Multi-Domain Interventions in Dementia Prevention P605

WEDNESDAY, JULY 18, 2012

SYMPOSIA: S4-01:

FROM OBSERVATION TO ACTION: MULTI-DOMAIN

INTERVENTIONS IN DEMENTIA PREVENTION

S4-01-01 RISK FACTOR REDUCTION AND ALZHEIMER’S

Symposia: S4-01:: From Observation to Action:

DISEASE PREVALENCE: PROJECTED EFFECT

AND PRACTICAL IMPLICATIONS

Deborah Barnes, University of California, San Francisco, San Francisco,

California, United States.

Background: Alzheimer’s disease (AD) is a multi-factorial process that

begins many years and possibly decades before clinical symptoms man-

ifest. Medications developed to date do not stop or reverse the disease

process. Therefore, there is tremendous interest in identifying effective

prevention strategies. Interventions that target health behaviors and treat-

ment or control of chronic health conditions are particularly attractive

due to their low side effect profile and potential to have other health ben-

efits. The goal of our presentation is to summarize and discuss the impli-

cations of recently published research related to the potential impact of

risk factor reduction strategies on AD prevalence worldwide and in the

US. Methods: A systematic review of the literature was performed to iden-

tify meta-analyses of longitudinal observational studies and randomized,

controlled trials (RCTs) related to potentially modifiable or treatable de-

mentia risk factors including physical inactivity, low education, diabetes,

hypertension, obesity, smoking and depression. The number and percent

of AD cases attributable to each risk factor alone and all risk factors com-

bined was calculated using population attributable risks (PARs), and the

projected effect of 10% and 25% risk factor reductions on AD prevalence

was determined. Results: Overall, approximately half of AD cases are po-

tentially attributable to the 7 risk factors examined. A 10-25% reduction in

all risk factors could lower AD prevalence by 1 to 3 million cases worldwide

and 200,000 to 500,000 cases in the US. Worldwide, low education contrib-

uted to the largest proportion of cases (19%) followed by smoking (14%),

physical inactivity (13%) and depression (11%). In the US, physical inactiv-

ity contributed to the largest proportion of cases (21%) followed by depres-

sion (15%), smoking (11%), and midlife hypertension (8%) or obesity (8%).

Conclusions: Nearly half of AD cases may be attributable to modifiable or

treatable risk factors, suggesting that population-based strategies targeting

health behaviors and treatment or control of chronic health conditions could

dramatically lower the number of AD cases over time. The most important

risk factors to target will depend on which risk factors are most common in

a given community. Multidomain interventions are likely to have the great-

est impact.

S4-01-02 INTENSIVE VASCULAR CARE IN DEMENTIA

PREVENTION (EVA AND PREDIVATRIALS)

Eric Moll van Charante, Lisa Eurelings, Suzanne Ligthart, Willem van

Gool, Edo Richard, Academic Medical Centre, University of Amsterdam,

Amsterdam, Netherlands.

Background: Vascular risk factors are associated with an increased risk

of dementia. Epidemiological studies suggest that cognitive decline and

dementia can be postponed or prevented by treatment of these risk fac-

tors. In the randomized controlled EVA-study (Evaluation of Vascular

Care in Alzheimer’s Disease) we have shown that intensive vascular

care slows progression of white matter lesions in early AD, but this is

not accompanied by a clinically relevant effect on cognition, behaviour

or handicap. Earlier intervention before the onset of cognitive decline

might be needed. Methods: The Prevention of Dementia by Intensive

Vascular Care (PreDIVA) study is a cluster-randomized clinical trial in

3534 non-demented elderly (70-78 years) comparing intensive vascular

care to standard care with a 6-year intervention and follow-up. The inter-

vention consists of 4-monthly visits to a practice nurse who addresses all

vascular risk factors (hypertension, dyslipidemia, DM, obesity, smoking,

lack of physical exercise) and initiates and monitors pharmacological and

non-pharmacological treatments in close collaboration with the general

practitioner. Primary outcomes are incident dementia and handicap.

