Randomised trial puts FINGER on cognitive health

By Eleanor McDermid, Senior medwireNews Reporter

The FINGER study, the first large randomised, controlled trial of its kind, suggests that a multifactorial intervention could slow cognitive decline in elderly people at risk of developing dementia.

The 2-year intervention targeted people who were aged between 60 and 77 years and had average or slightly below average cognition, but were considered at risk of cognitive decline because they had a Cardiovascular Risk Factors, Aging and Dementia (CAIDE) Dementia Risk Score of 6 points or more.

A total of 591 such individuals were assigned to the intervention group and received at least one post-baseline assessment. During the intervention period, these people participated in individual and group sessions to facilitate dietary modification, partake in strength and aerobic training, undergo cognitive training and manage metabolic and vascular risk factors. The sessions were overseen by nutritionists, physiotherapists, psychologists and study nurses/doctors, respectively.

At baseline, the participants’ average z-score on an extended version of the neuropsychological test battery was –0.03 and this improved by an average of 0.20 points over the 2 years of the study. The 599 control participants had an average baseline score of 0.03, which improved by 0.16 points. The intervention group’s z-score improved by a significant 0.022 more points per year than that of the control group, and by the end of the study the intervention group’s cognition had improved by 25% more than that of the control group.

However, Miia Kivipelto (Karolinska Institute, Stockholm, Sweden) and study co-authors say this difference “could be considered to be conservative”, as it did not account for adherence, and because the control group also received advice on managing metabolic and vascular risk factors on ethical grounds.

“The benefits of the multidomain intervention might thus be greater if compared with a do-nothing control group”, they write in The Lancet.

The intervention group had significantly greater improvements than the control group in executive function (by 83%) and processing speed (by 150%), but not in memory, although post-hoc analyses suggested greater improvements in “more complex memory tasks”.

The researchers now intend to follow-up the participants to 7 years, to monitor the incidence of dementia and Alzheimer’s disease.

“Postponing of the onset of Alzheimer’s disease by 5 years has been estimated to decrease its prevalence by up to 50% in 50 years”, they observe.

They note that about a third of Alzheimer’s cases are attributed to potentially modifiable factors, and say that “if the beneficial effects on cognition observed in FINGER will lead to even a modest delay in onset of dementia and Alzheimer’s disease, it would have a huge effect on both individual and societal levels.”

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