Lancet: 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
A randomised controlled trial of diet, exercise and cognitive training in older people at higher risk of dementia has shown a reduction in cognitive decline over two years. The research, led by scientists in Finland and Sweden, will now continue to see whether the volunteers also have a lower risk of dementia. The findings are published on 12 March in the journal Lancet.
Although population studies have linked cardiovascular risk factors such as poor diet, physical inactivity and high blood pressure to a higher risk of cognitive decline, very few studies have looked at whether interventions to manage and reduce these risk factors could directly benefit memory and thinking.
This clinical trial, called the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), followed 1260 people over two years. The volunteers were aged between 60 and 77 and were deemed at high risk of dementia based on a risk score which took into account age, sex, education, blood pressure, body mass index, total cholesterol and physical activity. Participants were split into two groups, one of which received regular health advice on healthy diet, physical and mental activities and how to manage cardiovascular risk factors. The other groups received an intense programme of activities which included up to 12 sessions led by a nutritionist around improving diet, a physical exercise training programme guided by physiotherapists, individual and group sessions focused on memory and thinking activities, and management of metabolic and cardiovascular risk factors in line with clinical guidance.
Participants underwent memory and thinking tasks at the start of the study and at the end of the two year period. Over the course of the study 14% of those in the intervention group dropped out of the trial compared to 11% of the control group. In total, across the different memory and thinking tasks, those volunteers following the multi-intervention programme showed 25% higher scores than those in the control group across the two year period. This difference was more marked for tasks specifically focused on how quickly volunteers could process information and on tests of reasoning, problem solving and planning. Memory test scores showed a smaller difference between the two groups over the time period.
The researchers will now complete a seven-year follow-up of volunteers to investigate whether they show any differences in long-term dementia risk.
Dr Simon Ridley, Head of Research at Alzheimer’s Research UK, the UK’s leading dementia research charity, said:
“Clinical trials are the highest quality method to test the impact of a new treatment or intervention, but are particularly challenging to do for lifestyle interventions. This study is one of the first of its kind, testing the benefits of a group of intensive lifestyle and health interventions on memory and thinking in older people at higher risk of dementia. The initial results are promising and suggest that a combination of improving cardiovascular health and keeping mentally active could slow decline in some aspects of our thinking, but it’s unclear which of the interventions carried the greatest benefit.
“Benefits on memory were not so clear from this study and we await the findings from the longer follow-up period to see whether this intervention also has long-term benefits in reducing the risk of dementia. We know that dementia is caused by a complex mixture of age combined with genetic and lifestyle risk factors. Further studies like this will be vital to help us unpick the best approaches to maintaining brain health as we age and potentially helping to reduce the burden of dementia in society. It will also be important to think about how we could promote and sustain these kinds of interventions across the population as a whole.”