The integration of novel biomarkers, artificial intelligence and digital health tools has the potential to transform dementia care, making it more personalised, efficient and adapted to the living conditions and needs of older people. In November 2023, the 7th Dementia Summit convened a panel of experts from geriatrics, neurology, neuropsychology, psychiatry, ethics as well as general medicine to discuss interdisciplinary challenges, advancements and their implications for the future of dementia care in Switzerland. The conference underscored the importance of a multidisciplinary approach to successfully integrate new technologies in both clinical-translational research and dementia prevention, diagnosis and care. While recent innovations represent major steps forward, their implementation also comes with important challenges including questions on healthcare system preparedness and adaptation, ethical aspects, technology literacy, acceptance and appropriate use.
... Recent reports and studies have indicated that maintaining a healthy lifestyle can slow cognitive decline and reduce nearly half of the risk of dementia in late life. [12][13][14][15][16] Healthy lifestyles can also extend life expectancy. [17][18][19] In a study from the United States, healthy lifestyles were shown to extend life expectancy and delay the onset of dementia, indicating that healthy lifestyles may compress the duration of life lived with dementia. ...
... 20 However, the benefits of a healthy lifestyle for cognitive health, regardless of APOE ε4 carrier status, remain inconclusive. 12,[21][22][23][24] Moreover, these studies often exclude populations from developing countries and low-and middle-income regions, such as China, where dementia prevalence continues to rise. 16 ...
INTRODUCTION
Understanding the interplay between genetic factors and lifestyle choices in cognitive health is crucial for enhancing late‐life quality. This study examines the effects of Apolipoprotein E (APOE) genotypes and healthy lifestyles on life expectancy with and without cognitive impairment (CI) in Chinese older adults.
METHODS
Data from 6488 participants aged at least 65 in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed using continuous‐time three‐state Markov models. Cognitive function was assessed with the Mini‐Mental State Examination (MMSE).
RESULTS
APOE ε4 allele carriers had a higher risk of transitioning from cognitively healthy (CH) to impaired, while ε2 carriers had a reduced risk of transitioning from healthy to death. Participants with 4 or 5 healthy lifestyle factors experienced significant protective effects, extending the cognitively healthy life expectancy.
DISCUSSION
These findings underscore the importance of promoting healthy lifestyles to delay cognitive decline, regardless of genetic predispositions, particularly in the Asian context.
Highlights
Compared with ε3 homozygotes, APOE ε4 carriers in China have a higher risk of transitioning from CH to CI, and APOE ε2 carriers with CH have a lower risk of transitioning to death.
Healthy lifestyles can extend life expectancy, primarily extending CH life expectancy.
Healthy lifestyles reduce the risk of CI and delay its onset in later life, regardless of APOE genetic risk.
... 9,10 Motivation, including beliefs, attitudes, and knowledge of health promotion/disease prevention, is essential to engage and maintain healthy lifestyle behaviors, 11 Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). [12][13][14][15] However, most intervention studies include older (i.e., age 60+) adults, who might be more motivated to engage in healthy behaviors than people in midlife; nevertheless, studies report adherence as a main barrier. For example, FINGER reported a 12% dropout rate, with one of the main dropout reasons being lack of time or motivation (14%). ...
... For example, FINGER reported a 12% dropout rate, with one of the main dropout reasons being lack of time or motivation (14%). 12 Given that greater adherence has been associated with better cognitive trajectories and health-related quality of life, adherence is crucial for the success of dementia prevention programs. 16 Three overarching factors associated with adherence have been identified in the current literature, as shown in Figure 1: intrinsic factors (e.g., motivation, dementia knowledge, and self-efficacy); extrinsic factors (e.g., family history of dementia); and demographic characteristics (e.g., age, sex/gender, and education). ...
Introduction
Intrinsic motivation is critical for dementia prevention but remains poorly understood.
Methods
A total of 347 middle‐aged adults completed questionnaires on intrinsic factors for dementia prevention, demographics, dementia risk, and healthy lifestyle behaviors. Latent profile analysis (LPA) grouped participants with similar intrinsic patterns. Subgroup differences in demographics, extrinsic factors, and healthy behaviors were examined.
Results
LPA identified four intrinsic profiles: Profile 1 had low motivation; Profile 2 had high motivation and self‐efficacy, but poor dementia knowledge; Profile 3 had moderate motivation; and Profile 4 had low motivation and high apathy. Subsequent analyses showed that profiles further differed on extrinsic factors, demographic characteristics, and engagement in health behaviors. Specifically, Profile 1 had the lowest dementia risk, best sleep quality, and least loneliness; Profile 2 had the highest income, greater dementia risk, highest cognitive activity, and greatest loneliness; Profile 3 had more caregiving experience and moderate engagement in all healthy behaviors; and Profile 4 had lower incomes, the worst health, and lowest engagement in all healthy behaviors.
Discussion
Results identified groups of middle‐aged adults with distinct intrinsic patterns who also differed in demographic/extrinsic factors and health behaviors. These profiles may benefit from different types of intervention strategies for dementia prevention.
... The most notable outcome was the enhanced improvement in cognitive function among participants who received both Fitbit-based activity monitoring and nutritional tracking, as evidenced by the significantly greater increase in MoCA scores compared to the control group (1.1 (0.7 to 1.5) vs 0.2 (-0.2 to 0.5), p=0.0004). This finding aligns with previous research by Ngandu et al. (2015), which demonstrated that combined lifestyle interventions targeting both physical activity and nutrition tend to yield superior cognitive outcomes compared to single-domain interventions. ...
... Notably, the subgroup that received opt-in notifications related to nutrition experienced even greater improvements, highlighting the effectiveness of the intervention's approach targeting multiple areas, including exercise, sleep, and nutrition. For example, the FINGER trial demonstrated that a 2-year multidomain intervention, incorporating physical activity, cognitive training, and dietary guidance, improved cognitive performance and slowed decline in older adults at risk for dementia [Ngandu et al., 2015;Rosenberg et al., 2018]. ...
Background
As the global population ages, there is an increasing demand for effective strategies to maintain and improve health among older adults. Wearable technology presents a promising tool for health monitoring and management, yet its effectiveness in comprehensive health improvement for older adults remains uncertain.
Objective
This study aimed to evaluate the effectiveness of personalized lifestyle notifications, based on wearable device recorded data, in improving health outcomes, specifically cognitive and physical function, among older adults, compared to usual care.
Methods
In a 6-month randomized controlled trial, 355 older adults (aged 65+), including those with frailty, were randomly assigned to an intervention group ( n =178) or a control group ( n =177). The intervention group wore Fitbit Charge 5 devices and received personalized lifestyle alerts with rule-based personalization, using thresholds derived by human experts, throughout the 6-month period. The control group received no such notifications and were instructed not to use wearable devices. Some opt-in subjects, an intervention group ( n =128) or a control group ( n =116), were requested to record all meals using the application to deliver nutritional alerts. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Physical function was evaluated using Fried Frailty Phenotype criteria. Measurements were conducted at baseline and after 6 months.
Results
In the intention-to-treat analysis, the intervention group showed significant improvements in general cognitive function (MoCA scores increased by 1.0 (95% CI: 0.6 to 1.3) vs 0.2 (−0.2 to 0.5) in the control group, p =0.011) and frailty status (Fried frailty phenotype index change: −0.3 (−0.5 to −0.2) vs −0.1 (−0.2 to 0.1) in the control group, p =0.029). Subgroup analysis of participants with nutritional tracking showed significant improvements in MoCA scores (1.2 (0.8 to 1.6) vs 0.2 (−0.2 to 0.5), p =0.0004) and frailty status (−0.3 (−0.5 to −0.2) vs 0.0 (−0.2 to 0.1) in the control group, p =0.009). The per-protocol analysis showed similar results.
Conclusion
This study provides evidence that personalized, multifaceted Fitbit-based interventions can effectively enhance cognitive function, with notable improvements specifically in MoCA scores, and mitigate frailty progression in older adults as expected. These findings suggest that comprehensive lifestyle interventions including exercise, sleep and nutrition using wearable technology may be valuable for promoting healthy aging.
... Several multidomain intervention studies have utilized a combination form of cognitive, exercise, and nutritional interventions. For instance, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) included older adults at risk of cognitive decline, indicating that multidomain intervention could reduce the occurrence of cognitive impairment and cardiovascular events [10,11]. The Frailty Intervention Trial (FIT) in Singapore developed by Tze Pin Ng et al. demonstrated a 6-month multidomain intervention significantly decreased the severity of frailty and sarcopenia in pre-frail and frail older adults [12,13]. ...
Background
The exploration of interventions to delay aging is an emerging topic that promotes healthy aging. The multidomain intervention has the potential to be applied in the field of aging because it concentrates on the functional ability of older adults. There is currently no literature reporting on a multidomain intervention involving cognition, exercise and nutrition for delaying aging.
Methods
The Multidomain Intervention for Delaying Aging in Community-dwelling Older Adults (MIDA) is a Zelen-design randomized controlled trial with a 6-month intervention duration. The multidomain intervention comprises cognitive training, exercise training, and nutritional guidance, delivered through both group sessions and individual family interventions. A total of 248 participants aged 60 to 85 years will be randomized to the intervention group or control group and followed up for 12 months. The primary outcome is the change in epigenetic age acceleration and pace of aging following the multidomain intervention. The secondary outcomes are the changes in frailty score and intrinsic capacity Z-score. Other outcomes include physical functions, body composition, aging biomarkers, inflammatory markers, haematology and biochemistry parameters, and lifestyle factors.
Conclusions
This study will explore the effects of the multidomain intervention on delaying aging in community-dwelling older adults. We aim to introduce a new approach to delaying aging and offer a practical multidomain intervention strategy for healthcare institutions.
... The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was the first long-term randomized controlled trial (RCT) aimed at assessing a multidomain approach to prevent cognitive decline (Ngandu et al., 2015). In this large RCT, participants in the intervention group received an intensive multidomain intervention while participants in the control group received regular health advice (Kivipelto et al., 2013). ...
Multidomain lifestyle interventions hold promise for preventing cognitive decline, but personalized approaches are essential for (maintaining) behaviour change and adherence. The Dutch FINGER-NL trial is based on the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) and includes 7 lifestyle intervention components, supported by technological elements. This study describes older adults’ motivations and attitudes regarding participation and lifestyle changes at the start of the FINGER-NL trial. This study followed a qualitative descriptive design, using in-depth, semi-structured interviews with 40 purposively selected participants of the FINGER-NL trial. Thematic analysis was applied. For theme (1) 'Reasons to participate', most participants mentioned personal gain, aiming to improve cognitive and physical health. Dementia prevention was a key motivator, driven by concerns about ageing, cognitive decline, and a desire for behavioural change. Public interest and contributing to a broader societal solution were also mentioned. Knowledge about dementia (prevention) was limited, and perceptions were largely shaped by personal experiences of dementia with close ones. In theme (2) 'Contextual factors influencing participation' are discussed, including work, living situation, and health conditions. According to participants, the main 'Lifestyle-related areas for improvement', theme (3), were diet and physical activity, followed to a lesser extent by cognition, sleep, social activities, and stress management. Theme (4) 'Expectations regarding FINGER-NL' discussed barriers to change which included physical health of participants, time constraints, established habits, and financial limitations. Participants emphasized the need for counselling, coaching in diet and exercise, experiencing positive effects of lifestyle change, participation in group setting and practical aspects, such as appointment reminders to support their commitment and adherence to the study. Participants held different experiences and opinions regarding 'Use of technology', theme (5). Personal experiences with dementia strongly influenced the motivation to participate in FINGER-NL, creating urgency for behaviour change. Participants expressed the wish to receive tailored interventions addressing individual needs and circumstances. Longitudinal follow-up within FINGER-NL promises valuable insights for future interventions.
