Kim Sarang, McMaster Mitchell, Torres Susan, Cox Kay L, Lautenschlager Nicola, Rebok George W, Pond Dimity, D'Este Catherine, McRae Ian, Cherbuin Nicolas, Anstey Kaarin J
Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia.
School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia.
BMJ Open. 2018 Mar 17;8(3):e019329. doi: 10.1136/bmjopen-2017-019329.
It has been estimated that a 10%-25% reduction in seven key risk factors could potentially prevent 1.1-3.0 million Alzheimer's disease cases globally. In addition, as dementia is preceded by more subtle cognitive deficits which have substantial social and economic impact, effective preventative interventions would likely have more extensive benefits. The current study evaluates in primary care a multidomain risk-reduction intervention targeting adults with high risk of developing dementia.
A randomised controlled trial (RCT) is being conducted to evaluate three intervention programmes using a pragmatic approach suitable to the clinic: (1) a 12-week online and face-to-face dementia risk-reduction intervention (Body Brain Life-General Practice (BBL-GP)); (2) a 6-week face-to-face group lifestyle modification programme (LMP); and (3) a 12-week email-only programme providing general health information. We aim to recruit 240 participants, aged 18 and over, to undergo a comprehensive cognitive and physical assessment at baseline and follow-ups (postintervention, 18, 36 and 62 weeks). The primary outcome is dementia risk measured with the modified version of the Australian National University-Alzheimer's Disease Risk Index Short Form. Secondary outcomes are cognitive function measured with Trails A and B, and the Digit Symbol Modalities Test; physical activity with moderate-vigorous physical activity and the International Physical Activity Questionnaire; depression with the Centre for Epidemiological Studies Depression; cost evaluation with the 12-item Short Form Health Survey, Framingham Coronary Heart Disease Risk Score and Australian Type 2 Diabetes Risk Assessment Tool; diet quality with the Australian Recommended Food Score; and sleep quality with the Pittsburgh Sleep Quality Index.
This RCT is a novel pragmatic intervention applied in a primary care setting to reduce the dementia risk exposure in adults at high risk. If successful, BBL-GP and LMP will provide a versatile, evidence-based package that can be easily and quickly rolled out to other primary care settings and which can be scaled up at relatively low cost compared with other strategies involving intensive interventions.
ACTRN12616000868482.
据估计，全球范围内，若将七个关键风险因素降低10%-25%，则有可能预防110万至300万例阿尔茨海默病。此外，由于痴呆症之前会出现更为细微的认知缺陷，这些缺陷会产生重大的社会和经济影响，因此有效的预防干预措施可能会带来更广泛的益处。本研究在初级保健中评估针对有患痴呆症高风险的成年人的多领域风险降低干预措施。
正在进行一项随机对照试验（RCT），以实用的方法评估三个干预项目，该方法适用于临床：（1）为期12周的在线和面对面痴呆症风险降低干预（身体大脑生活-全科医疗（BBL-GP））；（2）为期6周的面对面小组生活方式改善项目（LMP）；（3）为期12周的仅通过电子邮件提供一般健康信息的项目。我们的目标是招募240名18岁及以上的参与者，在基线和随访（干预后、18周、36周和62周）时进行全面的认知和身体评估。主要结局是用澳大利亚国立大学-阿尔茨海默病风险指数简表的修订版测量的痴呆症风险。次要结局包括用连线测验A和B以及数字符号替换测验测量的认知功能；用中等强度身体活动和国际体力活动问卷测量的身体活动；用流行病学研究中心抑郁量表测量的抑郁；用12项简短健康调查、弗雷明汉冠心病风险评分和澳大利亚2型糖尿病风险评估工具进行成本评估；用澳大利亚推荐食物评分评估饮食质量；用匹兹堡睡眠质量指数评估睡眠质量。
这项随机对照试验是在初级保健环境中应用的一种新型实用干预措施，旨在降低有高风险的成年人患痴呆症的风险。如果成功，BBL-GP和LMP将提供一个通用的、基于证据的方案，该方案可以轻松、快速地推广到其他初级保健环境，并且与其他涉及强化干预的策略相比，可以以相对较低的成本扩大规模。
ACTRN12616000868482。
