Multiple areas of lifestyle have been associated with reduced risk of cognitive decline in older adults, which suggests that multidimensional programs for older adults aimed at preventing or delaying the onset of cognitive decline may have the best chances of success. However, the effectiveness of such programs on older adults who already exhibited risk factors for cognitive decline had not been demonstrated in a large-scale experimental study. Recently, a large study conducted in Finland examined the potential impact on at-risk older adults of a program lasting two years that incorporated diet, exercise, cognitive training, and vascular risk monitoring.
This study, the Finnish Geriatric Study to Prevent Cognitive Impairment and Disability, was a randomized controlled trial involving 1,260 older adults judged to be at-risk due to having a CAIDE Dementia Risk Score over 6 (a scale based on age, sex, education, blood pressure, BMI, cholesterol, and physical activity on a 15-point scale), and a cognition level at or below the average for their age. The average age of participants was 69, with an average of 10 years of education. Half of these at-risk older adult were assigned to the multidimensional intervention program, while the other half formed a control group that was only given general health advice. The researchers then compared changes in cognition of the two groups after the two-year period.
The nutritional component of the intervention program included nine group sessions on nutrition and three individual nutrition consultations, with the aim of meeting the Finnish nutrition recommendations. The physical exercise component included strength training one to three times per week and aerobic training two to five times per week. The cognitive training was a mix of individual and group training. Individual training consisted of computerized training three times a week for 10 to 15 minutes in each session, which was conducted for two six-month periods. This computer training focused on executive processes, working memory, episodic memory, and mental speed. The group training consisted of educational content on age-related cognitive changes, memory, and reasoning strategies that can be applied in everyday life. Group sessions also included checking on progress in computerized-based training and a visit to the local Alzheimer’s Association. Vascular and metabolic syndrome risk factors were addressed in meetings with nurses and physicians that included measurements such as blood pressure, weight, and BMI, as well as recommendations for lifestyle management. Participation in each of these aspects was high for the program participants, with 83 percent of all program participants reporting taking part in three or four of the study areas described above.
The cognitive evaluations were done at the start of the study, and after 12 and 24 months. These evaluations included an overall cognition score, as well as specific scores for executive functioning, processing speed, and memory. In addition to cognitive tests, the researchers measured blood pressure, cholesterol, blood glucose levels, symptoms of depression, and disability.
A comparison of the groups after two years showed that the group in the multidimensional program had overall cognitive evaluation scores 25 percent higher than the control group. Looking at specific areas of cognition, the group in the multidimensional program showed an 83 percent higher score in executive functioning and 150 percent higher score on processing speed, but there were no statistically significant differences between the two groups on the memory tests. The group in the multidimensional program also showed better measurements of BMI, dietary habits, and physical activity.
Research continues to show multiple lifestyle factors that impact cognitive decline or risk of dementia, which suggests that an intervention that addresses multiple lifestyle dimensions could potentially have the greatest overall impact. To date, this is the strongest research support for a multidimensional approach to reducing cognitive decline. This study’s size, length, design, and focus on at-risk older adults are particularly impressive, and the researchers will follow up with participants for a period of seven years, so that the longer-term impact of the program can continue to be assessed. While the relative contribution of each of the areas involved in this program has yet to be evaluated, this study suggests that, even for at-risk individuals late in life, lifestyle changes can provide measurable cognitive benefit.
Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet. (2015). DOI:http://dx.doi.org/10.1016/S0140-6736(15)60461-5