... It is crucial to point out that despite SCD is linked to more serious and progressive cognitive decline, such as dementia and mild cognitive impairment, it does not mean that persons with SCD will necessarily develop dementia in their later years [1]. Previous studies have indicated that prompt identifcation and early intervention with individuals who may be at risk of developing SCD may efciently delay the onset of dementia [1,16,17]. Several tools have been developed to evaluate SCD, such as the Subjective Cognitive Decline Questionnaire (SCD-Q) and Subjective Cognitive Decline in Ageing (SCDA) scale [18,19]. Routine use of these screening tools can help track changes and pinpoint individuals at high risk who need further clinical evaluation and follow-up. ...
Background: Subjective cognitive decline (SCD) is a self-reported perception of cognitive deterioration in individuals who are cognitively normal. Cognitive functions keep steady during adulthood up until around age 40; thereafter, individuals are more likely to experience cognitive decline. SCD is viewed as a possible early sign of Alzheimer’s disease and other forms of dementia. Early detection and intervention addressing SCD could delay the onset of mild cognitive impairment and dementia. Several tools have been developed and evaluated for the phenomenon of SCD in different countries; however, limited research findings can be found in Hong Kong.
Objective: To investigate the prevalence of SCD among middle-aged and older adults in Hong Kong and identify the related factors contributing to its occurrence.
Methods: A cross-sectional survey was undertaken from December 2023 to January 2024 to 200 individuals living in Hong Kong aged 50 years or older. The respondents filled out a questionnaire that collected demographic information, including gender, age, education level and health status. They also completed the Subjective Cognitive Decline Questionnaire-21. Descriptive analysis, logistic analysis and factor analysis were conducted in this study.
Results: A total of 200 samples were collected, of which 122 were classified as having SCD, leading to a prevalence rate of 61% that exceeds that of neighbouring countries. SCD was correlated with the self-rated health score. The Cronbach’s alpha was 0.905. The findings demonstrated significant differences in response to patterns between the two scoring groups for all questions. The results of the factor analysis confirmed the reliability of the four-factor structure, reinforcing the strength of the scale.
Conclusion: The study analysed the prevalence of SCD among middle-aged and older adults in Hong Kong as well as explored the relationship between various factors and SCD. The initial insights gained from the questionnaire will inform the future development of more comprehensive and effective solutions to address cognitive decline in older adults in Hong Kong.
... Recent research has increasingly emphasized the significance of WMH as a key marker of cerebrovascular health, with studies like FINGER demonstrating its value in predicting cognitive outcomes (Ngandu et al. 2015). The quantification of WMH volume has emerged as a critical metric in large-scale clinical trials and population studies (Griffanti et al. 2018;Chen et al. 2019), highlighting the need for efficient assessment tools. ...
White matter hyperintensities (WMH) are neuroimaging markers linked to an elevated risk of cognitive decline. WMH severity is typically assessed via visual rating scales and through volumetric segmentation. While visual rating scales are commonly used in clinical practice, they offer limited descriptive power. In contrast, supervised volumetric segmentation requires manually annotated masks, which are labor‐intensive and challenging to scale for large studies. Therefore, our goal was to develop an automated deep‐learning model that can provide accurate and holistic quantification of WMH severity with minimal supervision. We developed WMH‐DualTasker, a deep learning model that simultaneously performs voxel‐wise segmentation and visual rating score prediction. The model employs self‐supervised learning with transformation‐invariant consistency constraints, using WMH visual ratings (ARWMC scale, range 0–30) from clinical settings as the sole supervisory signal. Additionally, we assessed its clinical utility by applying it to identify individuals with mild cognitive impairment (MCI) and to predict dementia conversion. The volumetric quantification performance of WMH‐DualTasker was either superior to or on par with existing supervised methods, as demonstrated on the MICCAI‐WMH dataset (N = 60, Dice = 0.602) and the SINGER dataset (N = 64, Dice = 0.608). Furthermore, the model exhibited strong agreement with clinical visual rating scales on an external dataset (SINGER, MAE = 1.880, K = 0.77). Importantly, WMH severity metrics derived from WMH‐DualTasker improved predictive performance beyond conventional clinical features for MCI classification (AUC = 0.718, p < 0.001) and MCI conversion prediction (AUC = 0.652, p < 0.001) using the ADNI dataset. WMH‐DualTasker substantially reduces the reliance on labor‐intensive manual annotations, facilitating more efficient and scalable quantification of WMH severity in large‐scale population studies. This innovative approach has the potential to advance preventive and precision medicine by enhancing the assessment and management of vascular cognitive impairment associated with WMH.
... Increasing evidence supports the effectiveness of multi-domain healthy lifestyle interventionsincluding physical activity, healthy diet, cognitive stimulation, social engagement, and health control-to treat and prevent NCDs, reduce stroke risk, and enhance cognitive reserve (9)(10)(11). In Chile, despite the presence of public primary prevention programs for NCD, there has been a significant increase in the prevalence of diabetes and obesity in the past decade (12,13). ...
Accepted Pre-print available at: https://preprints.jmir.org/preprint/71936/accepted
The final accepted version (not copyedited yet) will appear shortly on 10.2196/71936
... Dementia and Alzheimer's disease (AD) present an escalating public health challenge [ 1 , 2 ]. In light of recent advancements in diagnostic cri- [6][7][8][9][10][11][12][13]. For some targeted therapies, the presence of amyloid positive status is mandatory [ 14 , 15 ]. ...
... The multidomain intervention included diet, exercise, cognitive training, vascular risk monitoring, and encouragement for social connectedness. Findings from this study suggest that a multicomponent intervention could improve or maintain cognitive functioning in at-risk older adults, showing that those in the intervention group had approximately 30% less cognitive decline overall, with statistically significant differences in executive function and processing speed, but not memory [40]. ...
Purpose of Review
This review will discuss review normal aging and inform clinicians on how to advise their patients on best practices for limiting functional decline.
Recent Findings
Lifestyle, diet and social interactions can help patients limit functional and mental decline and improve their quality of life. Furthermore, Clinicians can play a large role in framing the process of aging and helping patients frame aging in a positive manner.
Summary
By removing negative stigma around aging, clinicians can help patients focus on what they are able to do and empower patients to take advantage of lifestyle changes that can improve their health
... Проведенное исследование FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability -Финляндское гериатрическое интервенционное исследование) с включением 1 260 пожилых лиц без деменции, рандомизированных в 2 равные группы, продемонстрировало, что изменение образа жизни (оптимизация питания, повышение физической активности и когнитивное стимулирование) приводит к достоверному уменьшению темпов прогрессирования сосудистых когнитивных нарушений [10,22]. ...
In conditions of increasing life expectancy, its quality is important, regardless of age. Due to the progressive growth of the aging population, the prevention of cognitive decline has become particularly relevant. Presumably moderate cognitive impairment occurs among people aged 60 years and older in 10–36.7% of cases. With age, involutive brain processes occur, which, in combination with microangiopathy, leads to the development of chronic cerebral ischemia (CCI). The core of this pathology is a cognitive disorder in combination with mental, non-cognitive (emotional-affective, behavioral, psychotic) neuropsychiatric manifestations. It is important to maintain cognitive and mental health, and this can be achieved by influencing potentially modifiable risk factors for dementia. Thus, in the report of the permanent commission on dementia prevention, intervention and patient care of the Lancet magazine, in 2024, 14 modifiable risk factors for dementia were identified, the share of which amounted to 45% of all factors: low level of education, hearing loss, hypertension, obesity, tobacco smoking, depression, physical inactivity, social isolation, diabetes mellitus, high LDL cholesterol, alcohol abuse, traumatic brain injury, air pollution and vision loss. To influence them, it is necessary to increase physical activity, cognitive stimulation, normalization of sleep, compliance with dietary recommendations, correction of vision and hearing, control of blood pressure, etc. It is equally important to follow the doctorеs prescriptions for taking the necessary lipid-lowering, antihypertensive, antiplatelet therapy, depending on the concomitant pathology, as well as neurotrophic, vasoactive, antioxidant drugs. 2 clinical cases are given as an illustration. The drugs of choice for the correction of cognitive and neuropsychological disorders should be highly effective drugs with a good safety profile. Combined medicines have advantages due to the synergism of the action of its components, increasing the patient’s adherence to treatment, and eliminating polypragmasia.
... Cognitive frailty has been reported to increase the risks of adverse health outcomes, such as all-cause mortality, functional disability, dementia, poor quality of life, and suicidal ideation [2,[4][5][6][7][8][9][10]. Specifically, older adults with CF, relative to those with either frailty or cognitive impairment alone, face an elevated risk of developing dementia and limitations of activities of daily living (ADLs) [8][9][10]. To prevent dementia and disability in older adults, an effective strategy is to implement intervention programs targeting those diagnosed with CF [11,12]. ...
Background
Several cognitive-frailty (CF) measurements, such as traditional CF, the CF phenotype, physio-cognitive decline syndrome (PCDS), and motoric cognitive risk syndrome (MCRS) have been developed but their predictive abilities for incident dementia and incident disability are seldom compared. We conducted a 2-year prospective study to compare the associations of traditional CF, the CF phenotype, PCDS, and MCRS with incident dementia and incident disability.
Methods
In total, 755 individuals aged 65 years or older, without preexisting dementia or disability, participated in the baseline assessment and were subsequently monitored over a 2-year period. Data on cognitive and frailty components of traditional CF, the CF phenotype, PCDS, and MCRS, were collected. The logistic regression model was used to investigate independent associations of each CF measure with incident dementia and incident disability.
Results
In total, 505 participants completed the two annual follow-ups. After adjusting for other CF measures, age, and sex, incident dementia was significantly associated with PCDS (odds ratio [OR] = 2.54; 95% confidence interval [CI], 1.25 ~ 5.19) but was not significantly associated with traditional CF, the CF phenotype, or MCRS, and incident disability was significantly associated with the CF phenotype (OR = 2.90; 95% CI, 1.59 ~ 5.30) but was not significantly associated with traditional CF, PCDS, or MCRS. After adjusting for other CF measures, age, sex, educational level, and other variables, incident dementia was not independently associated with any CF measure, while the association of incident disability with the CF phenotype remained significant (OR = 2.72; 95% CI, 1.45 ~ 5.11).
Conclusions
The CF phenotype, MCRS, and PCDS can possibly identify a higher number of CF cases than can the traditional CF measure. While the CF phenotype was a significant predictor of incident disability, all four CF measures lacked an independent association with incident dementia over a 2-year period. Future studies with a longer study period are needed to validate our results.
