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Tainta M, Ecay-Torres M, de Arriba M, Barandiaran M, Otaegui-Arrazola A, Iriondo A, Garcia-Sebastian M, Estanga A, Saldias J, Clerigue M, Gabilondo A, Ros N, Mugica J, Barandiaran A, Mangialasche F, Kivipelto M, Arrospide A, Mar J, Martinez-Lage P. GOIZ ZAINDU study: a FINGER-like multidomain lifestyle intervention feasibility randomized trial to prevent dementia in Southern Europe. Alzheimers Res Ther 2024; 16:44. [PMID: 38413990 PMCID: PMC10898038 DOI: 10.1186/s13195-024-01393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND GOIZ ZAINDU ("caring early" in Basque) is a pilot study to adapt the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) methodology to the Basque population and evaluate the feasibility and adherence to a FINGER-like multidomain intervention program. Additional aims included the assessment of efficacy on cognition and data collection to design a large efficacy trial. METHOD GOIZ ZAINDU is a 1-year, randomized, controlled trial of a multidomain intervention in persons aged 60+ years, with Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score ≥ 6, no diagnosis of dementia, and below-than-expected performance in at least one of three cognitive screening tests. Randomization to a multidomain intervention (MD-Int) or regular health advice (RHA) was stratified by sex, age (>/≤ 75), and cognitive status (mild cognitive impairment (MCI)/normal cognition). MD-Int included cardiovascular risk factor control, nutritional counseling, physical activity, and cognitive training. The primary outcomes were retention rate and adherence to the intervention program. Exploratory cognitive outcomes included changes in the Neuropsychological Test Battery z-scores. Analyses were performed according to the intention to treat. RESULTS One hundred twenty-five participants were recruited (mean age: 75.64 (± 6.46); 58% women). The MD-Int (n = 61) and RHA (n = 64) groups were balanced in terms of their demographics and cognition. Fifty-two (85%) participants from the RHA group and 56 (88%) from the MD-Int group completed the study. More than 70% of the participants had high overall adherence to the intervention activities. The risk of cognitive decline was higher in the RHA group than in the MD-Int group in terms of executive function (p =.019) and processing speed scores (p =.026). CONCLUSIONS The GOIZ-ZAINDU study proved that the FINGER methodology is adaptable and feasible in a different socio-cultural environment. The exploratory efficacy results showed a lower risk of decline in executive function and processing speed in the intervention group. These results support the design of a large-scale efficacy trial. TRIAL REGISTRATION GOIZ ZAINDU feasibility trial was approved and registered by the Euskadi Drug Research Ethics Committee (ID: PI2017134) on 23 January 2018. Retrospectively registered in ClinicalTrials.gov (NCT06163716) on 8 December 2023.
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Affiliation(s)
- Mikel Tainta
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | | | - Maria de Arriba
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | - Myriam Barandiaran
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | | | - Ane Iriondo
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | | | - Ainara Estanga
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | - Jon Saldias
- CITA-alzheimer Foundation, Donostia-San Sebastián, País Vasco, Spain
| | | | - Alazne Gabilondo
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, País Vasco, Spain
- Osakidetza, Organización Sanitaria Integrada (OSI) Bidasoa, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | - Naia Ros
- University of the Basque Country UPV/EHU, Donostia-San Sebastian, Spain
| | - Justo Mugica
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
| | - Aitziber Barandiaran
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, País Vasco, Spain
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Arantzazu Arrospide
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
| | - Javier Mar
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, País Vasco, Spain
- Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Spain
- Instituto de Investigación en Servicios Sanitarios Kronikgune, Barakaldo, Spain
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Tomaszewski Farias S, Fox J, Dulaney H, Chan M, Namboodiri S, Harvey DJ, Weakley A, Rahman S, Luna C, Beech BF, Campbell L, Schmitter-Edgecombe M. Memory support training and lifestyle modifications to promote healthy aging in persons at risk for Alzheimer's disease: a digital application supported intervention (Brain Boosters). BMC Geriatr 2023; 23:881. [PMID: 38129775 PMCID: PMC10740219 DOI: 10.1186/s12877-023-04574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Evidence-based interventions to protect against cognitive decline among older adults at risk for Alzheimer's disease and related dementias (ADRD) are urgently needed. Rehabilitation approaches to support memory and behavioral/lifestyle interventions are recognized as promising strategies for preserving or improving cognitive health, although few previous interventions have combined both approaches. This paper describes the protocol of the Brain Boosters intervention, which synergistically combines training in compensatory and healthy lifestyle behaviors and supports implementation and tracking of new behaviors with a digital application. METHODS The study utilizes a single-site, single-blinded, randomized controlled design to compare a structured lifestyle and compensatory aid intervention to an education-only self-guided intervention. We plan to enroll 225 community-dwelling adults (25% from underrepresented groups) aged 65 + who endorse subjective cognitive decline (SCD) and low baseline levels of healthy lifestyle behaviors. Both interventions will be administered in group format, consisting of 15 two-hour classes that occur weekly for ten weeks and taper to bi-monthly and monthly, for an intervention duration of 6 months. Participants in both interventions will receive education about a variety of memory support strategies and healthy lifestyle behaviors, focusing on physical and cognitive activity and stress management. The structured intervention will also receive support in adopting new behaviors and tracking set goals aided by the Electronic Memory and Management Aid (EMMA) digital application. Primary outcomes include global cognition (composite of memory, attention, and executive function tests) and everyday function (Everyday Cognition Questionnaire). Data will be collected at baseline and outcome visits, at approximately 6, 12, and 18 months. Qualitative interviews, self-report surveys (e.g., indicators of self-determination, health literacy) and EMMA data metrics will also be used to identify what components of the intervention are most effective and for whom they work. DISCUSSION Successful project completion will provide valuable information about how individuals with SCD respond to a compensation and preventative lifestyle intervention assisted by a digital application, including an understanding of factors that may impact outcomes, treatment uptake, and adherence. The work will also inform development, scaling, and personalization of future interventions that can delay disability in individuals at risk for ADRD. TRIAL REGISTRATION ClinicalTrials.gov. (NCT05027789, posted 8/30/2021).
