Multidomain Alzheimer Preventive Trial Research Articles

The multi-domain Alzheimer preventive trial (MAPT): A new approach for the prevention of Alzheimer's disease- characteristics of the study population

Because no effective curative approaches are available yet, preventive approaches in the field of Alzheimer disease (AD) are needed. In the past, several studies have suggested that many factors may be involved in the occurrence of AD in the late ages. Because of the probable multifactorial nature of AD, it would seem logical to initiate multidomain interventions designed to examine their potential synergistic effects. The aim of the MAPT study is to evaluate the efficacy of a multidomain intervention (nutritional, physical and cognitive training) and omega 3 treatment in the prevention of cognitive decline in frail elderly persons aged 70 years or over. This study also aimed to collect imaging and biological data which could be used for future AD prevention and treatment trials. MAPT is a 3-year randomized controlled trial conducted by university hospital practitioners specializing in memory disorders in 7 French cities (Bordeaux, Dijon, Limoges, Lyon, Montpellier, Nice, and Toulouse). This study plans to enrol 1200 frail elderly subjects with at least one the following criteria: subjective memory complaint spontaneously expressed to their general practitioner, limitation in one instrumental activity of daily living (IADL), and slow walking speed. Subjects are randomized in one of the following 4 groups: omega 3 alone, multidomain intervention alone, omega 3 plus multidomain intervention, or placebo group (n = 300 each). The principal outcome measure is the change in cognitive function at 3 years determined by the Grober and Buschke Test. The multidomain intervention includes training/information sessions and preventive consultations. The training/information sessions are based on recommendations relative to nutrition, physical exercise, cognitive stimulation (reasoning and memory training) and social activities. They are dispensed with the following frequency: twice a week for 1 month, then once a week for 1 month, then once a month for the rest of the follow-up period. The preventive consultations are standardised and designed to detect any hearing or visual disorders, mood disorders, anxiety, malnutrition, walking and balance problems, fear of falling and poor oral and dental health in collaboration with general practitioner. Recruitment in the MAPT study will be completed by June 2010. We will present baseline data of the recruited population.

The Multidomain Alzheimer Preventive Trial (MAPT): A new approach for the prevention of Alzheimer's disease

Because no effective curative approaches are available yet, preventive approaches in the field of Alzheimer disease (AD) are needed. In the past, several studies have suggested that many factors may be involved in the occurrence of AD in the late ages. Because of the probable multifactorial nature of AD, it would seem logical to initiate multidomain interventions designed to examine their potential synergistic effects. The aim of the MAPT study is to evaluate the efficacy of a multidomain intervention (nutritional, physical and cognitive training) and omega 3 treatment in the prevention of cognitive decline in frail elderly persons aged 70 years or over. This study also aimed to collect imaging and biological data which could be used for future AD prevention and treatment trials. MAPT is a 3-year randomized controlled trial conducted by university hospital practitioners specializing in memory disorders in 4 French cities (Bordeaux, Limoges, Montpellier and Toulouse). This study plans to enrol 1200 frail elderly subjects with at least one the following criteria: subjective memory complaint spontaneously expressed to their general practitioner, limitation in one instrumental activity of daily living (IADL), and slow walking speed. Subjects are randomized in one of the following 4 groups: omega 3 alone, multidomain intervention alone, omega 3 plus multidomain intervention, or placebo group (n = 300 each). The principal outcome measure is the change in cognitive function at 3 years determined by the Grober and Buschke Test. The multidomain intervention includes training/information sessions and preventive consultations. The training/information sessions are based on recommendations relative to nutrition, physical exercise, cognitive stimulation (reasoning and memory training) and social activities. They are dispensed with the following frequency: twice a week for 1 month, then once a week for 1 month, then once a month for the rest of the follow-up period. The preventive consultations are standardised and designed to detect any hearing or visual disorders, mood disorders, anxiety, malnutrition, walking and balance problems, fear of falling and poor oral and dental health in collaboration with general practitioner. Recruitment in the MAPT study is still in process and will last 2 years. Final results should be available in 2013.