... These factors included impairment in brief cognitive screening tests (defined as a Fototest score ≤ 35 [22] and/or a memory alteration test [M@T] score ≤ 40 [23,24]) and/or a subjective perception of cognitive decline within the last year, assessed using the final 12 items of the Saykin Cognitive Change Index (CCI) with a score ≥ 20 [25]. The selection of a CAIDE index score of ≥6 as an inclusion criterion was based on the design of the FINGER study [26], aiming to identify individuals at higher risk for future cognitive decline. This score indicates that, in addition to age and sex (if male), at least one additional risk factor for cognitive decline is present. ...
Background: Aging is a well-established independent risk factor for both cognitive impairment and sleep disorders, including obstructive sleep apnea (OSA), a modifiable yet underrecognized condition. OSA has been implicated in biological mechanisms contributing to Alzheimer’s disease, including amyloid-β accumulation, tau phosphorylation, and neuroinflammation. This underscores the need to optimize OSA diagnosis in individuals with an increased risk of dementia. Methods: This cross-sectional observational study enrolled adults aged 60–85 years with a CAIDE dementia risk score ≥6. Subjective sleep was evaluated using validated questionnaires (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the Oviedo Sleep Questionnaire), while objective sleep data were obtained through a single-night peripheral arterial tonometry (PAT)-based wearable device, complemented by a 7-day sleep diary. Participants also completed the STOP-BANG and Berlin questionnaires, with clinically relevant findings communicated to participants. Results: Among 322 participants (48.8% women; mean age 71.4 ± 6.4 years), moderate-to-severe OSA (apnea–hypopnea index [AHI] ≥ 15) was identified in 48.49%, despite the absence of prior diagnoses. Subjective screening tools frequently underestimated OSA severity compared to objective assessments. While no significant sex-based differences were noted, higher AHI values correlated strongly with increased body mass index and elevated dementia risk scores. Conclusions: A marked discrepancy between subjective and objective sleep measurements complicates the accurate diagnosis and management of most sleep disorders, including OSA. Sleep disorders remain significantly underdiagnosed in individuals at increased risk for dementia. Integrating wearable technologies and structured tools such as sleep diaries into routine assessments can enhance diagnostic precision, enabling timely interventions for these modifiable risk factors of dementia.
... Trials have focused on multi-domain interventions to modify vascular and lifestyle risk factors. For example, the FINGER trial found that diet, exercise, cognitive training, vascular risk monitoring resulted in improved or maintained cognitive function among the test group compared with controls but did not report sub-analyses by gender or ethno-cultural group, and did not assess how to widely scale up this intervention [53]. This work led to World-Wide FIN-GERS, a global network for dementia prevention trials, which aims to culturally-adapt FINGER-like interventions, but this appears to be based on the conduct of trials in 40 different countries, some of which focus on the elderly and some on rural communities, but none focus on ethno-culturally diverse women [54] -External Latino community liaisons were consulted to gather insights on preferences and barriers within the community -Lecture was delivered in English and Spanish -Lecture took place in a local community organization specialized in assisting the Latino community -Content was adapted to accommodate cultural nuances and preferences, including incorporating interactive activities, videos on Alzheimer's symptoms, assessment, and brain health promotion -Colloquial language and pictorial slides were utilized to cater to diverse literacy levels -Resources related to brain health, treatment, and caregiving services were included in the intervention to address community-specific needs and facilitate access to relevant support services -Presenters belonged to a Latino health research institution with a history of community engagement and partnership-building -Community members engaged in developing program -Used first language -Used plain/familiar language -Used visual aids -Included social interaction -Held in local, familiar community organization -Presenters of same ethno-cultural background -Presenters known to participants -Provided information about support services to overcome community-specific barriers Lincoln [40] Incorporated culturally tailored text messages designed specifically for African Americans, with African colloquialisms, idioms, tenses, style, language, and content ...
Background
Raising awareness about dementia risk reduction is particularly important for ethno-culturally diverse or immigrant women, who have greater risk of dementia compared with men due to multiple interacting factors. We aimed to synthesize prior research on culturally-safe strategies to raise diverse women’s awareness of dementia risk reduction.
Methods
We conducted a theoretical review. We searched for studies published up to April 2023 included in a prior review and multiple databases. We screened studies and extracted data in triplicate, informed by existing and compiled theoretical frameworks (WIDER, RE-AIM, cultural safety approaches) and used summary statistics, tables and text to report study characteristics, and strategy design, cultural tailoring, implementation and impact.
Results
We included 17 studies published from 2006 to 2021. Most were conducted in the United States (15, 88%), before-after cohorts (7, 41%), and included African, Caribbean or Latin Americans (82%). No studies focused solely on women (median women 72%, range 50% to 95%). All strategies consisted of in-person didactic lectures, supplemented with interactive discussion, role-playing, videos and/or reinforcing material. Strategies varied widely in terms of format, delivery, personnel, and length, frequency and duration. Details about tailoring for cultural safety were brief and varied across studies. Ten approaches were used to tailor strategies, most often, use of target participants’ first language. Assessment of implementation was limited to reach and effectiveness, offering little insight on how to promote adoption, fidelity of implementation and longer-term maintenance of strategies. Strategies increased knowledge of dementia and decreased misconceptions, but did not prompt participants to seek dementia screening in the single study that assessed behaviour.
Conclusions
While this review revealed a paucity of research, it offers insight on how to design culturally-safe dementia risk reduction strategies that may be suitable for ethno-culturally diverse or immigrant women. Healthcare professionals can use these findings to inform policy, clinical guidelines and public health programs. Future research is needed to establish the ideal number, length and duration of sessions, and confirm strategy effectiveness for diverse women.
... Different dementia prevention initiatives have already been developed around the world starting in the early 2000s [9][10][11]. While these studies focused on single domain interventions and revealed controversial results, the worldwide first statistically significant randomized controlled trial concerning dementia prevention (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, FINGER study) demonstrated that a multidomain treatment consisting of physical activity, cognitive stimulation, nutritional advice and the monitoring of medical risk factors could successfully prevent cognitive decline [12]. Based on these findings, the World Health Organization (WHO) urged all countries to develop dementia prevention strategies [13]: however, it has been stressed that such prevention initiatives must be culturally adapted to different settings [14]. ...
Background
Changes in lifestyle could reduce dementia cases by 45%. Successful international prevention initiatives show the importance of involving primary target groups early in the process of program development.
Objective
The aim of this study was to explore (1) the knowledge about dementia/brain health, (2) offers of activities related to dementia prevention in the community and (3) the feasibility of introducing the experience of art as a brain health-promoting method in a sample of community-dwelling older persons.
Material and methods
Senior volunteers from the community were invited to a workshop and a follow-up telephone interview. During the workshop, participants received expert input on dementia/brain health followed by several group discussion rounds using a “World Café” approach. After 6 weeks, participants were invited to a structured telephone interview.
Results
A total of 26 persons participated in the workshop, 20 of whom (mean age: 70.60 years) took part in the telephone interview. The workshop data revealed 4 main needs: (1) more information on dementia/brain health (2) a broader offer of activities for physical/mental stimulation in the community (3) the definition of a “brain health strategy”, and (4) development of specific services to experience art. The telephone interviews revealed a high motivation to start with dementia prevention but appropriate services are missing in the communities.
Conclusion
Our findings provide first insights into attitudes towards dementia prevention/brain health in an Austrian sample of senior citizens. People need information about the potential of dementia prevention and specific services need to be developed in the communities.
... Despite the substantial burden of AD, both pharmacological and non-pharmacological therapies, such as cognitive training, meditation, and nutritional changes, have shown limited efficacy in slowing cognitive decline and preventing dementia. This underscores the urgent need for effective and innovative therapeutic strategies [8][9][10]. Advancements in Qiuzhi Zhou and Weixia Wang contributed equally to this work. ...
The presence of hyperphosphorylated Tau proteins, which mislocalize and form neurofibrillary tangles, and the accumulation of amyloid-β plaques are hallmark features of Alzheimer’s disease (AD). These toxic protein aggregates contribute to synaptic impairment and neuronal dysfunction, underscoring the need for strategies aimed at effectively clearing or reducing these aggregates in the treatment of AD. In recent years, proteolysis targeting chimera (PROTAC) technology has emerged as a promising approach for selectively degrading dysfunctional proteins rather than merely inhibiting their function. This approach holds great potential for developing more effective interventions that could slow AD progression and improve patient outcomes. In this review, we first examine the pathological mechanisms underlying AD, focusing on abnormal protein degradation and accumulation. We then explore the evolution of PROTAC technology, its mechanisms of action, and the current status of drug development. Finally, we discuss the latest findings regarding the application of PROTACs in AD therapy, highlighting the potential benefits and limitations of this technology. Although promising, further clinical research is necessary to fully assess the safety and efficacy of PROTAC-based therapies for AD treatment.
... Our results particularly support calls for culturally adapted interventions that leverage existing family and social networks while addressing social and systemic barriers to healthcare access. Large-scale intervention studies have demonstrated that multicomponent approaches addressing multiple risk factors can significantly reduce cognitive decline, 73 and could be a promising approach to Hispanic populations. These patterns suggest the need for comprehensive intervention strategies that address multiple SDOH domains simultaneously. ...
Alzheimer's disease and related dementias (AD/ADRD) represent a growing healthcare crisis affecting over 6 million Americans. While genetic factors play a crucial role, emerging research reveals that social determinants of health (SDOH) significantly influence both the risk and progression of cognitive functioning, such as cognitive scores and cognitive decline. This report examines how these social, environmental, and structural factors impact cognitive health trajectories, with a particular focus on Hispanic populations, who face disproportionate risk for AD/ADRD. Using data from the Mexican Health and Aging Study (MHAS) and its cognitive assessment sub study (Mex-Cog), we employed ensemble of regression trees models to predict 4-year and 9-year cognitive scores and cognitive decline based on SDOH. This approach identified key predictive SDOH factors to inform potential multilevel interventions to address cognitive health disparities in this population.
... A measure of the intensity of the intervention that combines the dose delivered (i.e., total number of sessions) and the length of the intervention may be more useful for comparing adherence to different multimodal interventions. Among large multimodal intervention studies, the FINGER is the only one that demonstrated benefits on cognition [24]. The Multimodal Alzheimer Preventive Trial (MAPT) [9] and the Prevention of Dementia by Intensive Vascular Care (PreDIVA) [14], for example, reported no intervention effect on their primary cognitive outcomes. ...
Preventing dementia and Alzheimer’s disease (AD) is a global priority. Multimodal interventions targeting several risk factors and disease mechanisms simultaneously are currently being tested worldwide under the World-Wide FINGERS (WW-FINGERS) network of clinical trials. Adherence to these interventions is crucial for their success, yet there is significant heterogeneity in adherence reporting across studies, hindering the understanding of adherence barriers and facilitators. This article is a narrative review of available evidence from multimodal dementia prevention trials. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: nonpharmacological multimodal interventions (i.e., combining three or more intervention domains), targeting individuals without dementia, and using changes in cognitive performance and/or incident mild cognitive impairment or dementia as primary outcomes. Based on the findings, we propose future adherence reporting to encompass both participation (average attendance to each intervention component) and lifestyle change using dementia risk scores (e.g., the LIBRA index). Moreover, we provide an estimation of the expected intensity of multimodal interventions, defined as the ratio of the expected dose (i.e., the overall amount of the intervention offered specified in the trial protocol) to duration (in months). Adjusting the expected dose by average adherence enables estimation of the observed dose and intensity, which could be informative for identifying optimal dosage thresholds that maximize cognitive benefits across different populations. Finally, this article provides an overview of the determinants of adherence to multimodal interventions, emphasizing the need for improved adherence reporting to inform the design and implementation of precision prevention interventions.