Main secondary outcomes are cardiovascular events (stroke, myocardial

infarction, peripheral arterial disease), mortality and depression. Repeated

structural MRI is done in a subset. Results:At baseline only 12% of par-

ticipants had no risk factors amenable to treatment, >40% had 2 or more

risk factors, 39% had a systolic BP >160 mmHg and 23% had a BMI

>25. In early 2012 the 2-year follow-up will be complete. Preliminary

data show a reduction of the systolic blood pressure of 8.5 vs 4.9

mmHg in the intervention vs. control group. The use of antihypertensive

drugs increased by 16% vs. 9%. Further analysis of the effect on vascular

risk profile is ongoing and will be presented. A full interim analysis of

the effect on the primary outcomes dementia and handicap will take

place after 4 years of intervention and follow-up. Conclusions: Large-

scale nurse-led intensive vascular care is feasible and leads to improved

management of hypertension, and potentially other vascular risk factors.

Whether this will lead to prevention of cognitive decline and dementia

will be answered by the Prevention of Dementia by Intensive Vascular

Care (PreDIVA) study.

S4-01-03 RESULTS AND EXPERIENCES FROM

SCANDINAVIANMULTI-DOMAIN INTERVENTION

TRIALS (DRS EXTRA AND FINGER)

Alina Solomon1, Tiia Ngandu2, Satu Ahtiluoto2, Antti Jula2,

Tiina Laatikainen2, Rainer Rauramaa1, Timo Strandberg3,

Jaakko Tuomilehto4, Hilkka Soininen1, Miia Kivipelto5, 1University of

Eastern Finland, Kuopio, Finland; 2National Institute for Health and

Welfare, Helsinki, Finland; 3University of Oulu, Oulu, Finland; 4University

of Helsinki, Helsinki, Finland; 5Karolinska Institutet, Stockholm, Sweden.

Background: Finnish Geriatric Intervention Study to Prevent Cognitive

Impairment and Disability (FINGER) is a multicenter 2-year random-

ized controlled trial ongoing in Finland. It is partly based on another

ongoing trial, Dose-Responses to Exercise Training (DRs EXTRA).

Methods: DRs EXTRA: 1335 participants (57-78 years) were randomized

to aerobic exercise, resistance exercise, diet, combined aerobic exercise

and diet, combined resistance exercise and diet or reference group for

a 4-year intervention. The 2-year interim data is currently available. Exer-

cise was assessed by maximal oxygen uptake (VO2max), and cognition

(secondary outcome) with CERAD neuropsychological battery. FINGER:

1200 individuals (60-77 years) at risk of cognitive decline were recruited

from previous population-based surveys. Selection criteria used CAIDE

Dementia Risk Score and CERAD. The multi-domain intervention in-

cludes nutritional guidance; exercise; cognitive training and social activity;

management of metabolic and vascular risk factors. The control group re-

ceives regular health advice. Primary outcome is cognition (modified Neu-

ropsychological Test Battery, Stroop, and Trail Making tests). Main

secondary outcomes: dementia (after extended follow-up), disability, qual-

ity of life, utilization of health resources, and neuroimaging measures. Re-

sults: DRs EXTRA: improved VO2max was associated with improved

immediate memory in aerobic, resistance, diet and aerobic-diet groups,

improved delayed memory in diet group and verbal performance in aer-

obic group. Participants in the upper gender-specific VO2max tertile had

66.0% lower, and in the middle tertile 56.4% lower risk of impaired de-

layed memory compared to the lower VO2max tertile. FINGER: screen-

ing was completed in 2011. All 1200 participants are enrolled and the

intervention is ongoing as planned. Baseline characteristics indicate

that several vascular and lifestyle-related risk factors are present, creat-

ing prevention opportunities. Preliminary results after one year show

improved cardiovascular risk profiles in the intervention group. Inter-

vention will be completed during 2014. Conclusions: These experiences

indicate that participants can be motivated to adhere to significant life-

style changes, and that better physical fitness may mitigate memory im-

pairment. FINGER is at the forefront of international collaborative

efforts to solve the clinical and public health problems of early identi-

fication of individuals at increased risk of late-life cognitive impairment,