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Affiliation(s)
| | - J Fox
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - H Dulaney
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - M Chan
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - S Namboodiri
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - D J Harvey
- Department of Biostatistics, University of California, Davis, Davis, USA
| | - A Weakley
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - S Rahman
- Department of Psychology, Washington State University, Pullman, USA
| | - C Luna
- Department of Psychology, Washington State University, Pullman, USA
| | - B F Beech
- Department of Psychology, Washington State University, Pullman, USA
| | - L Campbell
- Department of Neurology, University of California, Davis, Sacramento, USA
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Huang TY, Chou MY, Liang CK, Lin YT, Chen RY, Wu PF. Physical activity plays a crucial role in multidomain intervention for frailty prevention. Aging Clin Exp Res 2023; 35:1283-1292. [PMID: 37101084 PMCID: PMC10132799 DOI: 10.1007/s40520-023-02412-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND AND AIMS Taiwan is one of the most rapidly aging countries worldwide. Both physical activity and frailty affect older adults, and multidomain interventions prevent frailty. This study investigated the associations between physical activity, frailty, and the effects of multidomain intervention. METHODS This study enrolled individuals aged 65 years or older. The physical activity level was assessed using the Physical Activity Scale for the Elderly (PASE). Enrollees participated in a multidomain intervention program that consisted of twelve 120-min sessions administered over a 12-week period that included health education, cognitive training, and exercise programs. The effects of the intervention were evaluated using the instrumental activities of daily living scale (IADL), Mini Nutritional Assessment short form (MNA-SF), five-item Geriatric Depression Scale (GDS-5), Mini-Mental State Examination (MMSE), timed up and go test (TUGT), and Fried's frailty phenotype. RESULTS In total, 106 older adults (aged 65-96 years) were enrolled in this study. The mean age was 77.47 ± 7.19 years, and 70.8% of participants were women. PASE scores were significantly lower among participants who were of older age, frail, and had a history of falls in the last 12 months. Frailty could be improved by multidomain interventions and was significantly positively correlated with depression, and negatively correlated with physical activity, mobility, cognition and daily living skills. Moreover, daily living skills were significantly positively correlated with cognition, mobility and physical activity, and negatively correlated with age, sex, and frailty. However, multidomain interventions did not affect daily living skills suggesting daily living skills may need to be maintained from a young age. Finally, results from multiple regressions suggest that physical activity, mobility and depression may be predictors of frailty. CONCLUSIONS Physical activity has an important role in frailty, may be a predictor of frailty, and strongly contributes to reducing frailty through multidomain intervention. Policies that encourage healthy aging should focus on increasing physical activity, maintaining basic daily living skills and reducing frailty.
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Affiliation(s)
- Tzu-Ya Huang
- Department of Family Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, 700, Kaohsiung University Rd., Kaohsiung, 811726, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
| | - Ru-Yih Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, 813414, Taiwan
- Department of Business Management, Institute of Health Care Management, National Sun Yat-sen University, No.70 Lienhai Rd., Kaohsiung, 804201, Taiwan
| | - Pei-Fung Wu
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, 700, Kaohsiung University Rd., Kaohsiung, 811726, Taiwan.
