The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce—randomised controlled trial

Abstract

Background Large-scale trials of multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aim to determine if a lower intensity, personally tailored secondary dementia prevention programme for older people with subjective or mild objective memory decline, informed by behaviour change theory, reduces cognitive decline over 2 years. Methods A multi-site, single-blind randomised controlled trial recruiting 704 older adults at high dementia risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Participants are randomised using 1:1 allocation ratio to the APPLE Tree intervention versus control arm (dementia prevention information), stratified by site. The intervention explores and implements strategies to promote healthy lifestyle, increase pleasurable activities and social connections and improve long-term condition self-management. Two facilitators trained and supervised by a clinical psychologist deliver ten, 1-h group video call sessions over 6 months (approximately every fortnight), video-call ‘tea breaks’ (less structured, facilitated social sessions) in intervening weeks and individual goal-setting phone calls every 2 weeks. From 6 to 12 months, participants meet monthly for ‘tea breaks’, with those not attending receiving monthly goal-setting phone calls. Participants receive a food delivery, pedometer and website access to cognitive training and information about lifestyle modification. Follow-ups for all outcome measures are at 12 and 24 months. The primary outcome is cognition (Neuropsychological Test Battery (NTB) score) at 24 months. Secondary outcomes are quality of life, cost per quality-adjusted life year (QALY) and wellbeing and lifestyle factors the intervention targets (diet, vascular risk, body weight, activity, sleep, anxiety, depression, social networks and loneliness, alcohol intake and smoking). Participants from purposively selected sites participate in qualitative process evaluation interviews, which will be analysed using thematic analytic methods. Discussion If effective, the intervention design, involving remote delivery and non-clinical facilitators, would facilitate intervention roll-out to older people with memory concerns. Trial registration ISRCTN17325135. Registration date 27 November 2019

Nature As a “Lifeline”: The Power of Photography When Exploring the Experiences of Older Adults Living With Memory Loss and Memory Concerns

“…We recruited participants aged 60 and older with subjective cognitive decline or MCI from the APPLE-Tree Randomized Controlled Trial, which evaluated a dementia prevention program involving weekly small groups, interactive video-call sessions, and phone calls with facilitators ( Cooper et al, 2021 ; Poppe et al, 2022 ). We recruited from across the intervention arm groups, promoting the study through emailed “leaflets” and visits to video-call sessions, with attention paid to cultural and ethnic diversity.…”

Non-clinically trained facilitators’ experiences of remote psychosocial interventions for older adults with memory loss and their family carers

“…Participants (henceforth called facilitators) were staff who did not hold a formal clinical qualification and were working on either of two new remote psychosocial interventions: (a) the New Interventions for Independence in Dementia – Family (NIDUS-Family) study, 13 a 1-year (six to eight manualised sessions) intervention delivered by video or telephone call to dyads (a person living with dementia and their family carer who took part as a pair, with the option of some one-on-one sessions), by one university-based facilitator (employed as research assistants); and (b) the Active Prevention in People at Risk of Dementia through Lifestyle, Behaviour Change and Technology to Build Resilience (APPLE-Tree) study, 3 a six-month (ten fortnightly 1-h manualised sessions) group-based (six to eight person), video call intervention for people with mild memory loss, with an unstructured 30-min ‘tea break’ on the weeks in-between sessions and one-to-one fortnightly telephone calls, facilitated by two staff, usually one university-based facilitator (research assistant) and one NHS or third-sector staff.…”

“…As cases of dementia are projected to increase to 152 million worldwide by 2050, 1 there is a clinical imperative to develop scalable psychosocial interventions, prevent dementia by addressing known modifiable risk factors 2 , 3 and improve quality of life and independence of individuals living with dementia. 4 …”

Social activities in multidomain dementia prevention interventions: insights from practice and a blueprint for the future

“…Early dementia lifestyle-based preventive interventions predominantly relied on trained professionals to deliver the intervention, and social interaction was stimulated by bringing participants together ( 40 ). The recent generation of trials often adopt a fully-digital or digitally-supported design, such as studies on the Healthy Aging Through Internet Counselling in the Elderly (HATICE) ( 52 , 53 ), Maintain Your Brain ( 54 ), MyCoach ( 55 ), or APPLE Tree ( 56 ). Although digital interventions enable participants to access the intervention from their own home, which could stimulate adoption and adherence, it seems counter intuitive when stimulating social activities.…”