Abstract
BackgroundSelecting high-risk participants for dementia prevention trials based on a modifiable dementia risk score may be advantageous, as it increases the opportunity for intervention. We studied whether a multi-domain intervention can prevent all-cause dementia and cognitive decline in older people across three different levels of a modifiable dementia risk score.MethodsPrevention of Dementia by Intensive Vascular Care (preDIVA) is a randomised controlled trial studying the effect of multi-domain vascular care during 6–8 years on incident all-cause dementia in community-dwelling people aged 70–78 years. For this post hoc analysis, we stratified preDIVA participants in tertiles based on their baseline LIfestyle for BRAin Health (LIBRA) index, a modifiable dementia risk score. With Cox proportional hazards regression, the intervention effect on dementia was assessed. The effect on cognition was measured every 2 years with the Mini-Mental State Examination and Visual Association Test.ResultsDementia developed in 220 of 3274 (6.7%) participants. In participants with a low, intermediate and high LIBRA index, the hazard ratio (HR) of the intervention on incident dementia was respectively 0.71 (95% CI 0.45–1.12), 1.06 (95% CI 0.66–1.69) and 1.02 (95% CI 0.64–1.62). Also, when adding the non-modifiable risk factors age, education and sex to the index, results were comparable (respectively HR 0.88, 95% CI 0.54–1.43; HR 0.91, 95% CI 0.57–1.47; HR 0.92, 95% CI 0.59–1.41). There was no statistically significant intervention effect on cognition during follow-up across the LIBRA groups.ConclusionsIn the preDIVA study population aged 70–78 years, the LIBRA modifiable dementia risk score did not identify a (high-)risk group in whom the multi-domain intervention was effective in preventing dementia or cognitive decline.Trial registrationInternational Standard Randomised Controlled Trial Number registry, ISRCTN29711771. Registered on 14 February 2006.
Highlights
Selecting high-risk participants for dementia prevention trials based on a modifiable dementia risk score may be advantageous, as it increases the opportunity for intervention
Systolic blood pressure (BP) was highest in the intermediate LIfestyle for BRAin Health (LIBRA) group
Adding education to the LIBRA index did not change these results (HR 1.06; 95% Confidence interval (CI) 0.90–1.24)
Summary
Selecting high-risk participants for dementia prevention trials based on a modifiable dementia risk score may be advantageous, as it increases the opportunity for intervention. Up to a third of Alzheimer’s disease cases may be attributable to potentially modifiable risk factors, including several vascular risk factors such as diabetes mellitus, midlife hypertension and physical inactivity [3]. This offers a window of opportunity for prevention strategies. Results from recent RCTs suggest that interventions may be most effective in those individuals at increased risk of dementia based on the presence of one or more dementia risk factors [5,6,7] In such an at-risk population the potential to improve modifiable risk factors such as hypertension and physical inactivity, and thereby prevent dementia, is higher. The higher dementia incidence rates in high-risk populations increase the study power, decreasing the total number of participants required to demonstrate a treatment effect
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