Abstract
Background: More than half of the people with dementia live in lower-middle income countries (LMIC), yet we lack research and evidence-based knowledge to guide health promotion and prevention strategies for cognitive decline. In the Philippines, the prevalence of mild cognitive impairment (MCI) and cardiovascular risk factors among older persons are high, making this population at high risk for developing dementia. This protocol describes a cluster randomized controlled trial that aims to investigate the efficacy of a multicomponent intervention to maintain cognitive performance among high-risk population.Methods: This is a cluster-randomized, two-arm, single-blind trial of a multicomponent intervention that combines dance called INDAK (Improving Neurocognition through Dance and Kinesthetics), nutrition counseling, and vascular risk management. The intervention arm will receive 12 months (1-h, twice per week) of INDAK and every 3 months of nutrition counseling and intensive vascular risk management and monitoring. The control group will receive the usual vascular care advice and referral. A total of 605 (20–25 clusters per arm) community-dwelling Filipino older adults aged ≥ 60 years old with MCI will participate in the study and will be assessed at baseline, 6th- and 12th-month follow-up. The primary outcome is cognitive performance assessed by the Alzheimer's Disease Assessment Scale—Cognitive (ADAS-Cog), Mnemonic Similarity Tasks (MST), and executive function composite (EFC). Secondary outcomes are functional connectivity assessed through brain imaging, and measures of behavioral, functional level, and quality of life.Discussion: The study aims to provide scientific evidence on a public health intervention that is contextualized in a community setting to reduce dementia risk among older adults with MCI. This model can be an ecological, low-cost, and effective program, thereby conducive to widespread implementation in the Philippines as well as in other low-resource settings with similar public health challenges. The pilot phase was underway with eight villages (clusters), but temporarily interrupted by the pandemic. The full study is anticipated to start after community restrictions are eased.
Highlights
The Filipino aging population comprised about 7% of the country’s total population in 2015 and is projected to increase by 11% in 2025 and 16% in 2045 [1]
The FINOMAIN study will carry out the first multicomponent intervention in the Philippines for older adults with mild cognitive impairment (MCI)
It will add to the limited evidence-based knowledge of complex interventions to reduce dementia risks in lower middle-income countries (LMIC) settings
Summary
The Filipino aging population comprised about 7% of the country’s total population in 2015 and is projected to increase by 11% in 2025 and 16% in 2045 [1]. In a population-based cohort study of Filipino older adults, aged ≥ 60 years, we found a dementia prevalence of 10.6% [5], much higher than the 7% estimate for Southeast Asia [2], and 23.2% had mild cognitive impairment (MCI). The odds of progressing to dementia is increased by 3.07 times among those with MCI [6] and further increased by 1.53–2.95 times higher if identified with comorbid conditions such as cardiovascular risks and metabolic syndrome [9] This condition is prevalent in Filipino older adults, with around 82.0% of men and 70.4% of women having at least one cardiovascular risk factor (hypertension, diabetes, dyslipidemia, and smoking) [5]. This protocol describes a cluster randomized controlled trial that aims to investigate the efficacy of a multicomponent intervention to maintain cognitive performance among high-risk population
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