Risk reduction strategies may improve cognition for older adults at risk for dementia

Key takeaways:

• Modifiable risk reduction strategies may improve cognition and the dementia risk profile among older adults.
• The intervention group demonstrated a 74% greater increase in cognition compared with a control group.

Modifiable risk reduction strategies improved cognitive scores as well as dementia risk factors and quality of life for older adults at risk for dementia, according to study results published in JAMA Internal Medicine.

The study provides “solid evidence that improving health and lifestyle risk factors for Alzheimer’s disease leads to better cognition,” Kristine Yaffe, MD, the Scola Endowed Chair and Vice Chair and director of the Center for Population Brain Health at the University of California, San Francisco, told Healio.

Yaffe and colleagues conducted a 2-year pilot randomized clinical trial with 172 adults aged 70 to 89 years who were randomly assigned to the personalized, multidomain intervention or a health education control.

The intervention was tailored to each participant and delivered by a health coach and nurse either in person or over the telephone. The health coaches helped participants set goals, such as walking a certain number of steps each day, to improve risk factors. Once the participant reached a goal, a new one was set. The participants also received information on risk factors, self-monitoring tools and resources, such as a fitness tracker, brain games and a portable BP monitor for those targeting hypertension.

In the control group, participants received mailed educational materials on dementia risk reduction every 3 months.

The primary outcome was change in a composite modified Neuropsychological Test Battery. The secondary outcomes were changes in risk factors and quality of life. The researchers assessed outcomes at baseline and 6, 12, 18 and 24 months in both study groups.

Overall, 149 participants completed the trial, including 68 in the intervention group and 81 in the control group.

The intention-to-treat analysis of the composite cognitive primary outcome showed a 74% greater increase in cognition among the intervention group compared with the control group (average treatment effect [ATE] of SD = 0.14; 95% CI, 0.03-0.25).

In addition, the researchers reported that the composite risk factor score improved in the intervention group compared with the control group (ATE of SD = 0.11; 95% CI, 0.01-0.2), as did quality of life (ATE = 0.81 points; 95% CI, 0.21 to 1.84).

“We were thrilled to have met our primary and secondary outcomes,” Yaffe said. “We hypothesized that if you can engage older adults on their risk factor profile and how they want to work to reduce risk in a personalized fashion, one could find improvements in risk factors and better cognitive outcomes over 2 years compared to controls.”

Despite oversampling Hispanic individuals and individuals who were a race other than white in the electronic health records, only 20% diversity was achieved, falling short of the study goal of 30%. Nonetheless, the study results still support further investigation of the personalized, patient-centered approach used in the intervention, according to the researchers.

“We are planning a larger trial study,” Yaffe said.