Soldevila-Domenech Natalia, Ayala-Garcia Amaia, Barbera Mariagnese, Lehtisalo Jenni, Forcano Laura, Diaz-Ponce Ana, Zwan Marissa, van der Flier Wiesje M, Ngandu Tiia, Kivipelto Miia, Solomon Alina, de la Torre Rafael
Integrative Pharmacology and Systems Neuroscience Research Group, Neuroscience Research Program, Hospital del Mar Research Institute, Dr. Aiguader 88, Barcelona, 08003, Spain.
Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Wellington 30, Barcelona, 08003, Spain.
Alzheimers Res Ther. 2025 Mar 17;17(1):61. doi: 10.1186/s13195-025-01691-0.
Preventing dementia and Alzheimer's disease (AD) is a global priority. Multimodal interventions targeting several risk factors and disease mechanisms simultaneously are currently being tested worldwide under the World-Wide FINGERS (WW-FINGERS) network of clinical trials. Adherence to these interventions is crucial for their success, yet there is significant heterogeneity in adherence reporting across studies, hindering the understanding of adherence barriers and facilitators. This article is a narrative review of available evidence from multimodal dementia prevention trials. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: nonpharmacological multimodal interventions (i.e., combining three or more intervention domains), targeting individuals without dementia, and using changes in cognitive performance and/or incident mild cognitive impairment or dementia as primary outcomes. Based on the findings, we propose future adherence reporting to encompass both participation (average attendance to each intervention component) and lifestyle change using dementia risk scores (e.g., the LIBRA index). Moreover, we provide an estimation of the expected intensity of multimodal interventions, defined as the ratio of the expected dose (i.e., the overall amount of the intervention offered specified in the trial protocol) to duration (in months). Adjusting the expected dose by average adherence enables estimation of the observed dose and intensity, which could be informative for identifying optimal dosage thresholds that maximize cognitive benefits across different populations. Finally, this article provides an overview of the determinants of adherence to multimodal interventions, emphasizing the need for improved adherence reporting to inform the design and implementation of precision prevention interventions.
预防痴呆症和阿尔茨海默病（AD）是一项全球优先事项。目前，在全球范围内的“全球手指试验（WW - FINGERS）”临床试验网络下，正在测试同时针对多种风险因素和疾病机制的多模式干预措施。坚持这些干预措施对其成功至关重要，但各研究在坚持情况报告方面存在显著异质性，这阻碍了对坚持障碍和促进因素的理解。本文是对多模式痴呆症预防试验现有证据的叙述性综述。通过医学数据库（经由PubMed的MEDLINE和SCOPUS）进行文献检索，以选择相关研究：针对无痴呆症个体的非药物多模式干预措施（即结合三个或更多干预领域），并将认知表现的变化和/或轻度认知障碍或痴呆症的发病作为主要结果。基于这些发现，我们建议未来的坚持情况报告应涵盖参与情况（对每个干预组成部分的平均参与度）和使用痴呆症风险评分（如天秤座指数）的生活方式改变。此外，我们提供了多模式干预措施预期强度的估计值，定义为预期剂量（即试验方案中规定的提供的干预总量）与持续时间（以月为单位）的比率。通过平均坚持率调整预期剂量，可以估计观察到的剂量和强度，这对于确定能在不同人群中最大化认知益处的最佳剂量阈值可能具有参考价值。最后，本文概述了坚持多模式干预措施的决定因素，强调需要改进坚持情况报告，以为精准预防干预措施的设计和实施提供信息。