... The discussion did however highlight the strongest recommendation to date, supported by the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, relative to the preventive efficacy of a multi-domain intervention strategy, whose initial results (at two years) are promising. 28 Individual participants commented that the control of metabolic and cardiovascular risk factors, despite achieving high consensus, may have a relatively limited impact at an advanced age, when the cognitive deficit is already present. The lower consensus on the lack of evidence as to the efficacy of nutritional supplements (consistent with the Italian guidelines' recommendations against their use) probably stems from the findings of one particular randomized controlled trial involving a multinutrient, which effectively reduced functional and cognitive decline in the prodromal phase of AD compared to placebo, despite not achieving statistical significance in its primary outcome. ...
Background
Strategies to identify and treat mild neurocognitive disorder (mild NCD) are still unclear.
Objective
The detection and management of mild NCD are crucial to prevent or delay its progression to major NCD, and to help those affected cope with cognitive impairment. The Cartesio Project aimed to reach a consensus on the management of mild NCD in primary care.
Methods
The Advisory Board of five experts (three neurologists, one geriatrician and one general practitioner (GP)), identified four domains of mild NCD: case finding; differential diagnosis; non-pharmacological, and pharmacological intervention. A literature review was performed by consulting the PubMed, PsycNET and Scopus databases from 2017 until August 2022, and guidelines, reviews and meta-analyses on mild NCD were reviewed. A care pathway involving 18 statements was then proposed and voted on by 61 participants (39% neurologists, 31% geriatricians, 25% GPs and 5% psychiatrists).
Results
Agreement was reached on 14 out of 18 statements. The practice of case finding in primary care and the need for a two-level diagnostic approach was supported, including referral to memory clinics. With regard to non-pharmacological treatments, no consensus was reached on nutritional supplementation. There was support for the use of nootropic drug treatments, but not for drugs to treat Alzheimer's disease.
Conclusions
The Cartesio Project developed a consensus to identify the best care for mild NCD. The consensus highlights educational interventions on timely detection and appropriate management of mild NCD in primary care, which may be of relevance for those patients who eventually develop Alzheimer's disease.
... Face-to-face or supervised programs targeting modifiable risk factors [6][7][8] have been developed and reported to have a positive effect on cognition in older adults at risk for dementia [ 9 ]. However, providing supervised or face-to-face interventions is costly and logistically challenging. ...
Background:
Online educational programs focused on ways to improve brain health could increase participant literacy, empowerment, and engagement in activities that support personal brain health, potentially reducing dementia risk.
Objectives:
Our goal was to develop an evidence-based online educational program with a focus on risk and protective factors for dementia. Here we present the rationale and features of the program and include results from a pilot study that assessed usability and acceptability.
Design:
This project is part of the Can-Thumbs UP (CTU) initiative. An Intervention Mapping Approach framework and co-construction approach was used to develop the online program. A pre-post pilot open label design was used to test the usability and acceptance of this at-home educational program.
Setting:
The program and assessment for the pilot study were delivered fully remotely.
Participants:
Twenty community-dwelling older adults (60-83 years of age, 65 % female) living in Canada who were at increased risk of dementia.
Program:
The Brain Health PRO/Santé Cerveau PRO is a web-based 45-week program available in French and English. It provides general information and guidance on seven modifiable risk factors for dementia: physical activity, nutrition, cognitively stimulating activities, sleep, social and psychological health, vascular health, and vision/hearing. After completing a brief intake questionnaire, users are provided with an individualized risk profile to personalize priorities and goals. During the course of the program, users receive feedback on lifestyle changes. For this pilot study, participants completed a 15-week version of the program.
Measurements:
This pilot study reports measures of usability (System Usability Scale), acceptance (Technology Acceptance Model-2) as well as risk profiles at intake based on self-reported questionnaires.
Results:
Two logic models were developed to identify the determinants of risk for dementia and how these could be targeted by the program. A review of dementia risk and protective factors and online educational programs for older adults, as well as co-creation activities with experts, stakeholders, and citizen advisors, were used to identify the determinants, target, format, and content of the program. The pilot study reports excellent usability and acceptance with scores of 80.4/100 and 93.5/120 respectively.
Conclusion:
Intervention mapping and co-construction approaches facilitated the design of a program that effectively balances the delivery of scientific content with the specific constraints, needs and abilities of older adults.
Trial registration:
NCT05347966.
... training, and vascular risk monitoring. In comparison to the control group receiving general health advice, the FINGER trial found that cognitive function was maintained in a group of participants at risk of cognitive decline 12 ; however, two other large-scale, multidomain randomized controlled trials targeting improvements in cognitive function or reduction in dementia incidence primarily reported negative results, with no significant improvements in cognitive function or reduction in dementia incidence across the entire study population 13,14 . Nevertheless, post-hoc analyses of both studies indicated that the multidomain interventions had positive effects on individuals with a higher risk of dementia, such as those experiencing mild cognitive impairment (MCI) or subjective cognitive decline (SCD) 15 . ...
Multidomain lifestyle interventions can improve cognitive function and mobile health technologies can deliver cost-effective interventions. We developed the smartphone app, Cognitive Evergreenland, to promote cognitive health in people at high risk of dementia, and assessed its usability. Functional modules were selected using a behaviour change wheel (BCW) theory-based method. Target behaviors were assessed by literature review and focus group interviews. Findings were mapped onto the Capability, Opportunity, and Motivation—Behaviour (COM-B) model and Theoretical Domains Framework, identifying behaviors requiring change and linking them to intervention functions. Behavior change techniques (BCTs) considered likely to be effective were selected, and corresponding COM-B components and BCTs translated into application functionalities. The app was optimized based on user feedback collected by interview and evaluated using “Mobile Health App Usability Questionnaire for Standalone mHealth Apps (Patient Version)”. Promoting adherence to multidomain lifestyle interventions required changes in physical and psychological abilities, reflective and automatic motivation reinforcement, and social and physical opportunities provision. We identified seven key intervention functions and selected 16 BCTs. Finalized Cognitive Evergreenland modules included health education, cognitive stimulation, cognitive training, interactive communication, health diary, functional assessment, and personal profile. Target users indicated overall satisfaction with usability. BCW theory application facilitated Cognitive Evergreenland development.
Recent technological advances have introduced novel therapeutic interventions for Alzheimer’s disease (AD). This study introduces a novel virtual reality (VR) intervention consisting of aesthetically pleasing and relaxing immersive videos paired with evocative music for patients with or without cognitive decline. The goal of this intervention is to improve the mood, evoke autobiographical memories in, and enhance the overall well-being of elderly individuals, across stages of cognitive decline (from absent to severe). Twenty-one elderly participants (5 cognitively healthy, 13 with a mild cognitive decline, 2 with a moderate decline, and 1 with a severe decline) were exposed to immersive 360-degree videos depicting both familiar and unfamiliar, pleasant and calming environments, accompanied by emotionally evocative, pleasant, and soothing music. The results demonstrated high levels of immersion and predominantly positive emotional responses, with several participants reporting autobiographical memory recall triggered by the VR stimulation. Statistical analysis revealed a significant improvement in mood over time, regardless of cognitive status, supporting the effectiveness of the intervention. While there were some side effects of fatigue or transient anxiety, the experience was generally perceived as engaging and meaningful. This feasibility study adds to the acceptability and potential clinical utility of VR interventions and provides a justification for future larger trials aimed at the integration of immersive technologies into cognitive rehabilitation interventions for individuals at different stages of cognitive decline.
Objective
A healthy lifestyle has been shown to mitigate cognitive decline in patients with mild cognitive impairment, with family caregivers playing a pivotal role in the patients’ lifestyle management. Exploring the level of dementia risk reduction lifestyle and the influencing factors at both the patient and caregiver levels in patients with mild cognitive impairment is crucial for identifying strategies to improve patients’ lifestyles and delay disease progression.
Methods
Using a convenience sampling method, 302 patients with mild cognitive impairment and their family caregivers admitted to the neurology departments of four tertiary care hospitals in China, from December 2024 to February 2025 were recruited and surveyed using a general information questionnaire, the Dementia Risk Reduction Lifestyle Scale (DRRLS), the Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction scale (MCLHB-DRR), the Perceived Social Support Scale (PSSS), and the Mutuality Scale (MS). Multiple linear regression was used to analyze the factors influencing the dementia risk reduction lifestyle of patients.
Results
DRRLS score of 83.61 ± 16.13, multiple linear regression showed that the patient’s monthly individual income, the presence of chronic disease, health beliefs, and social support were independent influences on their dementia risk reduction lifestyle. Furthermore, the lifestyle and mutuality of family caregivers were also independent influences on dementia risk reduction lifestyle in patients. The final model explained 75.5% of the variance in the lifestyle.
Conclusions
Patients with mild cognitive impairment have a general level of dementia risk reduction lifestyle. The characteristics of both patients and caregivers collectively influence the patients’ lifestyle. Healthcare providers should conduct early dyadic assessments and develop targeted dyadic intervention strategies based on influencing factors to improve patients’ lifestyles and help them delay disease progression.
The review is devoted to frailty in patients with atrial fibrillation (AF). The number of elderly patients with AF is constantly increasing, and this category of patients is characterized by high incidence of stroke and bleeding. Frailty is a key geriatric syndrome. Research of frailty in patients with AF is extremely important, since involutional processes in cardiovascular system, brain, kidneys and gastrointestinal tract cause metabolism of anticoagulants and increase the risk of thromboembolic and hemorrhagic complications. The review highlights the tools, scales and questionnaires for assessing frailty in patients with cardiovascular diseases. In addition, some biomarkers related to frailty syndromes in patients with AF are described. Data on negative impact of frailty on prognosis in patients with AF are presented, and measures to prevent frailty and its progression are outlined. These data indicate the need to introduce geriatric tools into interdisciplinary approach. This can delay loss of working capacity, improve the quality of life and prevent negative outcomes in elderly and senile patients with AF.
Loss of memory is the main feature of dementia, accompanied by personality changes. Alzheimer's disease (AD) is the most prevalent type of dementia globally and a major contributor to disability and mortality in older individuals. Most notably, the neurological damage caused by AD is irreversible, but the current market still lacks effective medications for the treatment of dementia. Numerous research studies have indicated that the inflammatory response is significantly involved in the development of cognitive impairment, and elevated C‐reactive protein (CRP) levels in healthy people increases the likelihood of future AD. CRP is a nonspecific indicator of inflammation. In clinical practice, CRP has long been proven to be one of the risk factors and powerful predictors of neurodegenerative diseases. Given the accessibility and cost‐effectiveness of CRP testing, it is reasonable to anticipate its utilisation for early screening and monitoring the progression of AD in the future. This review therefore focuses on the specific relationship between CRP and various types of dementia and explores how CRP contributes to cognitive impairment.