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Liu X, Ma Z, Zhu X, Zheng Z, Li J, Fu J, Shao Q, Han X, Wang X, Wang Z, Yin Z, Qiu C, Li J. Cognitive Benefit of a Multidomain Intervention for Older Adults at Risk of Cognitive Decline: A Cluster-Randomized Controlled Trial. Am J Geriatr Psychiatry 2023; 31:197-209. [PMID: 36414488 DOI: 10.1016/j.jagp.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We sought to assess cognitive benefits of a community-based multidomain intervention for improving cognition among older adults at risk of cognitive decline (COMBAT). DESIGN A two-armed cluster-randomized controlled trial. SETTING AND PARTICIPANTS Community-dwelling older adults aged 60 years or older and were at risk of cognitive decline (n = 209). INTERVENTION In this 9-month intervention study, 10 community hospitals in Beijing, China, were randomized (1:1) to receive either a multidomain intervention of meditation, cognitive training, exercise, and nutrition counseling or usual care. The intervention was delivered with weekly 1-hour group training sessions and weekly home homework. MEASUREMENTS Primary outcome was change in cognition as measured by a composite Z score of seven cognitive tests. Secondary outcomes included subjective cognitive abilities, positive and negative affective experiences, physical activity, and dietary habits. Assessments were administered at baseline, end of the intervention, and 1 year after completing the intervention (1-year follow-up). RESULTS Immediately after the intervention, the intervention group showed significant enhancement in cognitive performance (p = 0.026). The between-group difference in the Z score of change of cognition was 0.20 (95% CI: 0.053, 0.35), with a Hedges' g of 0.40 (95% CI: 0.29, 0.50). However, this cognitive benefit was not significant at 1-year follow-up. CONCLUSION This multidomain intervention was effective to improve cognition for at-risk individuals. Long-term effects on cognitive function and individual differences in response to the intervention deserve further investigation.
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Affiliation(s)
- Xiaomei Liu
- Center on Aging Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), University of Chinese Academy of Sciences, Beijing, China
| | - Zhuoya Ma
- Center on Aging Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), University of Chinese Academy of Sciences, Beijing, China
| | - Xinyi Zhu
- Center on Aging Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), University of Chinese Academy of Sciences, Beijing, China
| | - Zhiwei Zheng
- Center on Aging Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), University of Chinese Academy of Sciences, Beijing, China
| | - Jing Li
- Center on Aging Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), University of Chinese Academy of Sciences, Beijing, China
| | - Jiangning Fu
- Center on Aging Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), University of Chinese Academy of Sciences, Beijing, China
| | - Qi Shao
- Center on Aging Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), University of Chinese Academy of Sciences, Beijing, China
| | - Xiaoyan Han
- Chaoyang District Center for Disease Control and Prevention (XH, XW), Beijing, China
| | - Xiaoning Wang
- Chaoyang District Center for Disease Control and Prevention (XH, XW), Beijing, China
| | - Zhihui Wang
- Chinese Center for Disease Control and Prevention (ZW, ZY), Beijing, China
| | - Zhaoxue Yin
- Chinese Center for Disease Control and Prevention (ZW, ZY), Beijing, China
| | - Chengxuan Qiu
- Aging Research Center (CQ), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Juan Li
- Center on Aging Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology (XL, ZM, XZ, ZZ, JL, JF, QS, JL), University of Chinese Academy of Sciences, Beijing, China.
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5
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Belleville S, Cuesta M, Bieler-Aeschlimann M, Giacomino K, Widmer A, Mittaz Hager AG, Perez-Marcos D, Cardin S, Boller B, Bier N, Aubertin-Leheudre M, Bherer L, Berryman N, Agrigoroaei S, Demonet JF. Rationale and protocol of the StayFitLonger study: a multicentre trial to measure efficacy and adherence of a home-based computerised multidomain intervention in healthy older adults. BMC Geriatr 2020; 20:315. [PMID: 32859156 PMCID: PMC7453698 DOI: 10.1186/s12877-020-01709-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background In older adults, multidomain training that includes physical and cognitive activities has been associated with improvement of physical and cognitive health. The goal of the multisite StayFitLonger study is to assess a home-based computerised training programme, which combines physical exercises, stimulating cognitive activities and virtual coaching. Methods One hundred twenty-eight cognitively healthy older adults will be recruited from the community in Switzerland, Canada and Belgium. The study will comprise (1) a 26-week double-blind randomized controlled efficacy trial and (2) a 22-week pragmatic adherence sub-study. In the efficacy trial, participants will be randomly assigned to an experimental or an active control intervention. In the experimental intervention, participants will use the StayFitLonger programme, which is computerised on a tablet and provides content that combines physical activities with a focus on strength and balance, as well as divided attention, problem solving and memory training. Outcomes will be measured before and after 26 weeks of training. The primary efficacy outcome will be performance on the “Timed-Up & Go” test. Secondary outcomes will include measures of frailty, cognition, mood, fear of falling, quality of life, and activities of daily living. Age, sex, education, baseline cognition, expectation, and adherence will be used as moderators of efficacy. Following the 26-week efficacy trial, all participants will use the experimental programme meaning that participants in the control group will ‘cross over’ to receive the StayFitLonger programme for 22 weeks. Adherence will be measured in both groups based on dose, volume and frequency of use. In addition, participants’ perception of the programme and its functionalities will be characterised through usability, acceptability and user experience. Discussion This study will determine the efficacy, adherence and participants’ perception of a home-based multidomain intervention programme and its functionalities. This will allow for further development and possible commercialization of a scientifically validated training programme. Trial registration ClinicalTrials.gov, NCT04237519 Registered on January 22, 2020 - Retrospectively registered.
