Around a third of late onset dementia is attributable to seven risk factors, including diabetes, hypertension, obesity and physical inactivity.2 Hence there is great opportunity for comprehensive lifestyle intervention to reduce dementia incidence.3
The fact that only 10-30% of people with Alzheimer’s dementia have “pure” Alzheimer’s pathology is also in a way encouraging, since it again suggests the promise of intervention against more modifiable risk factors.4
Lifestyle intervention benefits cognition, overall health, and even the telomere
In addition to the 25% improvement on the primary cognition endpoint, the multidomain intervention in FINGER led to 30% lower risk of functional decline (in Independent Activities of Daily Living) and better health related quality of life than among controls who received standard health advice.5 The risk of developing multiple morbidities and of hospitalization was also reduced.
Perhaps most remarkably, the FINGER intervention reduced the shortening of telomeres among APOE4 carriers. Professor Kivipelto also mentioned preliminary evidence that the intervention was cost-effective.
Finnish FINGERS extend worldwide
As testament to the importance of these findings, around thirty countries are now involved in a global collaboration as part of the World-Wide FINGERS network, which aims to extend and generalize the multidomain intervention approach that was pioneered in Finland.
The initiative acknowledges that countries with divergent populations will want to organize their own studies and ask their own questions, but it also recognizes the benefits that flow from a degree of harmonization in the interventions used, the outcomes measured, methods of analysis, and data sharing.
The initiative also supports a biorepository to further the study of biomarkers in CSF and blood, genetics, brain imaging, and the microbiome.
Future prevention efforts will combine pharmacological and lifestyle approaches
Combined lifestyle and pharmacological intervention
The future of prevention, as foreseen by Professor Kivipelto, is one in which risk of dementia -- which we know to be multifactorial in origin -- is tackled through comprehensive intervention. This would be composed of multidomain lifestyle intervention together with a cocktail of disease modifying drugs covering amyloid and tau, neurotransmitter modulators, neuroprotective agents, and those targeting dementia risk factors.
As a modest start towards this goal, the phase 2b proof-of-concept MET-Finger-APOE trial now being planned would involve personalized lifestyle intervention in a high-risk group plus the trial of a drug repurposed from the diabetes arena.