Abstract

BackgroundThe Multidomain Alzheimer Preventive Trial (MAPT) was designed to assess the efficacy of omega-3 fatty acid supplementation, multidomain intervention (MI), or a combination of both on cognition. Although the MAPT study was negative, an effect of MI in maintaining cognitive functions compared to placebo group was showed in positive amyloid subjects. A FDG PET study (MAPT-NI) was implemented to test the impact of MI on brain glucose metabolism.MethodsMAPT-NI was a randomized, controlled parallel-group single-center study, exploring the effect of MI on brain glucose metabolism. Participants were non-demented and had memory complaints, limitation in one instrumental activity of daily living, or slow gait. Participants were randomly assigned (1:1) to “MI group” or “No MI group.” The MI consisted of group sessions focusing on 3 domains: cognitive stimulation, physical activity, nutrition, and a preventive consultation. [18F]FDG PET scans were performed at baseline, 6 months, and 12 months, and cerebral magnetic resonance imaging scans at baseline. The primary objective was to evaluate the MI effect on brain glucose metabolism assessed by [18F]FDG PET imaging at 6 months. The primary outcome was the quantification of regional metabolism rate for glucose in cerebral regions involved early in Alzheimer disease by relative semi-quantitative SUVr (FDG-based AD biomarker). An exploratory voxel-wise analysis was performed to assess the effect of MI on brain glucose metabolism without anatomical hypothesis.ResultsThe intention-to-treat population included 67 subjects (34 in the MI group and 33 in the No MI group. No significant MI effect was observed on primary outcome at 6 months. In the exploratory voxel-wise analysis, we observed a difference in favor of MI group on the change of cerebral glucose metabolism in limbic lobe (right hippocampus, right posterior cingulate, left posterior parahippocampal gyrus) at 6 months.ConclusionsMI failed to show an effect on metabolism in FDG-based AD biomarker, but exploratory analysis suggested positive effect on limbic system metabolism. This finding could suggest a delay effect of MI on AD progression.Trial registrationClinicalTrials.gov Identifier, NCT01513252.

Highlights

  • The Multidomain Alzheimer Preventive Trial (MAPT) was designed to assess the efficacy of omega-3 fatty acid supplementation, multidomain intervention (MI), or a combination of both on cognition

  • MI failed to show an effect on metabolism in FDG-based Alzheimer disease (AD) biomarker, but exploratory analysis suggested positive effect on limbic system metabolism

  • The MAPT (Multidomain Alzheimer Prevention Trial) study has tested the effect of omega 3 polyunsaturated fatty acid supplementation and multidomain intervention (MI), alone or in combination, on cognitive decline in elderly people with memory complaint [1]

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Summary

Introduction

The Multidomain Alzheimer Preventive Trial (MAPT) was designed to assess the efficacy of omega-3 fatty acid supplementation, multidomain intervention (MI), or a combination of both on cognition. A FDG PET study (MAPT-NI) was implemented to test the impact of MI on brain glucose metabolism. The MAPT (Multidomain Alzheimer Prevention Trial) study has tested the effect of omega 3 polyunsaturated fatty acid supplementation (omega-3) and multidomain intervention (MI), alone or in combination, on cognitive decline in elderly people with memory complaint [1]. The ancillary amyloid MAPT study (MAPTAV45) has provided new insights on the effects of MI alone or in combination with omega-3 in positive amyloid subjects in maintaining cognitive functions compared to the placebo group [3]. The number of published trials using [18F]FDG PET as outcome is limited, and in large MI trials

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