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Affiliation(s)
- S Belleville
- Research Centre, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565, Chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada. .,Université de Montréal, Montréal, Canada.
| | - M Cuesta
- Research Centre, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565, Chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada
| | - M Bieler-Aeschlimann
- Leenaards Memory Centre, University Hospital of Lausanne, Lausanne, Switzerland.,MindMaze SA, Lausanne, Switzerland
| | - K Giacomino
- HES-SO Valais-Wallis, School of Health Sciences, Loèche-les-Bains, Switzerland
| | - A Widmer
- HES-SO Valais-Wallis, School of Managment, Sierre, Switzerland
| | - A G Mittaz Hager
- HES-SO Valais-Wallis, School of Health Sciences, Loèche-les-Bains, Switzerland
| | | | - S Cardin
- MindMaze SA, Lausanne, Switzerland
| | - B Boller
- Research Centre, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565, Chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada.,Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - N Bier
- Research Centre, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565, Chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada.,Université de Montréal, Montréal, Canada
| | - M Aubertin-Leheudre
- Research Centre, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565, Chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada.,Université du Québec à Montréal, Montréal, Canada
| | - L Bherer
- Research Centre, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565, Chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada.,Université de Montréal, Montréal, Canada.,Montréal Heart Institute, Montréal, Canada
| | - N Berryman
- Research Centre, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 4565, Chemin Queen-Mary, Montréal, Québec, H3W 1W5, Canada.,Université du Québec à Montréal, Montréal, Canada
| | - S Agrigoroaei
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - J F Demonet
- Leenaards Memory Centre, University Hospital of Lausanne, Lausanne, Switzerland
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6
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Chen LK, Hwang AC, Lee WJ, Peng LN, Lin MH, Neil DL, Shih SF, Loh CH, Chiou ST. Efficacy of multidomain interventions to improve physical frailty, depression and cognition: data from cluster-randomized controlled trials. J Cachexia Sarcopenia Muscle 2020; 11:650-662. [PMID: 32134208 PMCID: PMC7296266 DOI: 10.1002/jcsm.12534] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/01/2019] [Accepted: 12/05/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Frailty is the pre-eminent exigency of aging. Although frailty-related impairments are preventable, and multidomain interventions appear more effective than unimodal ones, the optimal components remain uncertain. METHODS We devised multidomain interventions against physical and cognitive decline among prefrail/frail community-dwelling ≥65-year-olds and evaluated these in complementary cluster-randomized trials of efficacy and participant empowerment. The Efficacy Study compared ~3-monthly telephone consultations vs. 16, 2 h sessions/year comprising communally partaken physical and cognitive training plus nutrition and disease education; the Empowerment Study compared the standard Efficacy Study multidomain intervention (Sessions 1-10) vs. an enhanced version redesigned to empower and motivate individual participants. Changes from baseline in physical, functional, and cognitive performance were measured after 6 and 12 months in the Efficacy Study and after 6 months in the Empowerment Study, with post-intervention follow-up at 9 months. Primary outcomes are as follows: Cardiovascular Health Study frailty score; gait speed; handgrip strength; and Montreal Cognitive Assessment (MoCA). Secondary outcomes are as follows: instrumental activities of daily living; metabolic equivalent of task (MET); depressed mood (Geriatric Depression Scale-5 ≥2); and malnutrition (Mini-Nutritional Assessment short-form ≤11). Intervention effects were analyzed using a generalized linear mixed model. RESULTS Efficacy Study participants (n = 1082, 40 clusters) were 75.1 ± 6.3 years old, 68.7% women, and 64.7% prefrail/frail; analytic clusters: 19 intervention (410/549 completed) vs. 21 control (375/533 completed). Empowerment Study participants (n = 440, 14 clusters) were 75.9 ± 7.1 years old, 83.6% women, and 56.7% prefrail/frail; analytic clusters: seven intervention (209/230 completed) vs. seven control (189/210 completed). The standard and enhanced multidomain interventions both reduced frailty and significantly improved aspects of physical, functional, and cognitive performance, especially among ≥75-year-olds. Standard multidomain intervention decreased depression [odds ratio 0.56, 95% confidence interval (CI) 0.32, 0.99] and malnutrition (odds ratio 0.45, 95% CI 0.26, 0.78) by 12 months and improved concentration at Months 6 (0.23, 95% CI 0.04, 0.42) and 12 (0.46, 95% CI 0.22, 0.70). Participant empowerment augmented activity (4.67 MET/h, 95% CI 1.64, 7.69) and gait speed (0.06 m/s, 95% CI 0.00, 0.11) at 6 months, with sustained improvements in delayed recall (0.63, 95% CI 0.20, 1.06) and MoCA performance (1.29, 95% CI 0.54, 2.03), and less prevalent malnutrition (odds ratio 0.39, 95% CI 0.18, 0.84), 3 months after the intervention ceased. CONCLUSIONS Pragmatic multidomain intervention can diminish physical frailty, malnutrition, and depression and enhance cognitive performance among community-dwelling elders, especially ≥75-year-olds; this might supplement healthy aging policies, probably more effectively if participants are empowered.
