CRAHW Centre for Research on Ageing, Health & Wellbeing Ageing well through the prevention of dementia: A protocol for a multidomain MCI intervention Mitchell McMaster, Linda Clare, Sarang Kim, Kaarin Anstey Centre for Research on Ageing, Health & Wellbeing (CRAHW) The Australian National University

Overview Background Dementia Prevention for MCI Body, Brain, Life Project BBL-MCI Modifications Methodology Outcome Measures Defining A Successful Outcome

Background Growing consensus re: risk factors and efficacy of prevention (Beydoun, et al, 2014; Norton, et al, 2014) Preventable cases of dementia (Barnes & Yaffe, 2011) One of the highest risk groups are individuals with MCI (Plassman, et al, 2008) Need for more research in this area (Williams et al, 2010; Plassman, et al, 2008; Norton, 2014)

Dementia Prevention for MCI What is MCI? Currently there is uncertainty around the point at which interventions can still have a positive effect on the disease trajectory. -Emergence of pathology -MCI variability (progression vs remission) (Plassman et al, 2008; Malek-Almadi, 2016) -Several authors have identified MCI as a point where there should be increased research as a possibility for prevention and risk reduction

Body Brain Life Project (BBL) Progression BBL: Multidomain dementia risk-reduction intervention. - Dementia Literacy - Risk Factors - Physical activity - Diet - Cognitive Engagement - Social Engagement - Health Management - Mood   Practical Components Study Year Conducted Risk Factors Mood Physical Activity Diet Cognitive Activity BBL 2013 P × BBL-FIT 2015 BBL-GP 2016 BBL-MCI 2017

BBL-MCI Modifications Online modules reduced Complexity reduced Memory aids Additional “active” components -Physical activity -Nutrition -Cognitive engagement The program will be piloted with Alzheimer’s Australia to determine feasibility issues with MCI population

Methodology Population: Mild Cognitive Impairment/Subjective Memory Impairment Intervention vs active control Testing to take place at 4 time points: Baseline, post-intervention, 3 months and 6 months.

Outcome Measures Primary outcome: Functionality -Cognitive measures -IADLs Secondary outcome: Dementia Risk Reduction/Cost Effectiveness -ANU-ADRI -SF 12

Defining A Successful Outcome Prevention vs. Trajectory Modification (Adapted from Rosenberg, 2015)

Financial Support This PhD is supported by Alzheimer’s Australia Dementia Research Foundation (AADRF), Dementia Collaborative Research Centres (DCRC), Australian National University (ANU) 1:1 Scholarship

References Beydoun, M.A., et al.(2014). Epidemiologic studies of modifiable factors associated with cognition and dementia: Systematic review and meta- analysis. BMC Public Health, 14(1),1562-1624. Norton, S., et al. (2014) Potential for primary prevention of Alzheimer’s disease: An analysis of population-based data. Lancet Neurology, 13(8), 788-794. Barnes, D. & Yaffe, K. (2011). The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurology, 10, 819-828. Plassman, B.L., et al. (2008). Prevalence of cognitive impairment without dementia in the United States. Annals of Internal Medicine, 148(6), 427- 434. Williams, J.W., et al. (2010) Prevention Alzheimer's Disease and cognitive decline, in Evidence Report/Technology Assessment. Rockville, MD: Agency for Healthcare Research and Quality (US). Rosenberg, I. H. (2015). Keynote address: Aging and the nutrition imperative. New York Academy of Sciences eBriefing.

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