The best approach against cognitive decline in the elderly

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cognitive decline (348 posts to December 2011)

The best approach against cognitive decline in the elderly

Prominence

In a randomized clinical trial of 2,111 older adults at risk for cognitive decline and dementia, a structured lifestyle intervention demonstrated significantly greater benefit on global cognition over two years compared with a self-guided intervention.

Context

• Identifying effective interventions to slow or prevent cognitive decline associated with dementia is a public health priority due to the growing number of affected individuals and the profound economic, psychological, and social impacts of the disease.

• Late cognitive decline is often attributable to mixed pathologies, and effective treatment is likely to require a diversified therapeutic strategy to address the different mechanisms associated with Alzheimer's disease and vascular disease.

• Recent advances in the use of anti-amyloid antibodies demonstrate evidence of slowing the specific clinical progression of Alzheimer's disease, however, these treatments are only approved for individuals with confirmed disease.

• Non-pharmacological strategies targeting modifiable risk factors offer a promising, low-cost, accessible, and safe approach with the potential to reduce the incidence of dementia by up to 45%.

• The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated significant cognitive benefit after two years of intervention in multiple domains in older adults at high risk of dementia.

• The World-Wide FINGERS network was launched in 2017 to promote global collaboration, protocol alignment, and data sharing between non-pharmacological risk reduction trials.

Methodology

• Randomized, single-blind, multicenter clinical trial that included 2,111 participants at five clinical sites in the United States, with recruitment from May 2019 to March 2023 and final follow-up until May 14, 2025.

• Inclusion criteria were defined to select a population at higher risk of cognitive decline, including ages between 60 and 79 years, sedentary lifestyle, and inadequate diet, in addition to at least two other factors such as family history of memory impairment, cardiometabolic risk, race and ethnicity, advanced age, and gender.

• Participants were randomized in a 1:1 ratio to either the structured intervention (n = 1,056) or the self-guided intervention (n = 1,055), both of which encouraged increased physical and cognitive activity, a healthy diet, social engagement, and cardiovascular health monitoring.

• The primary comparison was the difference between the intervention groups in the annual variation in global cognitive function, assessed by a composite measure of executive function, episodic memory, and processing speed, over two years.