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Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - An-Chun Hwang
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Li-Ning Peng
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Hsien Lin
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - David L Neil
- Full Universe Integrated Marketing, Taipei, Taiwan
| | - Shu-Fang Shih
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Ching-Hui Loh
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Shu-Ti Chiou
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan.,Cheng-Hsin General Hospital, Taipei, Taiwan
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7
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Sivera R, Capet N, Manera V, Fabre R, Lorenzi M, Delingette H, Pennec X, Ayache N, Robert P. Voxel-based assessments of treatment effects on longitudinal brain changes in the Multidomain Alzheimer Preventive Trial cohort. Neurobiol Aging 2020; 94:50-59. [PMID: 32574818 DOI: 10.1016/j.neurobiolaging.2019.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/26/2019] [Accepted: 11/17/2019] [Indexed: 10/24/2022]
Abstract
The Multidomain Alzheimer Preventive Trial was designed to assess the effect of omega-3 supplementation and multidomain intervention on cognitive decline of subjects with subjective memory complaint. In terms of cognitive testing, no significant effect was found. In this paper, we evaluate the effect of the interventions on the brain morphological changes. Subjects with magnetic resonance imaging acquisitions at baseline and at 36 months were included (N = 376). Morphological changes were characterized by volume measurements and nonlinear deformation. The multidomain intervention was associated with a significant effect on the 3-year brain morphological changes in the deformation-based approach. Differences were mainly located in the left periventricular area next to the temporoparietal junction. These changes were associated with better cognitive performance and mood/behavior stabilization. No effect of the omega-3 supplementation was observed. This result suggests a possible effect on cognition, not yet observable after 3 years. We argue that neuroimaging could help define whether early intervention strategies are effective to delay cognitive decline and dementia.
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Affiliation(s)
- Raphaël Sivera
- Université Côte d'Azur, Inria Sophia Antipolis, Epione Research Project, Sophia Antipolis, France.
| | - Nicolas Capet
- Centre Hospitalier Universitaire (CHU) de Nice, CMRR, Nice, France
| | - Valeria Manera
- Université Côte d'Azur, CoBTeK Lab, Nice, France; Association Innovation Alzheimer, Nice, France
| | - Roxane Fabre
- Université Côte d'Azur, CoBTeK Lab, Nice, France; Centre Hospitalier Universitaire (CHU) de Nice, Département de Santé Publique, Nice, France
| | - Marco Lorenzi
- Université Côte d'Azur, Inria Sophia Antipolis, Epione Research Project, Sophia Antipolis, France
| | - Hervé Delingette
- Université Côte d'Azur, Inria Sophia Antipolis, Epione Research Project, Sophia Antipolis, France
| | - Xavier Pennec
- Université Côte d'Azur, Inria Sophia Antipolis, Epione Research Project, Sophia Antipolis, France
| | - Nicholas Ayache
- Université Côte d'Azur, Inria Sophia Antipolis, Epione Research Project, Sophia Antipolis, France
| | - Philippe Robert
- Centre Hospitalier Universitaire (CHU) de Nice, CMRR, Nice, France; Université Côte d'Azur, CoBTeK Lab, Nice, France; Association Innovation Alzheimer, Nice, France
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8
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Roh HW, Hong CH, Lim HK, Chang KJ, Kim H, Kim NR, Choi JW, Lee KS, Cho SM, Park B, Son SJ. A 12-week multidomain intervention for late-life depression: a community-based randomized controlled trial. J Affect Disord 2020; 263:437-444. [PMID: 31969275 DOI: 10.1016/j.jad.2019.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/08/2019] [Accepted: 12/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Given that current unimodal strategies for treating late-life depression are insufficient, the awareness of the necessity and importance of multidomain intervention has increased. We assessed the efficacy of multidomain intervention in reducing symptoms of late-life depression. METHODS This was a 12-week community-based randomized controlled trial in 78 older adults diagnosed with major depressive disorder. Participants were randomly assigned to the multidomain intervention or supportive therapy group. We provided four home visits and 12 telephone calls over 12 weeks. Four therapeutic approaches (physical activity, healthy diet, social activity, and brief cognitive restructuring) were incorporated into the multidomain intervention. The primary outcome was the change in depressive symptoms, as measured by the Montgomery-Asberg Depression Rating Scale (MADRS). Secondarily, we investigated changes in resting-state functional connectivity. RESULTS The MADRS total score was reduced more in the multidomain intervention group than in the supportive therapy group during the 12 weeks (intervention × time interaction, P = =0.007). After correction for multiple comparisons, the multidomain intervention group exhibited a lower MADRS total score at week 12 (score difference 5.117; P = =0.029). At follow-up, the multidomain intervention group also exhibited less functional connectivity between the posterior cingulate cortex and left inferior parietal lobule within the default mode network (FDR < 0.1). LIMITATIONS Caution is needed in the interpretation of the results, considering the small sample size and high percentage of female participants. CONCLUSIONS A 12-week multidomain intervention resulted in a greater reduction of depressive symptoms among the elderly with major depressive disorder than their counterparts who received supportive therapy.
