A lifestyle intervention targeted to persons at risk for dementia was most beneficial among those with fewer structural brain changes at baseline, according to the doctoral dissertation of Ruth Stephen, MPH. The results from the FINGER study show the importance of starting preventive interventions early before substantial brain changes have occurred.
Dementia and cognitive decline pose a major public health challenge having serious impact on affected individuals, their carers, and families. It is now established that brain pathology may begin decades before the appearance of the first symptoms. Therefore, for the prevention, it is important to target risk factors leading to the onset of cognitive decline and dementia, long before the damage is substantial.
The Finnish Geriatric Intervention Study to prevent cognitive impairment and disability (FINGER), targeted individuals aged 60-77 years at-risk for dementia from the general population through a multidomain lifestyle intervention. The multidomain lifestyle intervention consisted of diet, physical activity, cognitive training and monitoring of vascular and metabolic risk factors. The primary results have reported beneficial intervention effects on cognition and several other related outcomes. Stephen’s thesis aimed at studying FINGER intervention effects on the brain structure based on MRI data.
Individuals with higher brain volumes and cortical thickness at the intervention baseline, had more intervention-related cognitive benefits. This signifies the importance of starting preventive interventions early before substantial brain changes have occurred. The intervention seemed to have effects on brain white matter microstructure accompanied by improvement in cognition. Overall, changes in brain volumes and cortical thickness were not very pronounced during 2 years in this at-risk population without dementia or substantial impairment, and no statistically significant differences were observed between the intervention and control groups.
In the FINGER study, dementia risk was assessed using the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk score, based on age, sex, education, body mass index, blood pressure, cholesterol, and physical activity. Higher CAIDE dementia risk score earlier in life, before the FINGER intervention, was associated with more pronounced white matter lesions, markers of brain atrophy and lower cognition in late life. A reduction in the CAIDE risk score during the FINGER intervention was associated with beneficial effects on brain structure (less pronounced decline in hippocampus volume).
More prevention trials having longitudinal MRI data and larger neuroimaging sample sizes are essential to verify these findings and to understand the effects of healthy lifestyle management on brain structure. Encouraging results from the FINGER trial have led to the establishment of the World-Wide FINGERS (WW-FINGERS)- global network of dementia prevention trials, where the FINGER model is being adapted by different countries across the globe. These trials are planned in several European countries expanding up to the USA, Canada, China, Singapore, Australia, Japan, India, and Latin-American countries.
Findings from the FINGER brain MRI sub-study provide an example for integrating MRI outcomes into such a complex large-scale trial network, and present hypotheses that can be substantiated or refuted in upcoming trials. It is also crucial to study long-term intervention effects on brain structure, which will guide selection of most effective strategies in most appropriate persons, a step forward to the goal of dementia prevention at a population level.
The doctoral dissertation of Ruth Stephen, Master of Public Health, entitled The Finnish Geriatric Intervention Study to prevent cognitive impairment and disability (FINGER): findings from the structural brain MRI sub-study, will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Professor Robert Perneczky of Ludwig-Maximilians-Universität (LMU) München, and the Custos will be Associate Professor Alina Solomon of the University of Eastern Finland. The public examination will be held in English at Kuopio Campus, Medistudia Auditorium MS300, on 31 July 2020 starting at 12 noon.
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The public examination will be streamed and can be followed at the following address: https://stream.lifesizecloud.com/extension/4449839/c8879e85-aef4-4883-8b1f-19588a858292