With your risk of dementia your competent? doctor and hospital better be closely following this. If not, I don't know what you have for stroke recovery and dementia prevention!
1. A documented 33% dementia chance post-stroke from an Australian study? May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.`
3. A 20% chance in this research. July 2013.
4. Dementia Risk Doubled in Patients Following Stroke September 2018
5. Brain Bleeds Double Dementia Risk February 2025
The latest here:
Adherence and intensity in multimodal lifestyle-based interventions for cognitive decline prevention: state-of-the-art and future directions
Alzheimer's Research & Therapy volume 17, Article number: 61 (2025)
Abstract
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.
Background
Alzheimer’s disease (AD), the most prevalent cause of dementia, develops over a long preclinical period and its progression is associated with modifiable lifestyle factors [1, 2]. This offers a window of opportunity for testing early preventive measures. In the last decade, there has been a shift toward multimodal lifestyle-based interventions for dementia prevention (e.g., combining diet, physical activity, cognitive training, vascular risk monitoring, or social interaction), due to the multifactorial nature of this condition [3]. In contrast to interventions targeting one risk factor alone, multimodal interventions target multiple risk factors simultaneously and are expected to generate additive or synergistic preventive effects. However, there is still limited evidence on the effectiveness of multimodal interventions for the prevention of cognitive decline [4]. Additionally, uncertainties persist regarding barriers and facilitators of adherence and response to multimodal interventions, modes of intervention delivery, and the intervention intensity (dose, duration, and adherence) required to influence cognitive performance [5]. Addressing these questions is crucial for advancing and optimizing multimodal interventions for dementia prevention, both at the individual (i.e., personalized prevention), and population levels (i.e., precision prevention) [6, 7].
The effectiveness of a next generation of precision prevention interventions for cognitive decline will rely on how effectively preventive programs are provided to populations of interest, their ability to adhere to such interventions, and the ability of healthcare providers to monitor adherence and adjust the intervention as needed. Adherence is recognized as the strongest predictor of intervention success [8]. However, there is a paucity of studies addressing the determinants of adherence to multimodal interventions [9,10,11,12,13,14]. This gap in evidence is, in part, attributed to the absence of a gold standard definition of adherence to these complex multimodal interventions. Although a single definition may not universally apply to all studies, the development of consensus-based recommendations for measuring and reporting adherence to multimodal interventions could enhance consistency across studies and thus establish global standards for conducting comparative effectiveness research. This is particularly important in the framework of international collaborative networks conducting multimodal intervention trials aimed at preventing cognitive decline, e.g., the World-Wide FINGERS (WW-FINGERS) network [15]. Harmonizing measures of adherence to multimodal interventions will facilitate pooled analyses, which are crucial for providing robust evidence about adherence profiles and progressing in AD prevention research.
The aim of this narrative review is to provide an overview of the available evidence on adherence and efficacy from multimodal dementia prevention trials.
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