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Affiliation(s)
- Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Yeouido St. Mary's Hospital, Seoul, Republic of Korea
| | - Ki Jung Chang
- Department of Psychiatry, Ajou Good Hospital, Suwon, Republic of Korea
| | - Haena Kim
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Na-Rae Kim
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kang Soo Lee
- Department of Psychiatry, CHA University School of Medicine, CHA Bundang Medical Center, Bundang, Republic of Korea
| | - Sun-Mi Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea; Office of Biostatistics, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
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Delrieu J, Payoux P, Carrié I, Cantet C, Weiner M, Vellas B, Andrieu S. Multidomain intervention and/or omega-3 in nondemented elderly subjects according to amyloid status. Alzheimers Dement 2019; 15:1392-401. [PMID: 31558366 DOI: 10.1016/j.jalz.2019.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 07/02/2019] [Accepted: 07/14/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The Multidomain Alzheimer Preventive Trial (MAPT) assessed the efficacy of omega-3 fatty acid supplementation, a multidomain intervention (MI), or a combination of both on cognition. Impact according to cerebral amyloid status was evaluated by PET scan. METHODS Participants were nondemented and had memory complaints, limitation in one instrumental activity of daily living, or slow gait. The primary outcome was a change from baseline in 36 months measured with a cognitive composite Z score. RESULTS No effect was observed on cognition in the negative amyloid group (n = 167). In the positive amyloid group (n = 102), we observed a difference of 0.708 and 0.471 in the cognitive composite score between the MI plus omega-3 fatty acid group, the MI alone group, and the placebo group, respectively. DISCUSSION MI alone or in combination with omega-3 fatty acids was associated with improved primary cognitive outcome in subjects with positive amyloid status. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01513252.
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de Souto Barreto P, Rolland Y, Maltais M, Vellas B. Associations of Multidomain Lifestyle Intervention with Frailty: Secondary Analysis of a Randomized Controlled Trial. Am J Med 2018; 131:1382.e7-1382.e13. [PMID: 29969614 DOI: 10.1016/j.amjmed.2018.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/16/2018] [Accepted: 06/21/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The objective of this study was to investigate whether a long-term multidomain lifestyle intervention was associated with the severity and incidence of frailty in older adults. METHODS A 3-year randomized controlled trial was conducted among 1637 French community dwellers age ≥70: 821 controls and 816 who received a multidomain lifestyle intervention (cognitive training, nutrition counseling, and advice on physical activity). The intervention involved 12 2-hour sessions (in the first 2 months) followed by a 1-hour session each month until the study end. Controls received the usual care but did not receive any personalized lifestyle intervention. A frailty index (FI; range = 0-1, higher is worse) composed of 32 items was calculated at baseline, 6 months, 1 year, 2 years, and 3 years and constituted our main endpoint. FI ≥ 0.25 defined frailty. The 4 outcomes were severity of frailty (continuous FI score), incident frailty, incidence of persistent frailty (frailty at 2 consecutive time points), and reversibility of frailty (from frailty to nonfrailty). RESULTS Mixed-effect linear regression did not find a significant effect of the multidomain intervention on FI score. Frailty incidence occurred in 241 of 1146 subjects (138 controls and 103 in the multidomain group), whereas incidence of persistent frailty occurred in 75 of 1042 subjects (48 controls and 27 in the multidomain group). Cox models adjusted for baseline FI scores showed that compared with controls, subjects in the multidomain group had a decreased risk of developing both frailty (hazard ratio 0.72; 95% confidence interval, 0.55-0.93) and persistent frailty (hazard ratio 0.53; 95% confidence interval, 0.33-0.85). CONCLUSIONS This multidomain lifestyle intervention was associated with a reduced risk of developing frailty but did not affect the severity of frailty in community-dwelling older adults.
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Affiliation(s)
- Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France; Unité Mixte de Recherche (UMR) Institut National de la Santé et de la recherche médicale (INSERM) 1027, University of Toulouse III, France.
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France; Unité Mixte de Recherche (UMR) Institut National de la Santé et de la recherche médicale (INSERM) 1027, University of Toulouse III, France
| | - Mathieu Maltais
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, France; Unité Mixte de Recherche (UMR) Institut National de la Santé et de la recherche médicale (INSERM) 1027, University of Toulouse III, France
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11
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Pothier K, Soriano G, Lussier M, Naudin A, Costa N, Guyonnet S, Piau A, Ousset PJ, Nourhashemi F, Vellas B, de Souto Barreto P. A web-based multidomain lifestyle intervention with connected devices for older adults: research protocol of the eMIND pilot randomized controlled trial. Aging Clin Exp Res 2018; 30:1127-1135. [PMID: 29368298 DOI: 10.1007/s40520-018-0897-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/16/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multidomain interventions composed of nutritional counseling, exercise and cognitive trainings have shown encouraging results as effective preventive strategies delaying age-related declines. However, these interventions are time- and resource-consuming. The use of Information and Communication Technologies (ICT) might facilitate the translation from research into real-world practice and reach a massive number of people. AIM This article describes the protocol of the eMIND study, a randomized controlled trial (RCT) using a web-based multidomain intervention for older adults. METHODS One hundred and twenty older adults (≥ 65 years), with a spontaneous memory complaint, will be randomly assigned to a six-month web-based multidomain (nutritional counseling, physical and cognitive trainings) intervention group with a connected accelerometer (number of steps, energy expenditure), or to a control group with access to general information on healthy aging plus the accelerometer, but no access to the multidomain intervention. The main outcome is the feasibility/acceptability of the web-based intervention. Secondary clinical outcomes include: cognitive functions, physical performance, nutritional status and cost-effectiveness. RESULTS We expect a high amount of adherers (ie, > 75% compliance to the protocol) to reflect the feasibility. Acceptability, assessed through interviews, should allow us to understand motivators and barriers to this ICT intervention. We also expect to provide data on its effects on various clinical outcomes and efficiency. CONCLUSION AND DISCUSSION The eMIND study will provide crucial information to help developing a future and larger web-based multidomain lifestyle RCT, which should facilitate the translation of this ICT intervention from the research world into real-life clinical practice for the healthcare of older adults.
