Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial

Rosenberg, Anna; Ngandu, Tiia; Rusanen, Minna; Antikaínen, Riitta; Bäckman, Lars; Havulinna, Satu; Hänninen, Tuomo; Laatikainen, Tiina; Lehtisalo, Jenni; Levälahti, Esko; Lindström, Jaana; Paajanen, Teemu; Peltonen, Markku; Soininen, Hilkka; Stigsdotter-Neely, Anna; Strandberg, Timo; Tuomilehto, Jaakko; Solomon, Alina; Kivipelto, Miia

doi:10.1016/j.jalz.2017.09.006

Cited by 297 publications

(239 citation statements)

References 28 publications

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“…Even though the prevalence of carriage of two APOE4 alleles is much lower than the prevalence of Aβ misfolding (in our study: 1.5% vs. 11.0% among controls) and carriers of two APOE4 alleles comprise a very high risk group, the risk associated with Aβ misfolding was found to be stronger than APOE4 status in our study (OR, 23.0, 11.8–44.5). Additional risk stratification strategies and prevention studies have also been based on demographic, health, and lifestyle factors . The presented risk stratification strategy based on Aβ misfolding in blood plasma expressed greater long‐term disease prediction accuracy than APOE4 status or other health and lifestyle risk factors and may therefore be useful in targeting individuals for future research.…”

Section: Discussionmentioning

confidence: 99%

“…Individuals at high AD risk identified through plasma could receive additional PET imaging and/or CSF examination while low‐risk individuals could be immediately excluded thereby reducing costs, improving participant experience, and increasing ease. Furthermore, those at high AD risk could potentially be targeted in the future for enhanced preventative strategies including multidomain intervention programs incorporating lifestyle factors and vascular risk management …”

Section: Discussionmentioning

confidence: 99%

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Prediction of Alzheimer's disease diagnosis within 14 years through Aβ misfolding in blood plasma compared to APOE4 status, and other risk factors

Stocker

Nabers

Perna

et al. 2020

Alzheimer's & Dementia

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Introduction:Alzheimer's disease (AD) has a long prodromal stage and identifying high-risk individuals is critical. We aimed to investigate the ability of A misfolding in blood plasma, APOE4 status, and dementia risk factors to predict diagnosis of AD.Methods: Within a community-based cohort, A misfolding in plasma measured by immuno-infrared sensor and APOE genotype were determined at baseline in 770 participants followed over 14 years. Associations between A misfolding, APOE4, and other predictors with clinical AD, vascular dementia, and mixed dementia diagnoses were assessed. Results:A misfolding was associated with a 23-fold increased odds of clinical AD diagnosis within 14 years. No association was observed with vascular dementia/mixed dementia diagnoses. APOE4-positive participants had a 2.4-fold increased odds of clinical AD diagnosis within 14 years.Discussion: A misfolding in blood plasma was a strong, specific risk prediction marker for clinical AD even many years before diagnosis in a community-based setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prediction of Alzheimer's disease diagnosis within 14 years through Aβ misfolding in blood plasma compared to APOE4 status, and other risk factors

Stocker

Nabers

Perna

et al. 2020

Alzheimer's & Dementia

View full text Add to dashboard Cite

show abstract

“…They are also studying whether intervening on multiple risk factors simultaneously is more effective at reducing risk than addressing a single risk factor. Indeed, one such study, 132 the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), found that a multidomain lifestyle intervention was associated with beneficial effects on cognitive function in older adults at high risk for cognitive decline and dementia. The success of FINGER has led to the launch of multidomain lifestyle intervention studies in other countries, including the Alzheimer's Association U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) 133 …”

Section: Overview Of Alzheimer's Diseasementioning

confidence: 99%

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

2,033

653

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

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“…Some clinical trials have demonstrated that multimodal interventions aimed at reducing AD risk, including nutrition, physical activity, cognitive engagement, and management of comorbidities improved cognitive functioning in non-impaired individuals at risk for AD (14, 15). A subgroup analysis of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) trial showed that there was no significant difference between the effects of lifestyle modifications on cognitive function in APOE ε4 carriers versus non-carriers (16).…”

Section: Multi-modal Lifestyle Considerationsmentioning

confidence: 99%

Clinical Application of Apoe in Alzheimer’s Prevention: A Precision Medicine Approach

et al. 2018

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Population-attributable risk models estimate that up to one-third of Alzheimer’s disease (AD) cases may be preventable through risk factor modification. The field of AD prevention has largely focused on addressing these factors through universal risk reduction strategies for the general population. However, targeting these strategies in a clinical precision medicine fashion, including the use of genetic risk factors, allows for potentially greater impact on AD risk reduction. Apolipoprotein E (APOE), and specifically the APOE ε4 variant, is one of the most well-established genetic influencers on late-onset AD risk. In this review, we evaluate the impact of APOE ε4 carrier status on AD prevention interventions, including lifestyle, nutrigenomic, pharmacogenomic, AD comorbidities, and other biological and behavioral considerations. Using a clinical precision medicine strategy that incorporates APOE ε4 carrier status may provide a highly targeted and distinct approach to AD prevention with greater potential for success.

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Multidomain lifestyle intervention benefits a large elderly population at risk for cognitive decline and dementia regardless of baseline characteristics: The FINGER trial

Abstract: The FINGER intervention was beneficial regardless of participants' characteristics and can thus be implemented in a large elderly population at increased risk for dementia.

Cited by 297 publications

References 28 publications

Prediction of Alzheimer's disease diagnosis within 14 years through Aβ misfolding in blood plasma compared to APOE4 status, and other risk factors

Prediction of Alzheimer's disease diagnosis within 14 years through Aβ misfolding in blood plasma compared to APOE4 status, and other risk factors

2020 Alzheimer's disease facts and figures

Clinical Application of Apoe in Alzheimer’s Prevention: A Precision Medicine Approach

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