Background/Objectives: Neurodegenerative diseases represent a growing global health challenge with limited therapeutic options. Physical exercise has emerged as a promising non-pharmacological intervention with potential neuroprotective effects. This narrative review examines the mechanisms through which exercise induces neuroplasticity and their implications for neurodegenerative disease prevention. Methods: We synthesized evidence from molecular, animal, and human studies on exercise-induced neuroplasticity and neurodegenerative disease prevention through a comprehensive literature review. Results: Exercise enhances neuroplasticity through multiple pathways: (1) neurotrophic signaling (BDNF, IGF-1, VEGF), (2) neuroendocrine regulation, (3) epigenetic modifications, and (4) metabolic pathway optimization. These molecular changes support structural adaptations including hippocampal neurogenesis, enhanced synaptic plasticity, improved cerebrovascular function, and optimized brain network connectivity. Exercise directly impacts pathological features of neurodegenerative diseases by reducing protein aggregation, attenuating excitotoxicity and oxidative stress, and enhancing mitochondrial function. Clinical evidence consistently demonstrates associations between physical activity and reduced neurodegenerative risk, with intervention studies supporting causal benefits on cognitive function and brain structure. Conclusions: Exercise represents a multi-target intervention addressing several pathological mechanisms simultaneously across various neurodegenerative conditions. Its accessibility, minimal side effects, and multiple health benefits position it as a promising preventive strategy. Future research should focus on understanding individual response variability, developing sensitive biomarkers, and creating personalized exercise prescriptions for optimal neuroprotection.
Background
People living with subjective cognitive decline (SCD) have a high risk of future cognitive decline and progressing to dementia. Lifestyle risk factors that can be changed have been recognized as significantly contributing to cognitive decline. Therefore, implementing strategies to address these factors offers a considerable chance to minimize the cognitive decline and incidence of dementia among individuals. The most recent guidelines to prevent cognitive decline is multicomponent interventions. This trial shall aim to help develop practical strategies for enhancing brain and cognitive health in Indian older adults with SCD.
Objective
This study shall evaluate the efficacy and feasibility of a multicomponent intervention (physical, cognitive, and psychosocial [PCP] protocol) for older adults with SCD.
Study Design
Clinical study protocol for a randomized controlled trial (RCT).
Methods
The study protocol is of a single-blinded RCT. This study will investigate 12 weeks of intervention with a multicomponent protocol encompassing physical, cognitive, and psychosocial domains (PCP protocol) compared with 12 weeks of regular occupational therapy program followed by a no-contact period of 12 weeks. The intervention program will be for 50 min per session, twice weekly for 12 weeks. We plan to recruit 130 older adults with SCD. Older adults will be allocated to one of the study arms using block-wise randomization. There will be three steps of assessment, i.e., at the baseline, after 12 weeks and after 24 weeks. The outcome measures utilized will be Addenbrooke’s Cognitive Examination (ACE III), The Lawton Instrumental Activities of Daily Living scale, and Health related quality of life (QOL)-SF36.
Results
This study will test the efficacy of PCP protocol on cognition, functionality, and QOL in older adults with SCD. Data will be analyzed using analysis of variance following intention-to-treat. Level of significance will be at P = 0.05. Results from this trial will provide evidence of multicomponent intervention in SCD.
Trial Registration
Protocol was registered in clinical trials registry-India (CTRI) as CTRI/2022/10/046602 on 18.10.22.
Background
Idiopathic normal pressure hydrocephalus (iNPH) is a common disorder in aging populations. Alzheimer's disease (AD) is a significant comorbidity in iNPH patients, and the presence of AD pathology is associated with worse shunting outcomes. Cerebrospinal fluid (CSF) concentrations of AD-associated biomarkers in iNPH patients are universally reduced and the exact mechanism related to this is unknown.
Objective
Our aim was to study the effects of ventricular volume on CSF AD-associated biomarker levels in iNPH patients, to determine whether a dilution effect occurs and to assess if brain AD pathology contributes to this effect.
Methods
A total of 153 iNPH patients had lumbar CSF samples available for analysis, along with brain MRIs of sufficient quality. Automated image analysis software was used to determine the volume of different brain segments. Volumes normalized for age, sex and head size were used for analysis. Brain biopsy data on AD pathology was also available.
Results
None of the intracerebral ventricular volumes correlated with CSF levels of AD-associated biomarkers, indicating no dilution effect was present in this context. However, in iNPH patients positive for amyloid-β pathology in the biopsy, the volume of the fourth ventricle correlated inversely with all investigated biomarkers.
Conclusions
Intracerebral ventricular volumes do not correlate with AD biomarker levels in CSF, arguing against a dilution effect. However, in patients with AD pathology, the volume of the fourth ventricle is inversely correlated with CSF T-Tau and P-Tau 181 levels, suggesting a complex relationship between brain AD pathology, CSF flow and CSF volume in iNPH patients.
The objective of this review study is to examine the combined antidepressant effects of exercise and polyphenol supplementation, with a focus on specific polyphenolic compounds such as crocin, curcumin, and quercetin, as well as different forms of physical exercise, including aerobic and resistance training. The research examines how these interventions influence depressive-like behaviors, cognitive function, and neurochemical markers in animal models and human participants. The findings demonstrate that both exercise and polyphenols independently contribute to mood enhancement, reduced anxiety, and improved cognitive function through mechanisms such as neurogenesis, neurotransmitter modulation, and anti-inflammatory effects. Notably, the combined interventions showed a synergistic effect, providing more significant benefits in reducing symptoms of depression and anxiety, enhancing cognitive performance, and supporting overall mental well-being. These results suggest that integrating exercise and polyphenol supplementation could be a promising non-pharmacological approach to managing depression and related disorders.
Background
The global population is undergoing rapid aging, resulting in a significant increase in scientific publications addressing diseases and health challenges in the elderly population.
Methods
A literature search for publications on diseases in the elderly population was conducted using PubMed, Web of Science Core Collection, and Embase from January 1, 2000, to January 1, 2024. Bibliometric and visualization analyses were performed using VOSviewer software.
Results
A total of 16,862 publications were retrieved, with a notable increase in publication output after 2016. The United States led in both publication numbers ( n = 6502, 38.56%) and citations (342,586), underscoring its substantial contribution to this field. Influential institutions such as the University of Pittsburgh and Karolinska Institute played key roles. Keywords analysis identified 631 meaningful topics, classified into five clusters, with research hotspots focusing on cardiovascular diseases, dementia, frailty, and quality of life. Emerging keywords in public health and nursing, such as “mild cognitive impairment,” “multimorbidity,” and “frailty,” have been frequently highlighted in recent studies, indicating critical priorities for future research in elderly care.
Conclusions
This study provides a comprehensive bibliometric and visualization analysis of global research trends on diseases in the elderly population. It highlights key research areas and offers valuable insights to guide future directions in public health and nursing strategies, emphasizing the importance of interdisciplinary approaches to address aging‐related challenges.
Objective
This article introduces a special issue on advancing Alzheimer’s disease (AD) and AD-related dementias (ADRD) research drawing from research conducted by the Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research (JHAD-RCMAR).
Method
We describe the JHAD-RCMAR, highlighting work of early career investigators in the JHAD-RCMAR, summarize key accomplishments, and propose recommendations for next steps in ameliorating disparities in cognitive decline and AD/ADRD risk.
Results
Articles in this special issue report on innovative research focused on basic, clinical, psychosocial, or health services aspects of minority aging, AD/ADRD, and health disparities. In addition, we include a paper on how mixed methods can be used to enhance health equity in research on AD/ADRD and cognitive impairment.
Discussion
The Supplement helps fill a critical knowledge gap regarding drivers of disparities in cognitive decline or risk in AD/ADRD, thereby informing future work as it relates to AD/ADRD and health equity.
Alzheimer’s disease usually begins after age 60. The risk goes up as you get older. Your risk is also higher if a family member has had the disease. No treatment can stop the disease. However, some drugs may help keep symptoms from getting worse for a limited time. Alzheimer's disease is a devastating form of nonreversible dementia now affecting at least 5 out of 10 persons worldwide. Its course is marked by a gradual loss of memory, ability to communicate, and, eventually, physical capabilities. Appetite and food intake fluctuate with mood swings and increasing confusion. Feeding and alimentation skills regress gradually because of cognitive and physical deterioration; uncontrolled weight loss is almost inevitable in latter stages, despite quality of care. A number of etiological models exist, including some related to vitamin and mineral metabolism, although research has not yet yielded a certain cause or cure. Treatment is symptomatic relief through interdisciplinary health care intervention. Psychological, medical, nutritional, and nursing support are needed by the caregivers as well as by the patients themselves.
Undiagnosed cognitive impairment is a pervasive global issue, often due to subtle nature of early symptoms, necessitating the use of brief cognitive tests for early detection. However, most brief tests are not scalable (requiring trained professionals), and are not designed for lower literacy groups (e.g. in underserved communities). Here, we developed PENSIEVE-AITM, a drawing-based digital test that is less dependent on literacy, and can be self-administered in <5 min. In a prospective study involving 1758 community-dwelling individuals aged 65 and older from Singapore (education range = 0–23 years), our deep-learning model showed excellent performance in detecting clinically-adjudicated mild cognitive impairment and dementia (AUC = 93%), comparable to traditional neuropsychological assessments (AUC = 94%, Pcomparison = 1.000). Results were consistent even across education subgroups. Being less dependent on literacy, PENSIEVE-AI holds promise for broader deployment in literacy-diverse populations similar to Singapore (e.g. some Asian and lower- and middle-income countries), potentially improving early detection and intervention of cognitive impairment.
This manuscript examines the expanding role of population health strategies in neurology, emphasizing systemic approaches that address neurological health at a community-wide level. Key themes include interdisciplinary training in public health, policy reform, biomedical informatics, and the transformative potential of artificial intelligence (AI) and large language models (LLMs). In doing so, neurologists increasingly adopt a holistic perspective that targets the social determinants of health, integrates advanced data analytics, and fosters cross-sector collaborations—ensuring that prevention and early intervention are central to their efforts. Innovative applications, such as predictive analytics for identifying high-risk populations, digital twin technologies for simulating patient outcomes, and AI-enhanced diagnostic tools, illustrate the transition in neurology from reactive care to proactive, data-driven interventions. Examples of transformative practices include leveraging wearable health technologies, telemedicine, and mobile clinics to improve early detection and management of neurological conditions, particularly in underserved populations. These emerging methodologies expand access to care while offering nuanced insights into disease progression and community-specific risk factors. The manuscript emphasizes health disparities and ethical considerations in designing inclusive, data-driven interventions. By harnessing emerging technologies within frameworks that prioritize equity, neurologists can reduce the burden of neurological diseases, improve health outcomes, and establish a sustainable, patient-centered model of care benefiting both individuals and entire communities. This integration of technology, interdisciplinary expertise, and community engagement fosters a future where brain health is preventive, accessible, and equitable.