Commentary on “A roadmap for the prevention of dementia II. Leon Thal Symposium 2008.” The Multidomain Alzheimer Preventive Trial (MAPT): A new approach to the prevention of Alzheimer's disease

Background Because no effective curative approaches are available, preventive approaches in the field of Alzheimer's disease (AD) are needed. We present the design of the ongoing Multidomain Alzheimer Preventive Trial (MAPT) Study. Several previous studies suggested that many factors may be involved in the occurrence of AD at late ages. Because of the probable multifactorial nature of AD, it seems logical to initiate multidomain interventions to examine their potential synergistic effects. The MAPT Study aims to evaluate the efficacy of a multidomain intervention (nutritional, physical, and cognitive training) and omega 3 treatment in the prevention of cognitive decline in frail elderly persons aged 70 years or over. The study also collects imaging and biological data that could be used in future AD prevention and treatment trials. Methods The MAPT Study is a 3-year, randomized, controlled trial conducted by university hospital practitioners specializing in memory disorders in four French cities (Bordeaux, Limoges, Montpellier, and Toulouse). The study plans to enroll 1200 frail elderly subjects on the basis of at least one of the following criteria: subjective memory complaint spontaneously expressed to a general practitioner, limitation in one instrumental activity of daily living (IADL), and slow walking speed. To demonstrate the protective effect of interventions, subjects are randomized into one of the following four groups: omega 3 alone, multidomain intervention alone, omega 3 plus multidomain intervention, or placebo (n = 300 each). The principal outcome measure is a change in cognitive function at 3 years, as determined by the Grober and Buschke Test. Conclusions The MAPT Study is the first preventive trial involving multidomain interventions. Final results should be available in 2013.

Prevention of progression to dementia in the elderly: rationale and proposal for a health-promoting memory consultation (an IANA Task Force).

Alzheimer's disease (AD) is the most frequent form of dementia and according to the most recent estimation it affects nearly 27 million people in the world. The onset of the disease is generally insidious. It is becoming increasingly evident that the underlying pathophysiological mechanisms are active long before the appearance of the clinical symptoms of the disease. In the current context, it is important to develop strategies to delay the onset of cognitive decline. Delaying the onset by 5 years would reduce the prevalence by half at term, and a delay of 10 years would reduce it by three-quarters. The effectiveness of currently suggested preventive approaches remains to be confirmed, but certain strategies could be applied straight away to at-risk subjects. We propose that a health-promoting memory consultation should be set up for elderly persons who have attended a specialized memory consultation and in whom the diagnosis of dementia and of AD in particular, has not been established by standardized tools. Through this consultation, they would be offered full multidimensional investigation of all aspects of their health status, follow-up could be organized, general practitioners in private practice could be made more conscious of this population and the elderly could be made more aware of the risk factors to which they are exposed. The development of an information policy for the elderly would meet a present need. In our reflection, we must take into account the question of how to give this preventive consultation its due place in the healthcare pathway of the elderly person in order to ensure coordinated follow-up with all the other health professionals involved. The principle of the health-promoting memory consultation is undergoing validation in a large French multicentre preventive trial in 1200 frail elderly persons aged 70 years followed for three years, the Multidomain Alzheimer Preventive Trial (MAPT).

The menopause and hormone replacement therapy.

<h3>Objective:</h3> To investigate in vivo the relationship of regional brain β-amyloid (Aβ) to gait speed in a group of elderly individuals at high risk for dementia. <h3>Methods:</h3> Cross-sectional associations between brain Aβ as measured with [¹⁸F]florbetapir PET and gait speed were examined in 128 elderly participants. Subjects ranged from healthy to mildly cognitively impaired enrolled in the control arm of the multidomain intervention in the Multidomain Alzheimer Preventive Trial (MAPT). Nearly all participants presented spontaneous memory complaints. Regional [¹⁸F]florbetapir (AV45) standardized uptake volume ratios were obtained via semiautomated quantitative analysis using the cerebellum as reference region. Gait speed was measured by timing participants while they walked 4 meters. Associations were explored with linear regression, correcting for age, sex, education, body mass index (BMI), and <i>APOE</i> genotype. <h3>Results:</h3> We found a significant association between Aβ in the posterior and anterior putamen, occipital cortex, precuneus, and anterior cingulate and slow gait speed (all corrected <i>p</i> &lt; 0.05). A multivariate model emphasized the locations of the posterior putamen and the precuneus. Aβ burden explained up to 9% of the variance in gait speed, and significantly improved regression models already containing demographic variables, BMI, and <i>APOE</i> status. <h3>Conclusions:</h3> The present PET study confirms, in vivo, previous postmortem evidence showing an association between Alzheimer disease (AD) pathology and gait speed, and provides additional evidence on potential regional effects of brain Aβ on motor function. More research is needed to elucidate the neural mechanisms underlying these regional associations, which may involve motor and sensorimotor circuits hitherto largely neglected in the pathophysiology of AD.