Development of a healthy lifestyle index within a multidomain intervention aimed at prevention of cognitive impairment and dementia, and its association with cognition: Results from the FINGER trial

Abstract

AbstractBackgroundGiven the complex and multi‐factorial aetiology of dementia, preventive interventions targeting several risk‐factors simultaneously and tailored on specific risk‐profiles are likely to be most beneficial. To date, trials testing lifestyle‐ and vascular‐based multidomain interventions for dementia and cognitive decline prevention have shown inconsistent results. In particular, achieving sufficient level of intervention intensity, accurately assessing adherence, and identifying the optimal target population have been highlighted among the key challenges. Within FINGER, the first large trial showing the efficacy of a multidomain intervention in preventing cognitive decline, we aimed to develop a Healthy Lifestyle Index (HLI) as a potential easy‐access indicator of adherence, and to assess its association with cognition.MethodThe HLI (score 0‐24) was developed based on a brief set of self‐reported questions collected at baseline, 12, and 24 months within the FINGER trial (N=1260) and across four lifestyle components: physical activity, diet, smoking and alcohol, and social and cognitive activity. The FINGER cognitive outcomes were the overall z‐score from a Neuropsychological Test Battery (NTB, 14 tests, primary outcome) and the z‐scores of the NTB cognitive domains (secondary outcomes). Linear mixed‐models repeated‐measures with maximum likelihood estimation were used to assess the effect of the intervention on change in the HLI and associations between HLI and cognition over the 2‐year study period.ResultThe intervention led to an increase in HLI (P<0.001). At baseline, the HLI was directly associated with the overall NTB z‐score (b=0.024; 95% CI: 0.014‐0.033; P<0.001) and individual cognitive domains. Baseline HLI was significantly associated with 2‐year changes in the NTB z‐score (0.006; 95% CI: 0.003‐0.010; P<0.001), as well as the memory domain. Changes in HLI were not significantly associated with 2‐year changes in cognitive outcomes.ConclusionThe FINGER HLI may potentially help measure and monitor adherence to multidomain interventions aimed at prevention of cognitive decline. Being developed as an easy‐access tool, its application could be especially relevant for those settings where more complex assessments are not feasible, such as implementation trials in clinical practice, and primary care in particular. More evidence is needed to determine its efficacy in predicting response to such interventions.