Abstract
BackgroundCardiovascular risk factors and lifestyle factors are associated with an increased risk of cognitive decline and dementia in observational studies, and have been targeted by multidomain interventions.ObjectivesWe pooled individual participant data from two multi-domain intervention trials on cognitive function and symptoms of depression to increase power and facilitate subgroup analyses.DesignPooled analysis of individual participant data.SettingPrevention of Dementia by Intensive Vascular Care trial (preDIVA) and Multidomain Alzheimer Preventive Trial (MAPT).ParticipantsCommunity-dwelling individuals, free from dementia at baseline.InterventionMultidomain interventions focused on cardiovascular and lifestyle related risk factors.MeasurementsData on cognitive functioning, depressive symptoms and apathy were collected at baseline, 2 years and 3–4 years of follow-up as available per study. We analyzed crude scores with linear mixed models for overall cognitive function (Mini Mental State Examination [MMSE]), and symptoms of depression and apathy (15-item Geriatric Depression Scale). Prespecified subgroup analyses were performed for sex, educational level, baseline MMSE <26, history of hypertension, and history of stroke, myocardial infarction and/or diabetes mellitus.ResultsWe included 4162 individuals (median age 74 years, IQR 72, 76) with a median follow-up duration of 3.7 years (IQR 3.0 to 4.1 years). No differences between intervention and control groups were observed on change in cognitive functioning scores and symptoms of depression and apathy scores in the pooled study population. The MMSE declined less in the intervention groups in those with MMSE <26 at baseline (N=250; MD: 0.84; 95%CI: 0.15 to 1.54; p<0.001).ConclusionsWe found no conclusive evidence that multidomain interventions reduce the risk of global cognitive decline, symptoms of depression or apathy in a mixed older population. Our results suggest that these interventions may be more effective in those with lower baseline cognitive functioning. Extended follow-up for dementia occurrence is important to inform on the potential long-term effects of multidomain interventions.
Highlights
The global prevalence of dementia is expected to triple in the coming decades
3-4 year follow-up in MMSE and GDS scores between the control and intervention groups: Total MMSE score deteriorated by 0.09 points in the control group versus 0.05 points in the intervention group
Total GDS score deteriorated by 0.21 points in the intervention group versus 0.22 points in the control group (MDc between intervention and control group: -0.04, 95%CI -0.16 to 0.07)
Summary
The global prevalence of dementia is expected to triple in the coming decades. Over 50 million individuals were living with dementia in 2019, and this number might rise to 152 million by 2050 [1]. Several large multidomain intervention studies using cognitive functioning or dementia as primary outcome have been performed in older persons from the general population free from dementia at baseline [7–9]. OBJECTIVES: We pooled individual participant data from two multi-domain intervention trials on cognitive function and symptoms of depression to increase power and facilitate subgroup analyses. MEASUREMENTS: Data on cognitive functioning, depressive symptoms and apathy were collected at baseline, 2 years and 3-4 years of follow-up as available per study. No differences between intervention and control groups were observed on change in cognitive functioning scores and symptoms of depression and apathy scores in the pooled study population. CONCLUSIONS: We found no conclusive evidence that multidomain interventions reduce the risk of global cognitive decline, symptoms of depression or apathy in a mixed older population. Extended follow-up for dementia occurrence is important to inform on the potential long-term effects of multidomain interventions
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