Personalized strategies improved cognition, reduced dementia risk in seniors
An intervention with personalized risk-reduction goals, health coaching, and nurse visits was offered to patients who were between the ages of 70 and 89 years and had at least two targeted risk factors for dementia.
A personalized, multidomain intervention helped improve cognition, dementia risk factors, and quality of life among older adults with a heightened risk of dementia, new results of a pilot study show.
The Systematic Multi-Domain Alzheimer Risk Reduction Trial (SMARRT) randomized 172 adults from primary care clinics to an intervention with personalized risk-reduction goals, health coaching, and nurse visits or to a health education control group. All participants were between the ages 70 and 89 years and had at least two targeted risk factors for dementia. Researchers assessed changes on a composite modified Neuropsychological Test Battery and in dementia risk factors and quality of life at six, 12, 18, and 24 months. Findings were published by JAMA Internal Medicine on Nov. 27.
Average participant age was 75.7 years, and 62.8% were female. Participants had an average of 2.5 dementia risk factors, including low physical activity, uncontrolled hypertension, and poor sleep. Compared with the control group, those in the intervention group had greater improvements in the composite cognitive score (average treatment effect [ATE], 0.14 point [95% CI, 0.03 to 0.25 point]; P=0.02) after two years, amounting to a 74% greater increase in cognition compared with the control group. The intervention group also had larger improvements in composite risk factor score (ATE, 0.11 point [95% CI, 0.01 to 0.20 point]; P=0.03), and an improved quality of life (ATE, 0.81 point [95% CI, −0.21 to 1.84 point]; P=0.12). Researchers did not find any differences in serious adverse events between the two groups but intervention participants had more treatment-related adverse events like musculoskeletal pain (14 vs. 0; P<0.001). Most participants were highly satisfied with the intervention.
“The trial represents a promising strategy that could be examined in larger future trials to determine whether these 2-year gains translate into reduced risk or delayed onset of [Alzheimer disease and related dementias],” the authors wrote. “A personalized approach may be more effective in an at-risk population where dementia risk factors and motivations to work on risk reduction vary substantially,” they added. Limitations to the study include that it was carried out at a single site at an integrated health care system.
The authors noted that the risk-reduction strategies are generally beneficial to health. “Given the low rate of [adverse events] and benefits to overall health, especially cardiovascular, in addition to brain health, even the modest benefit observed with this intervention could have great public health effect,” they concluded.