An online intervention targeting modifiable dementia risk factors improved cognition over 3 years, a randomized controlled trial of 6,100 older adults in Australia showed.
The primary outcome of change in global cognitive composite (GCC) score at 3 years was met, said Henry Brodaty, MD, DSc, of the University of New South Wales in Sydney, and co-authors.
The GCC was the mean of z scores for three cognitive domains normalized to the baseline mean and standard deviation, with higher scores indicating better performance.
Mean GCC changes at 3 years were 0.28 (95% CI 0.25-0.32) for the intervention group and 0.10 (95% CI 0.07-0.13) for the control group, with a between-group difference of 0.18 (95% CI 0.13-0.23, P<0.001), Brodaty and colleagues reported in Nature Medicine.
Scores in all three cognitive domains -- complex attention, executive function, and memory -- showed statistically significant improvements favoring the intervention group (all P<0.001). Women had greater cognitive improvements than men, and people ages 55 to 65 showed more significant gains than those 66 to 77 years old.
The findings indicate that global cognition can be improved, Brodaty said. "We suggest that by attending to lifestyle factors, we can enhance the cognitive buffer -- or cognitive resilience -- to compensate for the build-up of pathology in the brain as we age," he told MedPage Today.
The results represent small effect sizes, Brodaty acknowledged. "However, an effect size at a population level of 0.18, or perhaps 0.28, is hugely beneficial," he pointed out.
"For example, the George Institute for Global Health found that reducing salt intake by 3 grams per day, which is less than a teaspoon, could reduce the risk of stroke by 14% and that effect size was 0.3," he said.
Last year, the Lancet Commission on dementia prevention, intervention, and care estimated that the worldwide risk for dementia would fall by 45% if 14 modifiable risk factors were addressed.
In 2015, a multidomain approach to reducing dementia risk showed promise in the Finnish FINGER study. A similar intervention is now being studied in the POINTER study in the U.S.
However, long-term digital solutions to dementia prevention remain underexplored, Brodaty and co-authors noted.
In the Maintain Your Brain trial, Brodaty and colleagues randomized 6,104 community-dwelling Australians with modifiable dementia risk factors to a personalized schedule of online coaching in two to four modules, or to a control group that received health information only.
The modules targeted physical activity, nutrition, cognitive activity, and depression or anxiety, and were assigned based on individual risk profiles.
Most participants (64%) were women, and nearly all participants (96%) were Caucasian. People ages 55 to 65 made up 56% of the sample; the rest were 66 to 77.
In the intervention group, coaches provided structured, personalized goal-oriented activities like exercise programs, diet plans, and brain-training exercises. The control group received publicly available health information without interactive engagement.
The active intervention lasted for 1 year, with follow-up continuing for an additional 2 years. Those who completed at least 60% of their assigned activities had significantly greater cognitive benefits than those with less engagement.
At 3 years, the intervention group reported increased levels of physical activity, greater adherence to a Mediterranean-style diet, and reduced psychological distress compared with controls (all P<0.001). No significant differences in body mass index (BMI) changes emerged between groups.
Adverse events related to the trial occurred in 19 people in the intervention group (0.60%), including one serious event.
The findings may have been influenced by potential self-selection bias, given participants' higher-than-average education levels, socioeconomic status, and aerobic activity levels, Brodaty and co-authors acknowledged.
The trial lacked racial and ethnic diversity and did not specifically address several dementia risk factors, including social function and hypertension, they added.
Disclosures
This trial was funded by a National Health and Medical Research Council grant.
Brodaty reported relationships with Biogen, Eisai, Eli Lilly, Medicines Australia, Roche, Skin2Neuron, Cranbrook Care, and Montefiore Homes.
Co-authors reported relationships with Biogen, Roche, and Skin2Neuron.
Primary Source
Nature Medicine
Source Reference: Brodaty H, et al "An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial" Nat Med 2025; DOI: 10.1038/s41591-024-03351-6.
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