http://www.medpagetoday.com/meetingcoverage/aan/64800
At-risk seniors seem to benefit from nutritional guidance, vigorous exercise
BOSTON -- A program that provides elderly people at risk for dementia with dietary guidance, exercise, cognitive training, and vascular risk monitoring could prevent cognitive decline, researchers said here.Prevention has been highlighted "as a key element in managing dementia, said Miia Kivipelto, PhD, of the Center for Alzheimer Research and Aging Research Center, Karolinska Insitutet in Stockholm in a presentation at the American Academy of Neurology annual meeting.
"At the same time it is increasingly clear that it is very difficult to find new drug treatments for Alzheimer's disease and dementia," she noted.
While there has been evidence in observational studies that modifiable vascular and lifestyle-related risk factors are associated with dementia risk, what has been lacking has been evidence from randomized control trials showing that modifying these risk factors can prevent cognitive decline, she noted.
The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study is a proof-of-concept randomized control trial designed to assess a "multidomain" approach to preventing cognitive decline in at-risk elderly persons. The results of the study were originally published in the Lancet.
In this trial conducted from 2009-2011, researchers
enrolled individuals between the ages of 60-77, with 631 randomly
assigned to the multidomain intervention group, and 629 to the control
group. Inclusion criteria include CAIDE (Cardiovascular Risk Factors,
Aging, and Incidence of Dementia) Dementia Risk Scores of at least 6
points, and cognition at mean level or slightly lower than expected for
age.
"As expected, both groups improved over the 2 years, but the intervention group improved much more," Kivipelto said.
The primary outcome was cognitive change as measured through a comprehensive neuropsychological test battery Z score.
The impact of the intervention on global cognition was significantly higher, said Kivipelto, with the intervention group showing a 25% greater improvement over baseline scores compared with the control group.
That pattern also held for outcomes such as executive functioning (83% improvement), processing speed (150%), and complex memory tasks (40%).
"We also saw that the control group had a 30% increased risk of cognitive decline [versus the intervention group] over the 2 years," she said.
Kivipelto added that new data from the trial also indicated that the intervention was beneficial regardless of sociodemographic factors, baseline cognition, or cardiovascular risk factors. "This indicates that the selection of the target group was successful and that this type of intervention may be implemented in a wider population."
The intervention also had positive effects on secondary outcomes such as activities of daily life (ADL) function, mobility, and quality of life. For example, the intervention group had a 30% lower risk of a decline in ADL function versus the control group.
While adverse events occurred in 46 (7%) of the people in the intervention group, compared with six (1%) in the control group, "there were no serious adverse events," Kivipelto said, adding that most adverse events involved slight muscular pain related to exercise.
As for future research in this area, "I think it will be very important in the future to have even larger multidomain, multinational studies, with tailored interventions, and pragmatic prevention programs," Kivipelto said.
Kivipelto disclosed no relevant relationships with industry.
Primary Source
American Academy of Neurology
Source Reference: Kivipelto M, et al "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 Randomized Control Trial" AAN 2017.
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