Centre for Research on Ageing, Health and Wellbeing (CRAHW), The Australian National University, Canberra, Australia.
Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia.
J Am Geriatr Soc. 2020 Nov;68(11):2629-2637. doi: 10.1111/jgs.16762. Epub 2020 Sep 9.
BACKGROUND/OBJECTIVES: To evaluate the efficacy of a multidomain intervention to reduce lifestyle risk factors for Alzheimer's disease (AD) and improve cognition in individuals with subjective cognitive decline (SCD) or mild cognitive impairment (MCI).
The study was an 8-week two-arm single-blind proof-of-concept randomized controlled trial.
Community-dwelling individuals living in Canberra, Australia, and surrounding areas.
Participants were 119 individuals (intervention n = 57; control n = 62) experiencing SCD or MCI.
The control condition involved four educational modules covering dementia and lifestyle risk factors, Mediterranean diet, physical activity, and cognitive engagement. Participants were instructed to implement this information into their own lifestyle. The intervention condition included the same educational modules and additional active components to assist with the implementation of this information into participants' lifestyles: dietitian sessions, an exercise physiologist session, and online brain training.
Lifestyle risk factors for AD were assessed using the Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI), and cognition was assessed using Alzheimer's Disease Assessment Scale-Cognitive subscale, Pfeffer Functional Activities Questionnaire, Symbol Digit Modalities Test (SDMT), Trail Making Test-B, and Category Fluency.
The primary analysis showed that the intervention group had a significantly lower ANU-ADRI score (χ = 10.84; df = 3; P = .013) and a significantly higher cognition score (χ = 7.28; df = 2; P = .026) than the control group. A secondary analysis demonstrated that the changes in lifestyle were driven by increases in protective lifestyle factors (χ = 12.02; df = 3; P = .007), rather than a reduction in risk factors (χ = 2.93; df = 3; P = .403), and cognitive changes were only apparent for the SDMT (χ = 6.46; df = 2; P = .040). Results were robust to intention-to-treat analysis controlling for missing data.
Results support the hypothesis that improvements in lifestyle risk factors for dementia can lead to improvements in cognition over a short time frame with a population experiencing cognitive decline. Outcomes from this trial support the conduct of a larger and longer trial with this participant group.
背景/目的：评估一种多领域干预措施对降低阿尔茨海默病（AD）生活方式风险因素和改善有主观认知下降（SCD）或轻度认知障碍（MCI）的个体认知的疗效。
该研究为 8 周双盲概念验证随机对照试验。
居住在澳大利亚堪培拉及其周边地区的社区居民。
共有 119 名参与者（干预组 n=57；对照组 n=62）患有 SCD 或 MCI。
对照组包括涵盖痴呆症和生活方式风险因素、地中海饮食、身体活动和认知参与的四个教育模块。参与者被指示将这些信息融入自己的生活方式中。干预组包括相同的教育模块和其他有助于将这些信息融入参与者生活方式的活动组件：营养师会议、运动生理学家会议和在线大脑训练。
使用澳大利亚国立大学阿尔茨海默病风险指数（ANU-ADRI）评估 AD 的生活方式风险因素，使用阿尔茨海默病评估量表认知子量表、佩尔夫功能活动问卷、符号数字模态测试（SDMT）、追踪测试 B 和类别流畅性评估认知。
主要分析显示，干预组的 ANU-ADRI 评分明显低于对照组（χ=10.84；df=3；P=.013），认知评分明显高于对照组（χ=7.28；df=2；P=.026）。二次分析表明，生活方式的变化是由保护性生活方式因素的增加驱动的（χ=12.02；df=3；P=.007），而不是风险因素的减少（χ=2.93；df=3；P=.403），并且只有在 SDMT 上才观察到认知变化（χ=6.46；df=2；P=.040）。结果在控制缺失数据的意向治疗分析中是稳健的。
结果支持这样一种假设，即改善痴呆症的生活方式风险因素可以在短时间内改善认知，对于经历认知下降的人群来说是如此。该试验的结果支持对该参与者群体进行更大和更长时间的试验。
