This week, Mr. Wu shared an analysis and discussion of a paper

《A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk eldery people(FINGER): a randomized controlled trial》

Ⅰ. Background

Seven factors: low education, midlife hypertension, midlife obesity, diabetes, physical inactivity, smoking, and depression

Complex etiology:Cognitive impairment, dementia, and Alzheimer’s disease are complex, multifactorial disorders, and multidomain interventions targeting several risk factors and disease mechanisms simultaneously could be needed for optimum preventive effects.

FINGER:Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is the first large, longer-term, and methodologically robust trial showing that a multidomain intervention can improve or maintain cognitive functioning and reduce the risk of cognitive decline among older at-risk individuals. 

Ⅱ. Methods

Experimental design:

Randomly assigned participants in a 1:1 ratio to a 2 year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), or a control group (general health advice) in six centers in Finland .

Participant & Inclusion criteria：

Age： 60-77， general population;

From CERAD（Consortium to Establish a Registry for Alzheimer’s Disease）;

Cognitive screening was done with the CERAD;

Word list memory task (ten words three times) results of 19 words or fewer; word list recall of 75% or less; or mini mental state examination of 26 points or less out of 30 points.

Participant & Exclusion criteria：

previously diagnosed dementia; 

suspected dementia after clinical assessment by study physician at screening visit ;

mini mental state examination less than 20 points; 

disorders affecting safe engagement in the severe loss of vision, hearing, or communicative ability; 

disorders preventing cooperation as judged by the study physician; 

coincident participation in another intervention trial.

Ⅲ.Results

Between Sept 7, 2009, and Nov 24, 2011, 2654 individuals were screened and 1260 were randomly assigned to the intensive intervention group (n=631) or control group (n=629). 

1168 (93%) participants completed the 12 month assessments.

1105 (88%) participants completed the 24 month assessments. 

Dropout rates were similar in the intervention (87 [14%] participants) and control (66 [11%] participants) groups (p=0·07). 

The main reasons for dropout were healthrelated (56 [37%] participants), lack of time or motivation (22 [14%]), and difficulties in arranging participation (18 [12%]). Ten individuals died during the study.

Ⅳ.Discussion

Significant effects：

Primary outcome : overall cognition.

Secondary outcomes: executive functioning and processing speed.

Other outcomes: BMI, dietary habits, and physical activity.

FINGER suggested beneficial effects on both global cognition and cognitive domains highly relevant for everyday activities (eg, executive functioning, processing speed, and complex memory tasks). 

Practice effects of repeated cognitive testing might partly account for improvements in both the intervention and control groups. However, improvement was significantly greater in the intervention group, suggesting cognitive benefits beyond practice or placebo effects

Cognitive training enhancement：

Improvement in the primary and main secondary cognitive outcomes was 25% to 150% better in the intervention group than in the control group.