Finnish Multidomain Intervention for Cognitive Decline: the FINGER Study

Researchers have linked Alzheimer’s disease risk to modifiable lifestyle factors, including: low education, midlife hypertension, midlife obesity, diabetes, physical inactivity, smoking, and depression.1 Addressing modifiable factors may help individuals maintain their cognitive function and possibly even prevent cognitive impairment. However, randomized controlled trials are needed to confirm the associations of modifiable factors and to determine effective prevention strategies.  The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment Disability (FINGER) utilized an intervention/control format.2

In this study, participants in the intervention group experienced improvements in overall cognition, executive functioning, processing speed, Body Mass Index (BMI), dietary habits, and physical activity.

FINGER is a population-based, randomized control study conducted in 6 centers in Finland with a screening period between September 2009 and November 2011 and intervention conducted in 2014. The FINGER study participants were recruited from previous non-interventional surveys. All participants were 60-77 years of age with Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) risk score of 6 points or higher (based on age, sex, education, systolic blood pressure, body-mass index, total cholesterol, and physical activity range).  Cognitive screening was done with the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological battery, and the criteria for inclusion was individuals with cognitive performance at or slightly below the mean level expected for age according to population norms. Individuals with previously diagnosed dementia, suspected dementia, mini mental state examination scores below 20, and health issues making participation unsafe were excluded from the study.

Participants were randomly assigned to a multidomain intervention group (n=631) or a general health advice group (n=629). All participants received baseline and 6, 12, and 24 month screenings with a nurse for blood pressure, weight, BMI, and hip and waist circumference. Blood samples were also collected at these intervals. All participants also met with a physician at screening and 24 months for a detailed medical history and physical examination. Standard neuropsychological tests were administered by a psychologist at baseline, 12 months, and 24 months.

At baseline, all participants were given oral and written information on healthy diet and physical, cognitive and social activities aimed at vascular management and disability prevention. All participants received the results of their blood panels in the mail with an explanation of the results and recommendation to contact their primary health care provider if needed. The intervention group also received four intervention components: nutrition (based on Finnish Nutrition Recommendations- 3 individual and 7 to 9 group sessions), physical activity (progressive muscle strength training 1–3 times per week and aerobic exercise 2–5 times per week), cognitive training (72 individual computer based training and 10 group sessions, 6 educational and 4 progress checking,), and social interactions (group meetings of intervention components).

The participants were recommended to consume a diet composed of 10% to 20% protein, 25% to 35% from fats and 45% to 55% from carbohydrates. There were specific guidelines within these strata for saturated and unsaturated fats, omega-3 fatty acids, refined sugar, fiber, salt, and alcohol.

Study adherence was high with 1% participating in only one intervention domain, 6% in two intervention domains, 21% in 3 intervention domains, and 72% in all four intervention domains. Few side-effects were reported, with 5% of intervention participants reporting slight exercise-related musculoskeletal pain.

The primary outcome measured for the study was change in total cognitive performance and secondary outcomes included executive functioning, processing speed, and memory. Improvements in the total cognitive performance score after 2 years were 25% higher in the intervention group than the control group. Also, improvements were found in secondary outcomes as well, with 83% increased executive functioning performance and 150% in memory recall for the treatment group versus the control group. Significant effects were also noted after two years for BMI, dietary habits and physical activity. The intervention was not associated with significant change in the secondary memory domain that was measured. Overall, risk of cognitive decline was increased in the control group compared with intervention group for the primary outcome of total cognitive performance and secondary outcomes of executive functioning and processing speed.

The study participants will be followed for an additional seven years to assess long-term intervention effects on incidence of dementia and Alzheimer’s disease and related functional outcomes.

    1. Norton S, Matthews FE, Barnes DE, Yaff K, Brayne C. Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurology, 2014; 13: 788-794.
    2. Ngandu T, Lethisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015; 385: 2255-63.

 

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