Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer’s Disease, and Dementia: From Finger to World-Wide Fingers

Abstract

Alzheimer’s disease (AD) and dementia are a global public health priority, and prevention has been highlighted as a pivotal component in managing the dementia epidemic. Modifiable risk factors of dementia and AD include lifestyle-related factors, vascular and metabolic disorders, and psychosocial factors. Randomized controlled clinical trials (RCTs) are needed to clarify whether modifying such factors can prevent or postpone cognitive impairment and dementia in older adults. Given the complex, multifactorial, and heterogeneous nature of late-onset AD and dementia, interventions targeting several risk factors and mechanisms simultaneously may be required for optimal preventive effects. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is the first large, long-term RCT to demonstrate that a multidomain lifestyle-based intervention ameliorating vascular and lifestyle-related risk factors can preserve cognitive functioning and reduce the risk of cognitive decline among older adults at increased risk of dementia. To investigate the multidomain intervention in other populations and diverse cultural and geographical settings, the World-Wide FINGERS (WW-FINGERS) network was recently launched (https://alz.org/wwfingers). Within this network, new FINGER-type trials with shared core methodology, but local culture and context-specific adaptations, will be conducted in several countries. The WW-FINGERS initiative facilitates international collaborations, provides a platform for testing multidomain strategies to prevent cognitive impairment and dementia, and aims at generating high-quality scientific evidence to support public health and clinical decision-making. Furthermore, the WW-FINGERS network can support the implementation of preventive strategies and translation of research findings into practice.

Strategies to reduce sample sizes in Alzheimer’s disease primary and secondary prevention trials using longitudinal amyloid PET imaging

“…Nonetheless, other interventions may have more subtle effects on amyloid burden, either directly or indirectly. Some examples would be BACE1 inhibitors [ 60 ], drugs with other targets which have downstream amyloid effects [ 61 ], or non-pharmacological therapies and multi-domain preventive trials such as those being tested in World-Wide FINGERS [ 62 , 63 ]. As such, 20% reduction of amyloid accumulation may be a relevant target to detect, especially in a short 1-year Proof-of-Concept study.…”

Platform Trials to Expedite Drug Development in Alzheimer’s Disease: A Report from the EU/US CTAD Task Force

“…Meanwhile, an international network of multidomain intervention clinical trials has been established to replicate the groundbreaking Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), which demonstrated that a combination of lifestyle interventions reduces the risk of cognitive decline in older adults with vascular risk factors that increase their risk of dementia. The Worldwide FINGERS initiative (WW-FINGERS) provides a platform for investigators in different countries and cultures to adapt the FINGERS protocol while using similar protocols and sharing data ( 19 ).…”

Effects of 12 Weeks Cosmos caudatus Supplement among Older Adults with Mild Cognitive Impairment: A Randomized, Double-Blind and Placebo-Controlled Trial

“…Mild cognitive impairment (MCI) is an etiologically heterogeneous syndrome characterized by memory performance below the age norm and represents a transitional state between normal aging and dementia disorders. Globally, efforts have been taken to explore neuroprotective effects of nutraceutical products among the aging population aiming for the prevention of neurodegenerative diseases such as dementia through food-based recommendations [ 7 , 8 , 9 , 10 ]. Asian in particular is rich in traditional herbs and vegetables potentially use as nutraceutical.…”