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Affiliation(s)
- Kristell Pothier
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France.
| | - G Soriano
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
| | - M Lussier
- School of Rehabilitation Sciences, Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, H3W 1W5, Canada
| | - A Naudin
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
| | - N Costa
- Medical Information Department, University Hospital of Toulouse, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - S Guyonnet
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - A Piau
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
| | - P J Ousset
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
| | - F Nourhashemi
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - B Vellas
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - P de Souto Barreto
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
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12
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Corsi M, Di Raimo T, Di Lorenzo C, Rapp-Ricciardi M, Archer T, Ricci S, Businaro R. Cognitive disability in alzheimer's disease and its management. Clin Ter 2017; 167:e123-e126. [PMID: 27845490 DOI: 10.7417/ct.2016.1955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cognitive disability linked to neurodegenerative diseases and in particular to Alzheimer's disease, remains an increasing cause for concern through a dramatic prevalence increment and associated socio-economic burdens. Initially Alzheimer's disease develops asymptomatically with primary clinical signs, such as memory impairment, decline of spatial and perceptual abilities, occurring at a later stage. This delay implies the possibility of promoting early interventions during the pre-symptomatic stage of the disease. Different strategies have been applied in order to prevent/delay onset of Alzheimer's disease or at least to improve quality of life and health conditions of Alzheimer's disease patients and their caregivers, especially in the absence of current viable therapies. Multidomain interventions, aimed at affecting several risk factors simultaneously, offer a versatility that may attain improved outcomes in comparison with single-domain prevention trials. These multidomain interventions involve diet, physical exercise, cognitive training and social activities, while music therapy, improving self-consciousness and reducing neurofibrils, may contribute to deceleration/delay onset of Alzheimer's disease progression. Information and Communication Technology (ICT) provides broad applications to improve quality of life and well-being of Alzheimer's disease patients and caregivers, suffering from psychological distress, as well as reducing additional public health costs.
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Affiliation(s)
- M Corsi
- Department of Medico-Surgical Sciences and Biotechnologies
| | - T Di Raimo
- Department of Medico-Surgical Sciences and Biotechnologies
| | - C Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies
| | - M Rapp-Ricciardi
- University of Gothenburg, Department of Psychology, Box 500, SE 40530 Gothenburg, Sweden; 4Network for Empowerment and Well Being, Sweden
| | - T Archer
- University of Gothenburg, Department of Psychology, Box 500, SE 40530 Gothenburg, Sweden; 4Network for Empowerment and Well Being, Sweden
| | - S Ricci
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sapienza University of Rome
| | - R Businaro
- Department of Medico-Surgical Sciences and Biotechnologies
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13
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Vellas B, Carrie I, Gillette-Guyonnet S, Touchon J, Dantoine T, Dartigues JF, Cuffi MN, Bordes S, Gasnier Y, Robert P, Bories L, Rouaud O, Desclaux F, Sudres K, Bonnefoy M, Pesce A, Dufouil C, Lehericy S, Chupin M, Mangin JF, Payoux P, Adel D, Legrand P, Catheline D, Kanony C, Zaim M, Molinier L, Costa N, Delrieu J, Voisin T, Faisant C, Lala F, Nourhashémi F, Rolland Y, Van Kan GA, Dupuy C, Cantet C, Cestac P, Belleville S, Willis S, Cesari M, Weiner MW, Soto ME, Ousset PJ, Andrieu S. MAPT STUDY: A MULTIDOMAIN APPROACH FOR PREVENTING ALZHEIMER'S DISEASE: DESIGN AND BASELINE DATA. J Prev Alzheimers Dis 2014; 1:13-22. [PMID: 26594639 PMCID: PMC4652787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The Multidomain Alzheimer Preventive Trial (MAPT study) was designed to assess the efficacy of isolated supplementation with omega-3 fatty acid, an isolated multidomain intervention (consisting of nutritional counseling, physical exercise, cognitive stimulation) or a combination of the two interventions on the change of cognitive functions in frail subjects aged 70 years and older for a period of 3 years. Ancillary neuroimaging studies were additionally implemented to evaluate the impact of interventions on cerebral metabolism (FDG PET scans) and atrophy rate (MRIs), as well as brain amyloïd deposit (AV45 PET scans). DESIGN PATIENTS 1680 subjects (mean age: 75.3 years; female: 64.8 %), enrolled by 13 memory clinics, were randomized into one of the following four groups: omega-3 supplementation alone, multidomain intervention alone, omega-3 plus multidomain intervention, or placebo. Participants underwent cognitive, functional and biological assessments at M6, M12, M24 and M36 visits. The primary endpoint is a change of memory function at 3 years, as assessed by the Free and Cued Selective Reminding test. All participants will be followed for 2 additional years after the 3-years intervention (MAPT PLUS extension study). INTERVENTIONS 1/Omega-3 supplementation: two soft capsules daily as a single dose, containing a total of 400 mg docosahexaenoic acid (DHA), i.e., 800 mg docosahexaenoic acid per day, for 3 years. 