马来西亚社区居住的认知衰弱老年人多领域干预对身体、认知、血管、饮食和心理社会结局的成本效益：无龄试验

The cost effectiveness of a multidomain intervention on physical, cognitive, vascular, dietary and psychosocial outcomes among community dwelling older adults with cognitive frailty in Malaysia: The AGELESS Trial.

作者信息

Ponvel Pavapriya, Shahar Suzana, Singh Devinder Kaur Ajit, Ludin Arimi Fitri Mat, Subramaniam Ponnusamy, Ibrahim Norhayati, Haron Hasnah, Ismail Aniza, Ai-Vyrn Chin, Mohamad Mazlyfarina, Fadzil Hidayah, Khalid Norhayati Mustafa, Safien A'isyah Mohammad, Hanipah Jamilah Mohammad, Ibrahim Azyana, Lehtisalo Jenni, Kivipelto Miia, Mangialasche Francesca

机构信息

Center of Wellness and Healthy Aging, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

Department of Physiotherapy, Faculty of Health and Life Sciences, Inti International University, BBN Putra Nilai, Negeri Sembilan, Malaysia.

出版信息

Alzheimers Res Ther. 2025 May 13;17(1):101. doi: 10.1186/s13195-025-01722-w.

DOI:10.1186/s13195-025-01722-w

PMID:40361174

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12070610/

Abstract

BACKGROUND

Cognitive frailty (CF) in older adults is a potentially reversible syndrome that may benefit from lifestyle-based multidomain interventions. This study assessed the AGELESS intervention's impact on cognitive, physical, vascular, dietary, and psychosocial outcomes, along with its cost-effectiveness, in a Low-Middle-Income Country (LMIC).

METHODS

The AGELESS randomized controlled trial recruited 106 older adults (above 60 years) from Klang Valley, Malaysia, with (pre)-CF (≥ 1 Fried's criteria and Clinical Dementia Rating scale = 0.5). Participants were randomly assigned to a 24-month multidomain intervention (physical activity, cognitive training, nutritional and psychological counselling, cardiovascular care) or control group (educational module). Primary outcomes, assessed at baseline, 12 and 24 months, included the modified Neuropsychological Tests Battery (mNTB) and physical performance measures. Intervention costs were calculated to determine Incremental Cost-Effectiveness Ratios (ICERs). An intention-to-treat analysis was conducted to account for attrition.

RESULTS

The trial occurred during the COVID-19 pandemic. Despite a 50% dropout rate, adherence among remaining participants was over 50% for all intervention components (range 53%-91%). The intervention led to significant improvements in selected parameters of cognitive function, physical performance, anthropometry, and dietary patterns (for all parameters, p < 0.05 for interaction time*group in repeat-measures ANOVA). The cost per participant was RM 1592.74 (≈USD 355.05) in the multidomain arm, and RM 488.21 (≈USD 108.83) in the control arm. The ICER computation indicated the 2-min step test as the most cost-effective measure (ICER RM 149.19 ≈USD33.26).

CONCLUSION

The AGELESS trial demonstrates that a multidomain, lifestyle-based intervention can improve cognitive and physical function in older adults with (pre)-CF. This cost-effective approach highlights CF as a modifiable health condition and supports its potential inclusion in health policy to promote healthy aging and reduce health risks in LMICs, where there is a larger prevention potential due to prevalent lifestyle-related risk factors.

摘要

背景

老年人的认知衰弱（CF）是一种潜在可逆转的综合征，可能受益于基于生活方式的多领域干预措施。本研究评估了“无龄感”干预措施在一个低收入和中等收入国家（LMIC）对认知、身体、血管、饮食和心理社会结局的影响及其成本效益。

方法

“无龄感”随机对照试验从马来西亚巴生谷招募了106名60岁以上的患有（或有）认知衰弱（≥1项弗里德标准且临床痴呆评定量表=0.5）的老年人。参与者被随机分配到为期24个月的多领域干预组（体育活动、认知训练、营养和心理咨询、心血管护理）或对照组（教育模块）。在基线、12个月和24个月时评估的主要结局包括改良神经心理测试电池组（mNTB）和身体表现指标。计算干预成本以确定增量成本效益比（ICER）。进行意向性分析以考虑失访情况。

结果

该试验在新冠疫情期间进行。尽管失访率为50%，但其余参与者对所有干预组成部分的依从性均超过50%（范围为53%-91%）。干预导致认知功能、身体表现、人体测量学和饮食模式的选定参数有显著改善（对于所有参数，重复测量方差分析中交互作用时间*组的p<0.05）。多领域组每位参与者的成本为1592.74马来西亚林吉特（约合355.05美元），对照组为488.21马来西亚林吉特（约合108.83美元）。ICER计算表明2分钟阶梯试验是最具成本效益的指标（ICER为149.19马来西亚林吉特≈33.26美元）。

结论

“无龄感”试验表明，基于生活方式的多领域干预可以改善患有（或有）认知衰弱的老年人的认知和身体功能。这种具有成本效益的方法凸显了认知衰弱是一种可改变的健康状况，并支持其可能被纳入卫生政策，以促进低收入和中等收入国家的健康老龄化并降低健康风险，在这些国家，由于普遍存在与生活方式相关的风险因素，预防潜力更大。