Abstract
BackgroundA growing body of evidence supports the use of lifestyle interventions for preventing or delaying the onset of Alzheimer disease and other forms of dementia in at-risk individuals. The development of internet-delivered programs would increase the scalability and reach of these interventions, but requires validation to ensure similar effectiveness to brick-and-mortar options.ObjectiveWe describe the study design, recruitment process, and baseline participant characteristics of the sample in the Virtual Cognitive Health (VC Health) study. Future analyses will assess the impact of the remotely delivered lifestyle intervention on (1) cognitive function, (2) depression and anxiety, and (3) various lifestyle behaviors, including diet, exercise, and sleep, in a cohort of older adults with subjective memory decline. Additional analyses will explore feasibility outcomes, as well as the participants’ engagement patterns with the program.MethodsOlder adults (aged 60-75 years) with subjective memory decline as measured by the Subjective Cognitive Decline 9-item (SCD-9) questionnaire, and who reported feeling worried about their memory decline, were eligible to participate in this single-arm pre-post study. All participants enrolled in the yearlong digital intervention, which consists of health coach-guided lifestyle change for improving diet, exercise, sleep, stress, and cognition. All components of this study were conducted remotely, including the collection of data and the administration of the intervention. We assessed participants at baseline, 12 weeks, 24 weeks, and 52 weeks with online surveys and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test. We will conduct intention-to-treat analysis on all outcomes.ResultsA total of 85 participants enrolled in the intervention and 82 are included in the study sample (3 participants withdrew). The study cohort of 82 participants comprises 61 (74%) female, 72 (88%) white, and 64 (78%) overweight or obese participants, and 55 (67%) have at least a college degree. The average baseline RBANS score was 95.9 (SD 11.1), which is within age-adjusted norms. The average SCD-9 score was 6.0 (SD 2.0), indicating minor subjective cognitive impairment at the beginning of the study. The average baseline Generalized Anxiety Disorder 7-item scale score was 6.2 (SD 4.5), and the average Patient Health Questionnaire 9-item score was 8.5 (SD 4.9), indicating mild levels of anxiety and depression at baseline.ConclusionsInternet-delivered lifestyle interventions are a scalable solution for the prevention or delay of Alzheimer disease. The results of this study will provide the first evidence for the effectiveness of a fully remote intervention and lay the groundwork for future investigations.Trial RegistrationClinicalTrials.gov NCT02969460; http://clinicaltrials.gov/ct2/show/NCT02969460 (Archived by WebCite at http://www.webcitation.org/71LkYAkSh)Registered Report IdentifierRR1-10.2196/11368
Highlights
70 What is palliative care? How, and when, is palliative care applicable to dementia care? Advanced care planning End-of-life care 76 Summary and conclusion 80Dementia care in Canada, China, Indonesia, Mexico, South Africa, South Korea and Switzerland 84
There is evidence that chronic physical health conditions are undermanaged for people with dementia, with missed opportunities to improve function and avoid acute crises leading to hospitalisation
Researchers should work with policymakers and providers to ensure that the innovations that they propose to evaluate are policy relevant, fully implementable in the context of the research evaluation, and capable of being taken to scale in the event that effectiveness and cost-effectiveness are demonstrated
Summary
70 What is palliative care? How, and when, is palliative care applicable to dementia care? Advanced care planning End-of-life care 76 Summary and conclusion 80Dementia care in Canada, China, Indonesia, Mexico, South Africa, South Korea and Switzerland 84. In the World Alzheimer Report 2013 ‘Journey of Caring’[1], we reviewed the literature on end-of-life care for people with dementia (section 4.2), and considered separately the applicability and use of advanced care planning (section 5.2). For each country we consider, briefly, key demographic and socioeconomic characteristics, the prevalence of dementia and estimated numbers of people with dementia in 2015 and 2030, the current dementia and healthcare policy context, other sources of care and support to people with dementia and the main challenges that need addressing in each of the dementia care systems These descriptions of the dementia care systems have been produced through a scoping review of both academic and grey literature. It is necessary to attend to the quality of care that people with dementia receive in hospital
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