Work Package 1: FINGER-NL lifestyle intervention

Findings from observational studies have linked several vascular and lifestyle-related risk factors such as diet and exercise with increased risk of late-life cognitive impairment. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was the first randomised controlled trial to evaluate a multi-modal lifestyle intervention to prevent cognitive decline. FINGER simultaneously targeted four lifestyle domains (physical activity, cognitive training, dietary counselling and cardiovascular risk management) and showed a positive effect on the cognitive composite primary outcome measure.

Inspired by the positive results in FINGER, World-Wide FINGERS (WW-FINGERS) is a global effort to extend the original findings around the globe, while simultaneously optimizing the intervention under local circumstances. Additional lifestyle domains that may benefit cognition are sleep and stress management. Souvenaid is a medical food that has shown a positive effect on cognition in individuals with mild cognitive impairment, and might benefit cognitively normal individuals as well.  Finally, the social aspect may be of particular relevance to maintaining brain health.

The primary objective of FINGER-NL is therefore to investigate the efficacy of an optimized personalised 2-year multi-domain lifestyle intervention on cognitive performance in older adults at risk of cognitive decline.

Design / methods

FINGER-NL is a multi-centre, randomized, controlled, multi-domain lifestyle intervention trial among 1,206 older adults at risk for cognitive decline with a duration of 24 months. Participants are randomized in a 1:1 ratio to a personalized multi-domain lifestyle intervention of high versus low intensity. The intervention targets physical activity, cognitive engagement, cardiovascular risk factors, diet, sleep, stress, and social activities, but with different intensities in both arms. The study is conducted in five study centres (Amsterdam, Maastricht, Wageningen, Groningen, Nijmegen). Outcome assessments for both groups are scheduled at study start, 12 months and 24 months. For recruitment, we leverage the online platform hersenonderzoek.nl.

Societal relevance of outcomes

Population ageing brings significant challenges to our society. With increasing age, the prevalence of debilitating neurodegenerative diseases, like dementia, increases as well. In 2018, 50 million people worldwide were living with dementia and it has been estimated that this number will reach 152 million in 2050. Up to 40% of dementia cases worldwide are estimated to be attributable to twelve modifiable factors (including midlife hypertension, midlife obesity, physical inactivity, and low social contact), providing opportunities for prevention. Therefore, preventing or delaying the onset of cognitive decline and dementia currently has utmost priority. The worldwide Covid-19 crisis has shown both the necessity and the opportunities of online interventions. The main rationale of FINGER-NL is that simultaneously targeting several modifiable risk factors (even with a small effect) over a longer period of time will have a protective effect on cognitive functioning.

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