The state of the science of nutrition and its relationship to brain health is complex, making dissemination of research findings difficult. One contributing factor is the lack of a consensus on defining brain health. Some organizations emphasize cognitive function (eg, memory, perception, judgment, decline, impairment) and/or the presence of dementia, whereas others use a broader conceptualization to include mood and stress. Regarding nutrition, some studies support specific dietary patterns, such as the MIND (Mediterranean–Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay) diet, for preserving cognitive function. Others find no effect. Public-facing organizations communicate this science in varying ways to meet consumer and patient needs and interest in preserving brain function as they age. Some organizations have standardized communication methods, whereas others communicate based on topics most salient to the consumer or patient, regardless of the strength of the evidence. This conceptual article reflects a roundtable discussion among stakeholders to document processes for communicating the state of the science to inform best practices moving forward. Six best practices are offered to ensure consistent, evidence-based communication, which is vital in the digital age where misinformation is pervasive.
A European Task Force has recently developed and published the concept and protocols for the setup of the innovative health offer of Brain Health Services for the secondary prevention of dementia and cognitive impairment (dBHS). dBHS are outpatient health care facilities where adult persons can find an assessment of their risk of developing cognitive impairment and dementia, have their risk level and contributing factors communicated using appropriate language supported by adequate communication tools, can decide to participate to programs for personalized risk reduction if at higher risk, and benefit from cognitive enhancement interventions. This health offer is distinct from that of currently active memory clinics. The ultimate aim of dBHS is to extend healthy life, free from cognitive impairment. Here, we (i) discuss the pertinent opportunities and challenges for those persons who want to benefit from dBHS, professionals, and wider society, (ii) describe the concepts, protocols, organizational features, and patient journeys of some currently active dBHS in Europe, and (iii) argue in favor of the business case for dBHS in Europe.
Chronic kidney disease affects almost all of the organs. Recently, more attention has been paid to the kidney and the central nervous system connections. In patients on kidney replacement therapy, including kidney transplantation, there is an increased prevalence of cognitive impairment, and depression and other neurological complications, such as cerebrovascular disorders and movement disorders. Kidney transplant recipients need an assessment for the risk factors and the pattern of cognitive impairment (memory, attention and executive function decline). This enables an accurate diagnosis to be made at an earlier stage. Partial post-transplant cognitive impairment recovery is also important. Finally, doctors and patients alike face numerous ethical concerns and challenges regarding the transplantation of kidneys and other solid organs. In this review, we examined some key issues regarding cognitive impairment in kidney transplant patients. We focused on the mechanism of cognitive impairment in kidney transplant recipients, patterns of cognitive impairment; evaluation of patients with cognitive impairment for kidney transplantation, the potential impact of cognitive impairment on waitlisted and transplanted patients on patient care, non-pharmacological interventions and unmet medical needs, psychological and ethical issues in kidney transplantation, and unmet needs. As cognitive impairment in kidney transplant recipients is an underestimated, underrecognized but clinically relevant problem, screening for cognitive function before and after kidney transplantation would be worth considering in standard routine practice.
Background:
New effective interventions to attenuate age-related cognitive decline are a global priority. Computerized cognitive training (CCT) is believed to be safe and can be inexpensive, but neither its efficacy in enhancing cognitive performance in healthy older adults nor the impact of design factors on such efficacy has been systematically analyzed. Our aim therefore was to quantitatively assess whether CCT programs can enhance cognition in healthy older adults, discriminate responsive from nonresponsive cognitive domains, and identify the most salient design factors.
Methods and findings:
We systematically searched Medline, Embase, and PsycINFO for relevant studies from the databases' inception to 9 July 2014. Eligible studies were randomized controlled trials investigating the effects of ≥ 4 h of CCT on performance in neuropsychological tests in older adults without dementia or other cognitive impairment. Fifty-two studies encompassing 4,885 participants were eligible. Intervention designs varied considerably, but after removal of one outlier, heterogeneity across studies was small (I(2) = 29.92%). There was no systematic evidence of publication bias. The overall effect size (Hedges' g, random effects model) for CCT versus control was small and statistically significant, g = 0.22 (95% CI 0.15 to 0.29). Small to moderate effect sizes were found for nonverbal memory, g = 0.24 (95% CI 0.09 to 0.38); verbal memory, g = 0.08 (95% CI 0.01 to 0.15); working memory (WM), g = 0.22 (95% CI 0.09 to 0.35); processing speed, g = 0.31 (95% CI 0.11 to 0.50); and visuospatial skills, g = 0.30 (95% CI 0.07 to 0.54). No significant effects were found for executive functions and attention. Moderator analyses revealed that home-based administration was ineffective compared to group-based training, and that more than three training sessions per week was ineffective versus three or fewer. There was no evidence for the effectiveness of WM training, and only weak evidence for sessions less than 30 min. These results are limited to healthy older adults, and do not address the durability of training effects.
Conclusions:
CCT is modestly effective at improving cognitive performance in healthy older adults, but efficacy varies across cognitive domains and is largely determined by design choices. Unsupervised at-home training and training more than three times per week are specifically ineffective. Further research is required to enhance efficacy of the intervention. Please see later in the article for the Editors' Summary.
Our aim is to describe the study recruitment and baseline characteristics of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study population. Potential study participants (age 60-77 years, the dementia risk score ≥6) were identified from previous population-based survey cohorts and invited to the screening visit. To be eligible, cognitive performance measured at the screening visit had to be at the mean level or slightly lower than expected for age. Of those invited (n = 5496), 48% (n = 2654) attended the screening visit, and finally 1260 eligible participants were randomized to the intervention and control groups (1:1). The screening visit non-attendees were slightly older, less educated, and had more vascular risk factors and diseases present. The mean (SD) age of the randomized participants was 69.4 (4.7) years, Mini-Mental State Examination 26.7 (2.0) points, systolic blood pressure 140.1 (16.2) mmHg, total serum cholesterol 5.2 (1.0) mmol/L for, and fasting glucose 6.1 (0.9) mmol/L for, with no difference between intervention and control groups. Several modifiable risk factors were present at baseline indicating an opportunity for the intervention. The FINGER study will provide important information on the effect of lifestyle intervention to prevent cognitive impairment among at risk persons.
Human cognitive aging differs between and is malleable within individuals. In the absence of a strong genetic program, it
is open to a host of hazards, such as vascular conditions, metabolic syndrome, and chronic stress, but also open to protective
and enhancing factors, such as experience-dependent cognitive plasticity. Longitudinal studies suggest that leading an intellectually
challenging, physically active, and socially engaged life may mitigate losses and consolidate gains. Interventions help to
identify contexts and mechanisms of successful cognitive aging and give science and society a hint about what would be possible
if conditions were different.
Background
Mild cognitive impairment (MCI) increases dementia risk with no pharmacologic treatment available.
Methods
The Study of Mental and Resistance Training was a randomized, double-blind, double-sham controlled trial of adults with MCI. Participants were randomized to 2 supervised interventions: active or sham physical training (high intensity progressive resistance training vs seated calisthenics) plus active or sham cognitive training (computerized, multidomain cognitive training vs watching videos/quizzes), 2–3 days/week for 6 months with 18-month follow-up. Primary outcomes were global cognitive function (Alzheimer's Disease Assessment Scale-cognitive subscale; ADAS-Cog) and functional independence (Bayer Activities of Daily Living). Secondary outcomes included executive function, memory, and speed/attention tests, and cognitive domain scores.
Results
One hundred adults with MCI [70.1 (6.7) years; 68% women] were enrolled and analyzed. Resistance training significantly improved the primary outcome ADAS-Cog; [relative effect size (95% confidence interval) −0.33 (−0.73, 0.06); P < .05] at 6 months and executive function (Wechsler Adult Intelligence Scale Matrices; P = .016) across 18 months. Normal ADAS-Cog scores occurred in 48% (24/49) after resistance training vs 27% (14/51) without resistance training [P < .03; odds ratio (95% confidence interval) 3.50 (1.18, 10.48)]. Cognitive training only attenuated decline in Memory Domain at 6 months (P < .02). Resistance training 18-month benefit was 74% higher (P = .02) for Executive Domain compared with combined training [z-score change = 0.42 (0.22, 0.63) resistance training vs 0.11 (−0.60, 0.28) combined] and 48% higher (P < .04) for Global Domain [z-score change = .0.45 (0.29, 0.61) resistance training vs 0.23 (0.10, 0.36) combined].
Conclusions
Resistance training significantly improved global cognitive function, with maintenance of executive and global benefits over 18 months.
The evaluation of cognitive functions by using CERAD (Consortium to Establish a Registry for Alzheimer's Disease) is recommended as a tool in basic health care for screening of memory diseases. The reliability of this method, adopted in Finland in 1999, has been impaired by the fact that there have been no comprehensive Finnish norms to serve as the basis for the cut-off limits of the test tasks. This article presents the new, revised cut-off values for the CERAD procedure, based on the comparison of Finnish population-based normative data with those of persons having very mild or mild Alzheimer's disease.
To assess the effects of aerobic exercise training on neurocognitive performance. Although the effects of exercise on neurocognition have been the subject of several previous reviews and meta-analyses, they have been hampered by methodological shortcomings and are now outdated as a result of the recent publication of several large-scale, randomized, controlled trials (RCTs).
We conducted a systematic literature review of RCTs examining the association between aerobic exercise training on neurocognitive performance between January 1966 and July 2009. Suitable studies were selected for inclusion according to the following criteria: randomized treatment allocation; mean age > or =18 years of age; duration of treatment >1 month; incorporated aerobic exercise components; supervised exercise training; the presence of a nonaerobic-exercise control group; and sufficient information to derive effect size data.
Twenty-nine studies met inclusion criteria and were included in our analyses, representing data from 2049 participants and 234 effect sizes. Individuals randomly assigned to receive aerobic exercise training demonstrated modest improvements in attention and processing speed (g = 0.158; 95% confidence interval [CI]; 0.055-0.260; p = .003), executive function (g = 0.123; 95% CI, 0.021-0.225; p = .018), and memory (g = 0.128; 95% CI, 0.015-0.241; p = .026).
Aerobic exercise training is associated with modest improvements in attention and processing speed, executive function, and memory, although the effects of exercise on working memory are less consistent. Rigorous RCTs are needed with larger samples, appropriate controls, and longer follow-up periods.
In the late 1960s, coronary heart disease (CHD) mortality among Finnish men was the highest in the world. From 1972 to 2007, risk factor surveys have been carried out to monitor risk factor trends and assess their contribution to declining mortality in Finland.
The first risk factor survey was carried out in the North Karelia and Kuopio provinces in 1972 as the basis for the evaluation of the North Karelia Project. Since then, up to five geographical areas have been included in the surveys. The target population has been persons aged 25-74 years, except in the first two surveys where the sample was drawn from a population aged 30-59 years. Risk factor contribution on mortality change was assessed by a logistic regression model.
A remarkable decline in serum cholesterol levels was observed between 1972 and 2007. Blood pressure declined among both men and women until 2002 but levelled off during the last 5 years. Prevalence of smoking decreased among men. Among women, smoking increased throughout the survey years until 2002 but did not increase between 2002 and 2007. Body mass index (BMI) has continuously increased among men. Among women, BMI decreased until 1982, but since then an increasing trend has been observed. Risk factor changes explained a 60% reduction in coronary mortality in middle-aged men while the observed reduction was 80%.