2/ Multidomain intervention: collective training sessions conducted in small groups (6-8 participants) in twelve 120-minute sessions over the first 2 months (two sessions a week for the first month, and one session a week the second month) then a 60-minute session per month in the following three areas: nutrition, physical activity, and cognition until the end of the 3 years. In addition to the collective sessions, individualized preventive outpatient visits exploring possible risk factors for cognitive decline are performed at baseline, M12 and M24. BASELINE POPULATION For cognition, the mean MMSE at baseline was 28.1 (± 1.6). About 58% and 42% of participants had a CDR score equal to 0 and 0.5, respectively. Regarding mobility status, 200 (11.9%) had a 4-m gait speed lower or equal to 0.8 m/s. According to the Fried criteria, 673 (42.1%) participants were considered pre frail, and 51 (3.2%) frail. The red blood cell DHA content was 26.1 ± 8.1 µg/g. Five hundred and three participants underwent baseline MRI. AV45 PET scans were performed in 271 individuals and preliminary results showed that 38.0% had a cortical SUVR > 1.17, which gave an indication of significant brain amyloïd deposit. DISCUSSION: The MAPT trial is presently the first largest and longest multidomain preventive trial relevant to cognitive decline in older adults with subjective memory complaints. The multidomain intervention designed for the MAPT trial is likely to be easily implemented within the general population.
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Affiliation(s)
- B Vellas
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - I Carrie
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France
| | - S Gillette-Guyonnet
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - J Touchon
- Department of Neurology, Memory Research Resource Center for Alzheimer's Disease, University Hospital of Montpellier, Montpellier, France
| | - T Dantoine
- Geriatrics Department, Memory Research Resource Center, University Hospital of Limoges, Limoges, France
| | - J F Dartigues
- INSERM U897, Memory Research Resource Center for Alzheimer's Disease, University Hospital of Bordeaux, Bordeaux, France
| | - M N Cuffi
- Geriatrics Department, Hospital of Castres, Castres, France
| | - S Bordes
- Geriatrics Department, Hospital of Tarbes, Tarbes, France
| | - Y Gasnier
- Geriatrics Department, Hospital of Tarbes, Tarbes, France
| | - P Robert
- Memory Research Resource Center, University Hospital of Nice, Nice, France
| | - L Bories
- Geriatrics Department, Hospital of Foix, Foix, France
| | - O Rouaud
- Memory Research Resource Center, Neurology Department, University Hospital of Dijon, Dijon, France
| | - F Desclaux
- Geriatrics Department, Hospital of Lavaur, Lavaur, France
| | - K Sudres
- Geriatrics Department, Hospital of Montauban, Montauban, France
| | - M Bonnefoy
- Geriatrics Department, Centre Hospitalier Lyon-Sud, Lyon, France
| | - A Pesce
- Geriatrics Department, Hospital of Princess Grace, Monaco
| | - C Dufouil
- INSERM Center U897, CIC-EC7, Bordeaux University, Department of Public Health of CHU Bordeaux, Bordeaux, France
| | - S Lehericy
- Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - M Chupin
- Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - J F Mangin
- CATI, NeuroSpin, CEA-Saclay Center, Gif-sur-Yvette, France
| | - P Payoux
- INSERM UMR 825, Toulouse, France ; Department of Nuclear Medicine, CHU Toulouse, Purpan University Hospital, Toulouse, France
| | - D Adel
- INSERM UMR 825, Toulouse, France
| | - P Legrand
- Nutrition Department, Agrocampus-INRA, Rennes, France
| | - D Catheline
- Nutrition Department, Agrocampus-INRA, Rennes, France
| | - C Kanony
- Institut de Recherche Pierre Fabre, Toulouse, France
| | - M Zaim
- Institut de Recherche Pierre Fabre, Toulouse, France
| | - L Molinier
- INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France ; Department of Medical Information, CHU Toulouse, Toulouse, France
| | - N Costa
- INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France ; Department of Medical Information, CHU Toulouse, Toulouse, France
| | - J Delrieu
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France
| | - T Voisin
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - C Faisant
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France
| | - F Lala
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France
| | - F Nourhashémi
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - Y Rolland
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - G Abellan Van Kan
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - C Dupuy
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France
| | - C Cantet
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - P Cestac
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - S Belleville
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada
| | - S Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Washington, USA
| | - M Cesari
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - M W Weiner
- University of California, San Francisco, California, United States
| | - M E Soto
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - P J Ousset
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France
| | - S Andrieu
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France ; INSERM UMR 1027, Toulouse, France ; University of Toulouse III, Toulouse, France ; Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France
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