Engaging Patients to Design the Systematic Multi-Domain Alzheimer’s Risk Reduction Trial (SMARRT) Intervention: Findings from a Web-Based Survey

Marcum, Zachary A.; Rosenberg, Dori E.; Barnes, Deborah E.; Yaffe, Kristine; Larson, Eric B.

doi:10.3233/adr-200210

Cited by 5 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…33 Prior to SMARRT, we surveyed almost 600 KPWA members, and most respondents were concerned about ADRD, wanted to know their personal risk factors, and were highly motivated to make lifestyle changes to lower dementia risk. 34 Given the recent fast pace of ADRD drug discovery, new disease-modifying agents are now an exciting reality. [3][4][5][6] Several drugs have recently or will be approved for early AD and MCI (not primary prevention), will require fairly intensive monitoring for AEs (such as amyloid-related imaging abnormalities), 35,36 and will be costly.…”

Section: Discussionmentioning

confidence: 99%

“…A personalized approach may be more effective in an at-risk population where dementia risk factors and motivations to work on risk reduction vary substantially . Prior to SMARRT, we surveyed almost 600 KPWA members, and most respondents were concerned about ADRD, wanted to know their personal risk factors, and were highly motivated to make lifestyle changes to lower dementia risk …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Yaffe,

Vittinghoff,

Dublin

et al. 2024

JAMA Intern Med

Self Cite

View full text Add to dashboard Cite

ImportanceModifiable 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.ObjectiveTo determine if a personalized, multidomain risk reduction intervention improves cognition and dementia risk profile among older adults.Design, Setting, and ParticipantsThe 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.InterventionParticipants 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 MeasuresThe 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 pandemic, were remote.ResultsThe 172 total participants had a mean (SD) age of 75.7 (4.8) years, and 108 (62.8%) were women. After 2 years, compared with the 90 participants in the control group, the 82 participants assigned to intervention demonstrated larger improvements in the composite cognitive score (ATE of SD, 0.14; 95% CI, 0.03-0.25; P = .02; a 74% improvement compared with the change in the control group), better composite risk factor score (ATE of SD, 0.11; 95% CI, 0.01-0.20; P = .03), and improved QOL (ATE, 0.81 points; 95% CI, −0.21 to 1.84; P = .12). There were no between-group differences in serious adverse events (24 in the intervention group and 23 in the control group; P = .59), but the intervention group had greater treatment-related adverse events such as musculoskeletal pain (14 in the intervention group vs 0 in the control group; P &lt; .001).Conclusions and RelevanceIn this randomized clinical trial, a 2-year, personalized, multidomain intervention led to modest improvements in cognition, dementia risk factors, and QOL. Modifiable risk-reduction strategies should be considered for older adults at risk for dementia.Trial RegistrationClinicalTrials.gov Identifier: NCT03683394

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Yaffe,

Vittinghoff,

Dublin

et al. 2024

JAMA Intern Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…Older adults have expressed strong interest in dementia risk factor reduction. 118 In addition, studies suggest they want to know their personal risk factors and can be highly motivated to make healthy lifestyle changes to lower dementia risk. Such findings suggest that future interventions can be improved by ensuring that technological tools are suitable for older individuals and taking into account participant characteristics, preferably by using individually tailored approaches to increase adherence to different components of the multidomain intervention.…”

Section: Methodological Issuesmentioning

confidence: 99%

Trials and Treatments for Vascular Brain Health: Risk Factor Modification and Cognitive Outcomes

Kivipelto

Palmer

Hoang

et al. 2022

Stroke

Self Cite

View full text Add to dashboard Cite

There is robust evidence linking vascular health to brain health, cognition, and dementia. In this article, we present evidence from trials of vascular risk factor treatment on cognitive outcomes. We summarize findings from randomized controlled trials of antihypertensives, lipid-lowering medications, diabetes treatments (including antidiabetic drugs versus placebo, and intensive versus standard glycemic control), and multidomain interventions (that target several domains simultaneously such as control of vascular and metabolic factors, nutrition, physical activity, and cognitive stimulation etc). We report that evidence on the efficacy of vascular risk reduction interventions is promising, but not yet conclusive, and several methodological limitations hamper interpretation. Evidence mainly comes from high-income countries and, as cognition and dementia have not been the primary outcomes of many trials, evaluation of cognitive changes have often been limited. As the cognitive aging process occurs over decades, it is unclear whether treatment during the late-life window is optimal for dementia prevention, yet older individuals have been the target of most trials thus far. Further, many trials have not been powered to explore interactions with modifiers such as age, race, and apolipoprotein E, even though sub-analyses from some trials indicate that the success of interventions differs depending on patient characteristics. Due to the complex multifactorial etiology of dementia, and variations in risk factors between individuals, multidomain interventions targeting several risk factors and mechanisms are likely to be needed and the long-term sustainability of preventive interventions will require personalized approaches that could be facilitated by digital health tools. This is especially relevant during the coronavirus disease 2019 (COVID-19) pandemic, where intervention strategies will need to be adapted to the new normal, when face-to-face engagement with participants is limited and public health measures may create changes in lifestyle that affect individuals’ vascular risk profiles and subsequent risk of cognitive decline.

show abstract

“…Lastly, the US-based Systematic Multidomain Alzheimer's Risk Reduction Trial (SMARRT) aims to improve the efficacy and adherence to a personalized multidomain intervention by a process of patient engagement in the intervention design [28 ▪ ]. The research group conducted an online survey among a convenience sample of 561 patients in a large health system.…”

Section: Current Developments (2020–2022)mentioning

confidence: 99%

Multidomain interventions for risk reduction and prevention of cognitive decline and dementia: current developments

Röhr

Kivipelto

Mangialasche

et al. 2022

Current Opinion in Psychiatry

View full text Add to dashboard Cite

Purpose of reviewThe potential for dementia prevention is deemed substantial if modifiable risk factors were addressed. First large-scale multidomain lifestyle interventions aiming at reducing risk of cognitive decline and dementia have yielded mixed but promising evidence. Recent findingsDespite the impact of the COVID-19 pandemic on trials conduction, causing interruptions and delays, the research landscape on multidomain interventions is growing rapidly. The successful Finish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) has led to an adaptation of the FINGER model in trials underway or being planned in over 40 countries. Recent studies identified barriers and facilitators of and adherence to multidomain interventions, showed the suitability of dementia risk scores as surrogate outcomes, and suggested mechanisms. Multidomain interventions are increasingly conducted in the Global South, and study protocols are increasingly testing expanded FINGER models, for example, with pharmacological components, in digital/remote settings and co-designed personalized interventions.

show abstract

Engaging Patients to Design the Systematic Multi-Domain Alzheimer’s Risk Reduction Trial (SMARRT) Intervention: Findings from a Web-Based Survey

Cited by 5 publications

References 9 publications

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

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

Trials and Treatments for Vascular Brain Health: Risk Factor Modification and Cognitive Outcomes

Multidomain interventions for risk reduction and prevention of cognitive decline and dementia: current developments

Contact Info

Product

Resources

About