The 80% decline in coronary mortality in Finland mainly reflects a great reduction of the risk factor levels; these in turn have been associated with long-term comprehensive chronic disease prevention and health promotion interventions.
Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known.
We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index [weight in kilograms divided by the square of the height in meters], 31) with impaired glucose tolerance to either the intervention group or the control group. Each subject in the intervention group received individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. An oral glucose-tolerance test was performed annually; the diagnosis of diabetes was confirmed by a second test. The mean duration of follow-up was 3.2 years.
The mean (+/-SD) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group (P<0.001 for both comparisons between the groups). The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval, 17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group. The reduction in the incidence of diabetes was directly associated with changes in lifestyle.
Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.
Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated.
To determine the effects of cognitive training on daily function and durability of training on cognitive abilities.
Five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups. A volunteer sample of 2832 persons (mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample.
Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training.
Self-reported and performance-based measures of daily function and cognitive abilities.
The reasoning group reported significantly less difficulty in the instrumental activities of daily living (IADL) than the control group (effect size, 0.29; 99% confidence interval [CI], 0.03-0.55). Neither speed of processing training (effect size, 0.26; 99% CI, -0.002 to 0.51) nor memory training (effect size, 0.20; 99% CI, -0.06 to 0.46) had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing (effect size, 0.30; 99% CI, 0.08-0.52). No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years (memory: effect size, 0.23 [99% CI, 0.11-0.35]; reasoning: effect size, 0.26 [99% CI, 0.17-0.35]; speed of processing: effect size, 0.76 [99% CI, 0.62-0.90]). Booster training produced additional improvement with the reasoning intervention for reasoning performance (effect size, 0.28; 99% CI, 0.12-0.43) and the speed of processing intervention for speed of processing performance (effect size, 0.85; 99% CI, 0.61-1.09).
Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention.
clinicaltrials.gov Identifier: NCT00298558.
Current evidence shows that type 2 diabetes (T2D) can be prevented by life-style changes and medication. To meet the menacing diabetes epidemic, there is an urgent need to translate the scientific evidence regarding prevention of T2D into daily clinical practice and public health. In Finland, a national programme for the prevention of T2D has been launched. The programme comprises 3 concurrent strategies for prevention: the population strategy, the high-risk strategy and the strategy of early diagnosis and management. The article describes the implementation strategy for the prevention programme for T2D.
The implementation project, FIN-D2D, is being conducted in 5 hospital districts, covering a population of 1.5 million, during the years 2003-2007. The main actors in the FIN-D2D are primary and occupational health care providers.
The goals of the project are (1) to reduce the incidence and prevalence of T2D and prevalence of cardiovascular risk factor levels; (2) to identify individuals who are unaware of their T2D; (3) to generate regional and local models and programmes for the prevention of T2D; (4) to evaluate the effectiveness, feasibility and costs of the programme; and (5) to increase the awareness of T2D and its risk factors in the population and to support the population strategy of the diabetes prevention programme. The feasibility, effectiveness and costs of the programme will be evaluated according to a specific evaluation plan.
Current research evidence shows that the type 2 diabetes can be effectively prevented in high-risk subjects by life-style changes, which include increased physical activity and weight reduction. FIN-D2D explores ways to implement these methods on a national level.
Intensified multifactorial intervention - with tight glucose regulation and the use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents - has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria. We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes.
In the Steno-2 Study, we randomly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy; the mean treatment period was 7.8 years. Patients were subsequently followed observationally for a mean of 5.5 years, until December 31, 2006. The primary end point at 13.3 years of follow-up was the time to death from any cause.
Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P=0.02). Intensive therapy was associated with a lower risk of death from cardiovascular causes (hazard ratio, 0.43; 95% CI, 0.19 to 0.94; P=0.04) and of cardiovascular events (hazard ratio, 0.41; 95% CI, 0.25 to 0.67; P<0.001). One patient in the intensive-therapy group had progression to end-stage renal disease, as compared with six patients in the conventional-therapy group (P=0.04). Fewer patients in the intensive-therapy group required retinal photocoagulation (relative risk, 0.45; 95% CI, 0.23 to 0.86; P=0.02). Few major side effects were reported.
In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes. (ClinicalTrials.gov number, NCT00320008.)
Process-specific training can improve performance on untrained tasks, but the magnitude of gain is variable and often there is no transfer at all. We demonstrate transfer to a 3-back test of working memory after 5 weeks of training in updating. The transfer effect was based on a joint training-related activity increase for the criterion (letter memory) and transfer tasks in a striatal region that also was recruited pretraining. No transfer was observed to a task that did not engage updating and striatal regions, and age-related striatal changes imposed constraints on transfer. These findings indicate that transfer can occur if the criterion and transfer tasks engage specific overlapping processing components and brain regions.
OBJECTIVE: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults. PARTICIPANTS: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. EVIDENCE: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature. Process: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults. SUMMARY: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management. Language: en
Importance
Assessing the ability of Alzheimer disease neuroimaging markers to predict short-term cognitive decline among clinically normal (CN) individuals is critical for upcoming secondary prevention trials using cognitive outcomes.Objective
To determine whether neuroimaging markers of β-amyloid (Aβ) and neurodegeneration (ND) are independently or synergistically associated with longitudinal cognitive decline in CN individuals.Design, Setting, and Participants
Academic medical center longitudinal natural history study among 166 CN individuals (median age, 74 years; 92 women).Main Outcomes and Measures
The Aβ status was determined with Pittsburgh Compound B–positron emission tomography, while ND was assessed using 2 a priori measures, hippocampus volume (magnetic resonance imaging) and glucose metabolism (positron emission tomography with fludeoxyglucose F 18), extracted from Alzheimer disease–vulnerable regions. Based on imaging markers, CN individuals were categorized into the following preclinical Alzheimer disease stages: stage 0 (Aβ−/ND−), stage 1 (Aβ+/ND−), stage 2 (Aβ+/ND+), and suspected non–Alzheimer disease pathology (Aβ−/ND+). Cognition was assessed with a composite of neuropsychological tests administered annually.Results
The Aβ+ CN individuals were more likely to be classified as ND+: 59.6% of Aβ+ CN individuals were ND+, whereas 31.9% of Aβ− CN individuals were ND+ (odds ratio, 3.14; 95% CI, 1.44-7.02; P = .004). In assessing longitudinal cognitive performance, practice effects were evident in CN individuals negative for both Aβ and ND, whereas diminished practice effects were observed in CN individuals positive for either Aβ or ND. Decline over time was observed only in CN individuals positive for both Aβ and ND, and decline in this group was significantly greater than that in all other groups (P < .001 for all). A significant interaction term between Aβ and ND confirmed that this decline was greater than the additive contributions of Aβ and ND (P = .04).Conclusions and Relevance
The co-occurrence of Aβ and ND accelerates cognitive decline in CN individuals. Therefore, both factors are important to consider in upcoming secondary prevention trials targeting CN individuals at high risk for progression to the symptomatic stages of Alzheimer disease.
Objective:
Investigate time-related age differences in cognitive functioning without influences of prior test experience.
Methods:
Cognitive scores were compared in different individuals from the same birth years who were tested in different years, when they were at different ages. These types of quasi-longitudinal comparisons were carried out on data from three large projects: the Seattle Longitudinal Study [Schaie, K. W. (2013). Developmental influences on adult intelligence: The Seattle Longitudinal Study (2nd ed.). New York, NY: Oxford University Press], the Betula Project [Ronnlund, M., & Nilsson, L-G. (2008). The magnitude, generality, and determinants of Flynn effects on forms of declarative memory and visuospatial ability: Time-sequential analyses of data from a Swedish cohort study. Intelligence, 36, 192-209], and the Virginia Cognitive Aging Project (this study).
Results:
In each data set, the results revealed that the estimates of cognitive change with no prior test experience closely resembled the estimates of age relations based on cross-sectional comparisons. Furthermore, longitudinal comparisons revealed positive changes at young ages that gradually became more negative with increased age, whereas all of the estimates of change without prior test experience were negative except those for measures of vocabulary.
Discussion:
The current results suggest that retest effects can distort the mean age trends in longitudinal comparisons that are not adjusted for experience. Furthermore, the findings can be considered robust because the patterns were similar across three data sets involving different samples of participants and cognitive tests, and across different methods of controlling experience effects in the new data set.
Background
Recent estimates suggesting that over half of Alzheimer's disease burden worldwide might be attributed to potentially modifiable risk factors do not take into account risk-factor non-independence. We aimed to provide specific estimates of preventive potential by accounting for the association between risk factors.
Methods
Using relative risks from existing meta-analyses, we estimated the population-attributable risk (PAR) of Alzheimer's disease worldwide and in the USA, Europe, and the UK for seven potentially modifiable risk factors that have consistent evidence of an association with the disease (diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, and low educational attainment). The combined PAR associated with the risk factors was calculated using data from the Health Survey for England 2006 to estimate and adjust for the association between risk factors. The potential of risk factor reduction was assessed by examining the combined effect of relative reductions of 10% and 20% per decade for each of the seven risk factors on projections for Alzheimer's disease cases to 2050.
Findings
Worldwide, the highest estimated PAR was for low educational attainment (19·1%, 95% CI 12·3–25·6). The highest estimated PAR was for physical inactivity in the USA (21·0%, 95% CI 5·8–36·6), Europe (20·3%, 5·6–35·6), and the UK (21·8%, 6·1–37·7). Assuming independence, the combined worldwide PAR for the seven risk factors was 49·4% (95% CI 25·7–68·4), which equates to 16·8 million attributable cases (95% CI 8·7–23·2 million) of 33·9 million cases. However, after adjustment for the association between the risk factors, the estimate reduced to 28·2% (95% CI 14·2–41·5), which equates to 9·6 million attributable cases (95% CI 4·8–14·1 million) of 33·9 million cases. Combined PAR estimates were about 30% for the USA, Europe, and the UK. Assuming a causal relation and intervention at the correct age for prevention, relative reductions of 10% per decade in the prevalence of each of the seven risk factors could reduce the prevalence of Alzheimer's disease in 2050 by 8·3% worldwide.
Interpretation
After accounting for non-independence between risk factors, around a third of Alzheimer's diseases cases worldwide might be attributable to potentially modifiable risk factors. Alzheimer's disease incidence might be reduced through improved access to education and use of effective methods targeted at reducing the prevalence of vascular risk factors (eg, physical inactivity, smoking, midlife hypertension, midlife obesity, and diabetes) and depression.
Funding
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough.
Background
Observational studies suggest that higher levels of physical activity and cardiorespiratory fitness associate with improved cognition. However, evidence from randomised controlled trials (RCT) is limited. We hypothesised that increased regular exercise improves cognition in older individuals. The trial is registered: ISRCTN45977199 (http://isrctn.org).
Background:
Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a multi-center, randomized, controlled trial ongoing in Finland.
