Nothing here tells me if it actually works to prevent dementia.
Acceptability and fidelity of the multidomain ‘Brain Bootcamp’ dementia risk reduction program: a mixed-methods approach
BMC Public Health volume 25, Article number: 619 (2025)
Abstract
Background
Interventions targeting dementia prevention typically lack comprehensive exploration of feasibility, acceptability, and long-term translation factors prior to deployment. Our study aimed to explore the acceptability, fidelity and participants’ experiences with Brain Bootcamp, a multi-domain behaviour change intervention targeting reduced dementia risk and increased dementia risk factor awareness for older adults.
Methods
Conducted in New South Wales, Australia, from January to August 2021, our concurrent single-group mixed-methods feasibility study involved post-intervention surveys and qualitative interviews with community-dwelling older adults. Descriptive statistics were used to assess acceptability of the methods, outcome measures, and fidelity to the program components. Thematic analysis of semi-structured interviews explored participant experiences, preferences, barriers, and recommendations.
Results
Out of 853 enrolled participants, only 355 completed the program (41.6%). Among these participants, 79.1% agreed that the intervention improved their awareness of dementia risk factors, and 92.4% expressed intent to continue maintaining brain healthy behaviours post- program. Participants typically set 2–4 modifiable risk factor lifestyle goals, which were most often related to physical activity (83.7%). A majority (91.5%) successfully achieved at least one brain health goal. Qualitative analyses (n = 195) identified three overarching themes on the role of education on behaviour modification (i.e., the transformative role of the program in enhancing knowledge about dementia prevention and fostering behavioral modifications), psychological considerations (e.g., intrinsic versus extrinsic motivation on their engagement and perception of the program) and future directions (e.g., sustainability concerns and the need for tailored strategies for specific demographics).
Conclusions
While Brain Bootcamp had low completion rates, those who completed the program reported high acceptability. Future refinements, incorporating targeted strategies and enhanced participant support and communication, will facilitate pragmatic initiatives.
Clinical trial number
ACTRN12621000165886.
Introduction
Dementia is a condition where cognitive functioning declines beyond normal ageing and impacts on one’s ability to perform everyday social and working tasks [1]. This has ongoing impacts not only on the lives of people with dementia, their caregivers but also the wider community [1]. Exact numbers of the population living with dementia in Australia is currently unknown and likely underrepresented. In 2022, an estimated 400,000 to 459,000 Australians were diagnosed with dementia, and in the next 30 years this number is expected to double [2]. Despite extensive global research, there is no curative treatment available yet [3], which poses significant challenges for healthcare systems worldwide. As populations continue to age, the prevalence of dementia is expected to increase substantially, leading to a corresponding rise in healthcare costs [4].
Observational research strongly suggests that dementia can be potentially modifiable through behaviours [5]. These modifiable risk factors include lower levels of education, hearing loss, traumatic brain injury, hypertension, alcohol consumption, obesity, smoking, depression, social isolation, physical inactivity, diabetes, and exposure to air pollution [5]. However, results from randomised trials show mixed results [6]. For instance, the Dutch Prevention of Dementia by Intensive Vascular Care (preDIVA) found that a nurse-led intensive vascular care program delivered in primary care did not decrease risk of all-cause dementia, but lowered risk in a pre-planned subgroup analysis of people with untreated hypertension and the risk of non-Alzheimer’s disease dementia [7]. The Multi-domain Alzheimer Preventive Trial (MAPT) targeted nutrition, physical and cognitive activity through 3 individual or group consultations and found no differences in cognitive decline across the intervention groups in the 3 year trial period, but cognitive decline was less pronounced in participants with higher dementia risk as indicated by amyloid blood status [8]. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) tested the effect of a multidomain lifestyle and behaviour intervention of diet guidance, physical exercise, cognitive training and vascular risk management in 1260 older adults, and found a more favourable cognitive trajectory after two years in the intervention group [9]. The smaller scale SMARRT randomised clinical trial involving person-delivered health coaching also demonstrated improvements in cognitive scores and risk factor scores amongst older adults over two years [10].
Efforts to address modifiable dementia risk both nationally and internationally in the form of lifestyle programs are increasing in popularity [11]. Examples of trials either currently being designed or implemented include the Maintain Your Brain (MYB) trial [12], Japan-Multimodal Intervention Trial for Prevention of Dementia PRIME Tamba (J-MINT) [13], Canadian Therapeutic Platform Trial for Multidomain Interventions to Prevent Dementia (CAN-THUMBS UP) [14], the APPLE Tree program [15], the Body Brain Life trial [16], the LEISURE study [17] and the AgeWell.de [18] which target various dementia risk factors utilising numerous approaches such as physical resources [15], face-to-face lifestyle coach-delivered sessions [13, 16, 17], as well as m-health and web-based platforms [14, 15, 19] in an effort to educate and support lifestyle behaviours for brain health. Moreover, the collective efforts extend beyond the mentioned trials, with more ongoing trials aiming to contribute further insights and solutions to the complex challenge of dementia prevention [11].
Despite the above evidence to indicate that multidomain lifestyle interventions may be effective in promoting cognitive health and reducing dementia risk [6, 20, 21], these programs are often criticised for being time and resource consuming, too costly and require substantial caregiver support. Additionally, they tend to have limited generalisability as many trials involved highly selective populations that predominantly consisted of individuals from Anglo backgrounds. As a result, these interventions may struggle to achieve compliance or success when scaled for broader, more diverse, population-scale implementation [22, 23]. Furthermore, whilst acceptability and feasibility are both important aspects to consider in the design, evaluation and implementation of interventions are often not fully evaluated [24]. These aspects are critical to understanding the extent of anticipated cognitive and emotional responses of participants to the intervention as well as its appropriateness and practicality to scaling up of future programs [24].
Brain Bootcamp is an Australian multidomain dementia risk reduction program developed to increase dementia risk factor awareness and reduce dementia risk scores by addressing multiple modifiable risk factors for older adults. Following recommendations of the Medical Research Council (MRC) guidance for complex interventions [25], evaluations of program acceptability can support future program development. This paper thus aimed to explore the feasibility and acceptability of the Brain Bootcamp program using a mixed-methods approach.
More at link.
No comments:
Post a Comment