Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults

作者：Kristine S. Yaffe, Eric Vittinghoff, Sascha Dublin, Carrie Brumback Peltz, Lynn E. Fleckenstein, Dori E. Rosenberg, Deborah E. Barnes, Benjamin H. K. Balderson, Eric B. Larson · 发表于：JAMA Internal Medicine · 年份：2023 · DOI：10.1001/jamainternmed.2023.6279 · 被引用次数：128 · 研究领域：Dementia and Cognitive Impairment Research、Frailty in Older Adults、Cardiovascular Health and Risk Factors

Importance: Modifiable risk factors are hypothesized to account for 30% to 40% of dementia; yet, few trials have demonstrated that risk-reduction interventions, especially multidomain, are efficacious. Objective: To determine if a personalized, multidomain risk reduction intervention improves cognition and dementia risk profile among older adults. Design, Setting, and Participants: The Systematic Multi-Domain Alzheimer Risk Reduction Trial was a randomized clinical trial with a 2-year personalized, risk-reduction intervention. A total of 172 adults at elevated risk for dementia (age 70-89 years and with ≥2 of 8 targeted risk factors) were recruited from primary care clinics associated with Kaiser Permanente Washington. Data were collected from August 2018 to August 2022 and analyzed from October 2022 to September 2023. Intervention: Participants were randomly assigned to the intervention (personalized risk-reduction goals with health coaching and nurse visits) or to a health education control. Main Outcomes and Measures: The primary outcome was change in a composite modified Neuropsychological Test Battery; preplanned secondary outcomes were change in risk factors and quality of life (QOL). Outcomes were assessed at baseline and 6, 12, 18, and 24 months. Linear mixed models were used to compare, by intention to treat, average treatment effects (ATEs) from baseline over follow-up. The intervention and outcomes were initially in person but then, due to onset of the COVID-19 pan...