TY - JOUR
T1 - The Effect of Multidomain Interventions on Global Cognition, Symptoms of Depression and Apathy — A Pooled Analysis of Two Randomized Controlled Trials
AU - preDIVA and MAPT/DSA groups
AU - den Brok, Melina G. H. E.
AU - Hoevenaar-Blom, M. P.
AU - Coley, N.
AU - Andrieu, S.
AU - van Dalen, J.
AU - Meiller, Y.
AU - Guillemont, J.
AU - Brayne, C.
AU - van Gool, W. A.
AU - Moll van Charante, E. P.
AU - Richard, E.
N1 - Funding Information: Funding: The present study was financially supported by the European Union’s Seventh Framework Program (FP7, 2007–2013, grant nr. 305374), as part of the HATICE project. The preDIVA study was financially supported by the Dutch Ministry of Health, Welfare and Sport (grant number 50-50110-98-020), the Dutch Innovation Fund of Collaborative Health Insurances (grant number 05-234), and the Netherlands Organisation for Health Research and Development (grant number 62000015). The MAPT study was supported by grants from the Gérontopôle of Toulouse, the French Ministry of Health (PHRC 2008, 2009), Pierre Fabre Research Institute (manufacturer of the omega-3 supplement), ExonHit Therapeutics SA, and Avid Radiopharmaceuticals Inc. The promotion of this study was supported by the University Hospital Center of Toulouse. The data sharing activity was supported by the Association Monegasque pour la Recherche sur la maladie d’Alzheimer (AMPA) and the UMR 1027 Unit INSERM-University of Toulouse III. The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; in the preparation of the manuscript; or in the review or approval of the manuscript. Funding Information: Conflict of interest disclosure: M.G.H.E. den Brok, M.P. Hoevenaar-Blom, N. Coley, J. van Dalen, C. Brayne, W.A. van Gool, E.P. Moll van Charante, E. Richard have nothing to disclose. Y. Meiller, J. Guillemont and S. Andrieu report grants from the European Union, during the conduct of the study (FP7, 2007–2013, grant nr. 305374). S. Andrieu additionally reports grants from the French Ministry of health (PHRC 2008, 2009), Pierre Fabre Research Institute, and AMPA during the conduct of the study. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background: Cardiovascular risk factors and lifestyle factors are associated with an increased risk of cognitive decline and dementia in observational studies, and have been targeted by multidomain interventions. Objectives: We pooled individual participant data from two multi-domain intervention trials on cognitive function and symptoms of depression to increase power and facilitate subgroup analyses. Design: Pooled analysis of individual participant data. Setting: Prevention of Dementia by Intensive Vascular Care trial (preDIVA) and Multidomain Alzheimer Preventive Trial (MAPT). Participants: Community-dwelling individuals, free from dementia at baseline. Intervention: Multidomain interventions focused on cardiovascular and lifestyle related risk factors. Measurements: Data on cognitive functioning, depressive symptoms and apathy were collected at baseline, 2 years and 3–4 years of follow-up as available per study. We analyzed crude scores with linear mixed models for overall cognitive function (Mini Mental State Examination [MMSE]), and symptoms of depression and apathy (15-item Geriatric Depression Scale). Prespecified subgroup analyses were performed for sex, educational level, baseline MMSE <26, history of hypertension, and history of stroke, myocardial infarction and/or diabetes mellitus. Results: We included 4162 individuals (median age 74 years, IQR 72, 76) with a median follow-up duration of 3.7 years (IQR 3.0 to 4.1 years). No differences between intervention and control groups were observed on change in cognitive functioning scores and symptoms of depression and apathy scores in the pooled study population. The MMSE declined less in the intervention groups in those with MMSE <26 at baseline (N=250; MD: 0.84; 95%CI: 0.15 to 1.54; p<0.001). Conclusions: We found no conclusive evidence that multidomain interventions reduce the risk of global cognitive decline, symptoms of depression or apathy in a mixed older population. Our results suggest that these interventions may be more effective in those with lower baseline cognitive functioning. Extended follow-up for dementia occurrence is important to inform on the potential long-term effects of multidomain interventions.
AB - Background: Cardiovascular risk factors and lifestyle factors are associated with an increased risk of cognitive decline and dementia in observational studies, and have been targeted by multidomain interventions. Objectives: We pooled individual participant data from two multi-domain intervention trials on cognitive function and symptoms of depression to increase power and facilitate subgroup analyses. Design: Pooled analysis of individual participant data. Setting: Prevention of Dementia by Intensive Vascular Care trial (preDIVA) and Multidomain Alzheimer Preventive Trial (MAPT). Participants: Community-dwelling individuals, free from dementia at baseline. Intervention: Multidomain interventions focused on cardiovascular and lifestyle related risk factors. Measurements: Data on cognitive functioning, depressive symptoms and apathy were collected at baseline, 2 years and 3–4 years of follow-up as available per study. We analyzed crude scores with linear mixed models for overall cognitive function (Mini Mental State Examination [MMSE]), and symptoms of depression and apathy (15-item Geriatric Depression Scale). Prespecified subgroup analyses were performed for sex, educational level, baseline MMSE <26, history of hypertension, and history of stroke, myocardial infarction and/or diabetes mellitus. Results: We included 4162 individuals (median age 74 years, IQR 72, 76) with a median follow-up duration of 3.7 years (IQR 3.0 to 4.1 years). No differences between intervention and control groups were observed on change in cognitive functioning scores and symptoms of depression and apathy scores in the pooled study population. The MMSE declined less in the intervention groups in those with MMSE <26 at baseline (N=250; MD: 0.84; 95%CI: 0.15 to 1.54; p<0.001). Conclusions: We found no conclusive evidence that multidomain interventions reduce the risk of global cognitive decline, symptoms of depression or apathy in a mixed older population. Our results suggest that these interventions may be more effective in those with lower baseline cognitive functioning. Extended follow-up for dementia occurrence is important to inform on the potential long-term effects of multidomain interventions.
KW - Multidomain intervention trials
KW - apathy
KW - cognition
KW - depression
KW - pooled analysis
UR - http://www.scopus.com/inward/record.url?scp=85115653151&partnerID=8YFLogxK
U2 - https://doi.org/10.14283/jpad.2021.53
DO - https://doi.org/10.14283/jpad.2021.53
M3 - Article
C2 - 35098979
SN - 2274-5807
JO - Journal of Prevention of Alzheimer's Disease
JF - Journal of Prevention of Alzheimer's Disease
ER -