For August 2015, we have selected: Ngandu T, Lehtisalo J, Solomon A, et al. A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomized controlled trial. The Lancet Neurology 2015;385:2255-2263.
The progressive aging of the world population and the related increased number of people with neurodegenerative disorders such as Alzheimer disease (AD) and other dementias, urge to find new and effective prevention strategies. Seven modifiable factors, such as low education, hypertension, obesity, diabetes, lack of exercise, smoking and depression have been linked with AD. Therefore, it could be possible to successfully prevent cognitive decline and dementia by acting on these risk factors during the presymptomatic and at-risk states.
In this multicenter, double-blind randomised prospective Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), 1,260 subjects between 60-77 years old and at risk of developing cognitive decline were enrolled in six centers from previous population-based non-interventional surveys. The cognitive impairment risk was assessed using the Cardiovascular Risk Factors, Aging and Dementia (CADE) Dementia Risk Score (required to be ≥6 points at baseline). The selected subjects met also the criteria of a cognitive performance at the average or slightly lower level than expected for their age before being randomized. The 629 individuals of the control group received regular health advices, whereas in the intervention group 631 individuals received four intervention components, focused on diet recommendations, physical exercise, cognitive training and vascular risk monitoring. The primary outcome measure was change in cognitive performance scores using a comprehensive neuropsychological test battery (NTB) Z score at the 2-year endpoint.
There was a significant beneficial effect of the intervention components, with an estimated mean change in the NTB total Z score of 0.2 (SE 0.01, SD 0.51) in the intervention group and 0.16 (0.01, 0.51) in the control group. The difference in the change of the NTB score per year between groups was also significant (95%CI 0.002-0.042, p=0.03). The improvement in the NTB total score was 25% higher in the interventional group compare to the control group.
“This is a very encouraging study which provides strong evidence for the use of a multifocused approach in maintaining cognitive function, and it could provide a potential model for preventing dementia,” says Professor G. Waldemar, Department of Neurology, Rigshospitalet, Copenhagen, Denmark. ”There was a high self-reported adherence to the intervention components, with only 12% dropout. The side effects rate was low (5%), with the most common side effect being exercise-related pain. These findings indicate that well defined multidomain lifestyle-based strategies are easily accepted and integrated in the daily life.”
“Although some practice effect of repeated cognitive testing cannot be fully excluded, this paper supports the application of a multimodal intervention approach in other neurodegenerative diseases”, continues Prof. Waldemar. ”When dealing with multifactorial disorders, only a wide broad prevention at a very early stage would be probably effective.”
The other nominees for the August paper of the month are:
- Pollack CV, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. JAMA 2015; June 22. DOI: 10.1056/NEJMoa1502000. The efficacy and safety of the antibody fragment idarucizumab in reversing the anticoagulant effect of dabigatran was prospectively assessed in 90 patients with serious bleeding or requiring urgent procedures. Idarucizumab was able to completely reverse the dabigatran anticoagulant effect within minutes in most patients.
- Tintore M, Rovira A, Rio J, et al. Defining high, medium and low impact prognostic factors for developing multiple sclerosis. Brain 2015;138:1863-1874. A large cohort of 1015 patients with clinical isolated syndromes was followed for an average of 81 months to identify predictive factors of multiple sclerosis development or disability accumulation. The number of brain MRI lesions, the presence of oligoclonal bands, and demographic/topographic characteristics were found as high, medium and low prognostic factors, respectively.
- Low PA, Reich SG, Jankovic J, et al. Natural history of multiple system atrophy in the USA: a prospective cohort study. Lancet Neurology 2015; May 27. In this prospective study 175 patients with multiple system atrophy were followed in 12 USA centers every 6 months for up to 5 years. There was a median survival of 9.8 years from symptom onset, with no major difference between MSA-P and MSA-C patients. Severe symptomatic autonomic failure at diagnosis was associated with worse prognosis.