Materials:
Participants (1200 individuals at risk of cognitive decline) are recruited from previous population-based non-intervention studies. Inclusion criteria are CAIDE Dementia Risk Score ≥6 and cognitive performance at the mean level or slightly lower than expected for age (but not substantial impairment) assessed with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery. The 2-year multidomain intervention consists of: nutritional guidance; exercise; cognitive training and social activity; and management of metabolic and vascular risk factors. Persons in the control group receive regular health advice. The primary outcome is cognitive performance as measured by the modified Neuropsychological Test Battery, Stroop test, and Trail Making Test. Main secondary outcomes are: dementia (after extended follow-up); disability; depressive symptoms; vascular risk factors and outcomes; quality of life; utilization of health resources; and neuroimaging measures.
Results:
Screening began in September 2009 and was completed in December 2011. All 1200 persons are enrolled and the intervention is ongoing as planned. Baseline clinical characteristics indicate that several vascular risk factors and unhealthy lifestyle-related factors are present, creating a window of opportunity for prevention. The intervention will be completed during 2014.
Conclusions:
The FINGER is at the forefront of international collaborative efforts to solve the clinical and public health problems of early identification of individuals at increased risk of late-life cognitive impairment, and of developing intervention strategies to prevent or delay the onset of cognitive impairment and dementia.
Practice effects on cognitive tests have been shown to further characterize patients with amnestic mild cognitive impairment (aMCI) and may provide predictive information about cognitive change across time. We tested the hypothesis that a loss of practice effects would portend a worse prognosis in aMCI.
Longitudinal, observational design following participants across 1 year.
Community-based cohort.
Three groups of older adults: 1) cognitively intact (n = 57), 2) aMCI with large practice effects across 1 week (MCI + PE, n = 25), and 3) aMCI with minimal practice effects across 1 week (MCI - PE, n = 26).
Neuropsychological tests.
After controlling for age and baseline cognitive differences, the MCI - PE group performed significantly worse than the other groups after 1 year on measures of immediate memory, delayed memory, language, and overall cognition.
Although these results need to be replicated in larger samples, the loss of short-term practice effects portends a worse prognosis in patients with aMCI.
The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) has developed brief, comprehensive, and reliable batteries of clinical and neuropsychological tests for assessment of patients with the clinical diagnosis of Alzheimer's disease (AD). We administered these batteries in a standardized manner to more than 350 subjects with a diagnosis of AD and 275 control subjects who were enrolled in a nationwide registry by a consortium of 16 university medical centers. The tests selected for this study measured the primary cognitive manifestations of AD across a range of severity of the disorder, and discriminated between normal subjects and those with mild and moderate dementia. The batteries also detected deterioration of language, memory, praxis, and general intellectual status in subjects returning for reassessment 1 year later. Interrater and test-retest reliabilities were substantial. Long-term observations of this cohort are in progress in an effort to validate the clinical and neuropsychological assessments and to confirm the diagnosis by postmortem examinations. Although information on validation is limited thus far, the CERAD batteries appear to fill a need for a standardized, easily administered, and reliable instrument for evaluating persons with AD in multicenter research studies as well as in clinical practice.
The goal of this study was to project the future prevalence and incidence of Alzheimer's disease in the United States and the potential impact of interventions to delay disease onset.
The numbers of individuals in the United States with Alzheimer's disease and the numbers of newly diagnosed cases that can be expected over the next 50 years were estimated from a model that used age-specific incidence rates summarized from several epidemiological studies, US mortality rates, and US Bureau of the Census projections.
in 1997, the prevalence of Alzheimer's disease in the United States was 2.32 million (range: 1.09 to 4.58 million); of these individuals, 68% were female. It is projected that the prevalence will nearly quadruple in the next 50 years, by which time approximately 1 in 45 Americans will be afflicted with the disease. Currently, the annual number of new incident cases in 360,000. If interventions could delay onset of the disease by 2 years, after 50 years there would be nearly 2 million fewer cases than projected; if onset could be delayed by 1 year, there would be nearly 800,000 fewer prevalent cases.
As the US population ages, Alzheimer's disease will become an enormous public health problem. interventions that could delay disease onset even modestly would have a major public health impact.
A meta-analytic study was conducted to examine the hypothesis that aerobic fitness training enhances the cognitive vitality of healthy but sedentary older adults. Eighteen intervention studies published between 1966 and 2001 were entered into the analysis. Several theoretically and practically important results were obtained. Most important fitness training was found to have robust but selective benefits for cognition, with the largest fitness-induced benefits occurring for executive-control processes. The magnitude of fitness effects on cognition was also moderated by a number of programmatic and methodological factors, including the length of the fitness-training intervention, the type of the intervention, the duration of training sessions, and the gender of the study participants. The results are discussed in terms of recent neuroscientific and psychological data that indicate cognitive and neural plasticity is maintained throughout the life span.
Several vascular risk factors are associated with dementia. We sought to develop a simple method for the prediction of the risk of late-life dementia in people of middle age on the basis of their risk profiles.
Data were used from the population-based CAIDE study, which included 1409 individuals who were studied in midlife and re-examined 20 years later for signs of dementia. Several midlife vascular risk factors were studied to create the scoring tool. The score values were estimated on the basis of beta coefficients and the dementia risk score was the sum of these individual scores (range 0-15).
Occurrence of dementia during the 20 years of follow-up was 4%. Future dementia was significantly predicted by high age (> or = 47 years), low education (< 10 years), hypertension, hypercholesterolaemia, and obesity. The dementia risk score predicted dementia well (area under curve 0.77; 95% CI 0.71-0.83). The risk of dementia according to the categories of the dementia risk score was 1.0% for those with a score of 0-5, 1.9% for a score of 6-7, 4.2% for a score of 8-9, 7.4% for a score of 10-11, and 16.4% for a score of 12-15. When the cut-off of 9 points or more was applied the sensitivity was 0.77, the specificity was 0.63, and the negative predictive value was 0.98.
The dementia risk score is a novel approach for the prediction of dementia risk, but should be validated and further improved to increase its predictive value. This approach highlights the role of vascular factors in the development of dementia and could help to identify individuals who might benefit from intensive lifestyle consultations and pharmacological interventions.
To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.
A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.
The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature.
After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.
The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.
To report the psychometric properties of an alternative instrument to the cognitive subscale of the Alzheimer's Disease Assessment Scale, a neuropsychological test battery (NTB) for measuring drug efficacy in Alzheimer disease clinical trials.
The NTB was evaluated in a randomized, double-blind, placebo-controlled trial of AN1792(QS-21) (synthetic beta-amyloid plus an adjuvant) (300 patients) and isotonic sodium chloride solution (72 patients). The test-retest reliability of the NTB was examined, and the NTB was correlated with other cognitive (cognitive subscale of the Alzheimer's Disease Assessment Scale and Mini-Mental State Examination) and functional (Disability Assessment Scale for Dementia and Clinical Dementia Rating Sum of Boxes) measures. In addition, a factor analysis was performed on NTB components. Finally, the sensitivity of the NTB to change was assessed as a function of Mini-Mental State Examination performance.
The NTB had high test-retest reliability at 6 (Pearson product moment correlation [r] = 0.92) and 12 (r = 0.88) months. Internal consistency was high (Cronbach alpha = 0.84). The correlations between the NTB z score and scores on traditional measures of cognition and function were significantly different from 0 (P < .001). A factor analysis yielded "memory" and "executive function" factors. The NTB z score declined linearly over 1 year in patients receiving placebo and, in contrast to the Alzheimer's Disease Assessment Scale cognitive subscale, demonstrated similar declines in patients with high (21-26) and low (15-20) Mini-Mental State Examination scores at baseline.
The NTB exhibits excellent psychometric properties and seems to be a reliable and sensitive measure of cognitive change in patients with mild to moderate Alzheimer disease. The psychometric properties of the NTB suggest that it may have particular utility in evaluating drug efficacy in clinical trials in which patients with mild Alzheimer disease are included.
Harmful consequences in health status caused by disease are referred to as outcomes, and in clinical studies the measures of these outcomes are called endpoints. A major challenge when deciding on endpoints is to represent the outcomes of interest accurately, and the accuracy of such representation is assessed through validation. Complex diseases like Alzheimer's disease have many different and interdependent outcomes. We present a consensus for endpoints to be used in clinical trials in Alzheimer's disease, agreed by a European task force under the auspices of the European Alzheimer Disease Consortium. We suggest suitable endpoints for primary and secondary prevention trials, for symptomatic and disease-modifying trials in very early, mild, and moderate Alzheimer's disease, and for trials in severe Alzheimer's disease. A clear and consensual definition of endpoints is crucial for the success of further clinical trials in the field and will allow comparison of data across studies.
Aging cognition unconfounded by prior test experience published online Sept 2. DOI:10.1093/geronb/gbu063 Synergistic eff ect of β-amyloid and neurodegeneration on cognitive decline in clinically normal individuals
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- Mormino Ec
- Ra Betensky
- T Hedden
30 Salthouse TA. Aging cognition unconfounded by prior test experience. J Gerontol B Psychol Sci Soc Sci 2014; published online Sept 2. DOI:10.1093/geronb/gbu063. 31 Mormino EC, Betensky RA, Hedden T, et al. Synergistic eff ect of β-amyloid and neurodegeneration on cognitive decline in clinically normal individuals. JAMA Neurol 2014; 71: 1379–85.
Preventing Alzheimer's disease and cognitive decline Evidence report/technology assessment No. 193. (Prepared by the Duke Evidence-based Practice Center under Contract No. HHSA 290-2007-10066-I.) AHRQ Publication No. 10-E005
- J Williams
- B Plassman
- J Burke
- T Holsinger
- S Benjamin
Williams J, Plassman B, Burke J, Holsinger T, Benjamin S.
Preventing Alzheimer's disease and cognitive decline. Evidence
report/technology assessment No. 193. (Prepared by the Duke
Evidence-based Practice Center under Contract No. HHSA
290-2007-10066-I.) AHRQ Publication No. 10-E005. Rockville, MD:
Agency for Healthcare Research and Quality, 2010.
Geneva: World Health Organization—Alzheimer's Disease International http://www. who.int/mental_health/publications/dementia_report_2012/en/ (accessed Sept 29, 2014). 2 G8 dementia summit declaration. https://www.gov.uk/government/ publications/g8-dementia-summit-agreements
- Who Dementia
1
WHO. Dementia: a public health priority. Geneva: World Health
Organization—Alzheimer's Disease International, 2012. http://www.
who.int/mental_health/publications/dementia_report_2012/en/
(accessed Sept 29, 2014).
2
G8 dementia summit declaration. https://www.gov.uk/government/
publications/g8-dementia-summit-agreements (accessed
April 28, 2014).
Evidence report/technology assessment No. 193. (Prepared by the Duke Evidence-based Practice Center under Contract No. HHSA 290-2007-10066-I.) AHRQ Publication No. 10-E005
- J Williams
- B Plassman
- J Burke
- T Holsinger
- S Benjamin
Williams J, Plassman B, Burke J, Holsinger T, Benjamin S.
Preventing Alzheimer's disease and cognitive decline. Evidence
report/technology assessment No. 193. (Prepared by the Duke
Evidence-based Practice Center under Contract No. HHSA
290-2007-10066-I.) AHRQ Publication No. 10-E005. Rockville, MD:
Agency for Healthcare Research and Quality, 2010.