The effect of a digital health coaching and health education protocol on cognition in adults at-risk for Alzheimer’s

Abstract

Several modifiable lifestyle factors have been linked to cognitive ability and the risk of developing Alzheimer’s disease and related dementias (ADRD). Health coaching (HC) is an intervention that addresses lifestyle factors associated with cognition. The effectiveness of an HC protocol was evaluated and compared with a health education (HE) intervention, representing the current standard of care, in a sample of 216 adults between the ages of 45 and 75 years who were at-risk for developing ADRD. Outcomes examined were global cognition, neuropsychological cognition, and Alzheimer’s risk. HC participants received personalized coaching from a health coach focusing on nutrition, physical activity, sleep, stress, social engagement, and cognitive activity. HE participants received biweekly education materials focusing on the same modifiable lifestyle factors addressed by HC. Participants were assessed at baseline and again 4 months later. Self-reported global cognition scores improved only in the HC group (16.18 to 15.52, p = .03) and neuropsychological cognitive ability improved in the HE group (104.48 to 108.76, p < .001). When non-adherence in the HC group was accounted for, however, the mean change in neuropsychological score was similar between groups (p > .05), self-reported global cognition demonstrated an even larger mean improvement in the HC group (16.20 to 15.41, p = .01), and the HC group saw an improvement in ADRD protective risk score (− 10.39 to − 11.45, p = .007). These results indicate that HC and HE can both improve cognition, but HC may be more effective and may yield increased protection against ADRD risk.

Digital 2-year multidomain health interventions improve cognition and stabilize Alzheimer’s disease risk in at-risk adults (DC-MARVEL): A randomized controlled trial

“…To meet the inclusion criteria for this study, a participant had to be between the ages of 45 and 75 years, be uent in English, own a smartphone, be willing to communicate via text message, and have at least two of the following risk factors for ADRD based on the Australian National University-Alzheimer's disease risk index (ANU-ADRI) 22 : high school education or less; a body mass index (BMI) ≥ 25 kg/m 2 but less than 40 kg/m 2 ; or history of diabetes, hypertension, high cholesterol, smoking, or traumatic brain injury. Exclusion criteria were visual problems impacting the ability to view a screen at a normal distance; history of a learning disability; recent cardiovascular event; current participation in a cognitive training intervention or lifestyle change program; current diagnosis of any mental health condition, neurologic condition, dementia, mild cognitive impairment, or any other serious health condition; or more than one of the following ADRD protective factors based on the ANU-ADRI: high physical activity level, eating non-fried sh or seafood more than 5 times per week, or a high level of cognitive engagement 10,21 .…”

“…U.S. POINTER's integration of HC is notable as the paradigm has been shown to improve many of the modi able risk factors associated with cognitive disease 19,20 via increased participation in activities associated with better brain health 19 . To our knowledge, however, the only published research examining HC speci cally for its potential to reduce ADRD risk and modify cognition in at-risk adults was a preliminary analysis of the data collected through the current Digital Cognitive Multidomain Risk Velocity Study (DC-MARVEL) 10 . DC-MARVEL aimed to take the next step in modi able risk factor interventions by implementing interventions that were digital, fully remote, and scalable, while focusing on a sample at-risk for ADRD.…”

“…Recognizing the limited e cacy of current interventions designed to combat ADRD, researchers have shifted focus away from treating patients with active diagnoses, moving upstream towards preclinical cognitive impairment 9 , as well as cognitively intact, but at-risk individuals 8, 10,11 . In fact, the present standard of care recommended by the World Health Organization (WHO) focuses on reducing disease risk through behavior modi cation to slow disease progression and lower risk 7,8,12 .…”

“…DC-MARVEL was evaluated and approved as an ethical research study by the Institutional Review Board at the University of Arkansas (Protocol Number: 2009280813A009), and the NIA's Data and Safety Monitoring Board provided ongoing safety and regulatory oversight. The study protocol 21 and preliminary analyses from four months of intervention 10 were published previously.…”

Developing the Healthy Actions and Lifestyles to Avoid Dementia or Hispanos y el ALTo a la Demencia program

“…Educational interventions have been shown to improve knowledge and belief in the importance of health behaviors for dementia among healthy adults, adults at‐risk of dementia, and among dementia patient caregivers 15–17 . However, there is limited availability for evidence‐informed tool(s) that deliver quality education about dementia risk reduction and that incorporate other aspects such as increasing self‐efficacy and goal setting to support positive behavior change 18–22 . These tools would be particularly helpful in primary care and geriatric health clinics where fast‐paced health care delivery and limited resources often limit effective education and support for behavioral modification 23 .…”