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Quantifying dementia prevention potential in the FINGER randomized controlled trial using the LIBRA prevention index
Author(s) -
Deckers Kay,
Koehler Sebastian,
Ngandu Tiia,
Verhey Frans RJ,
Kivipelto Miia,
Solomon Alina
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.037948
Subject(s) - dementia , randomized controlled trial , medicine , cognitive decline , cognition , population , physical therapy , neuropsychology , psychological intervention , gerontology , psychiatry , disease , environmental health
Abstract Background Individuals in early dementia prevention trials may differ in how much they benefit from the interventions depending on their initial level of dementia risk. Using a composite risk score comprising health‐ and lifestyle factors (i.e., modifiable dementia risk) might be useful to better target future interventions and to monitor intervention effects during study execution. The present study examines whether the effects of a multi‐domain lifestyle intervention on cognition differ across baseline modifiable dementia risk, and to investigate the potential use of a modifiable dementia risk score as an outcome measure in intervention studies. Method The 2‐year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) randomized controlled trial recruited 1260 people aged 60‐77 and at‐risk of dementia from the general Finnish population. Participants were randomized 1:1 to a multi‐domain intervention group (diet, exercise, cognition, and vascular risk management) or control group (general health advice). Modifiable dementia risk was ascertained with the ‘LIfestyle for BRAin health’ (LIBRA) score. LIBRA consists of 12 risk and protective factors for cognitive decline and dementia, with higher scores indicating greater dementia risk (i.e. a more unhealthy lifestyle; range: –5.9 to +12.7). Primary outcome was change in cognition (baseline, 1‐ and 2‐year) measured with a comprehensive neuropsychological test battery (NTB) total score, and other outcomes include executive functioning, processing speed, memory and abbreviated memory. Result Higher LIBRA scores at baseline were associated with lower cognitive test scores and predicted more decline on the NTB total score and in the memory and abbreviated memory domain over the 2‐year study period, but treatment outcomes did not differ across LIBRA scores/tertiles. LIBRA scores declines both at one and two year follow‐up. There was more decline in the LIBRA score in the intervention group compared to the control group (B = ‐0.184, 95% CI ‐0.328 to ‐0.040; p = 0.012). Conclusion The FINGER intervention was evenly effective in those at low, medium or high lifestyle‐based risk. LIBRA may be useful as a surrogate/intermediate endpoint and surveillance tool to monitor intervention success during trial execution.