Maintain Your Brain

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Dementia affects approximately 44 million people worldwide and by 2050, as the population ages, the prevalence of dementia is set to triple. Globally, it is a leading cause of disability with costs estimated to be more than 600 billion dollars and over the next forty years, these costs are projected to exceed those of all other chronic diseases.

Alzheimer's disease (AD) is the major cause of dementia accounting for over 50% of cases. Available medicines reduce symptom progression but do not alter progression of the disease. In the absence of available disease-modifying drugs, a shift toward delaying onset and possible prevention of AD has gained momentum. Modifiable risk factors account for up to a third of all AD cases.

As dementia is primarily a disease of late-life, delaying the onset by targeting these modifiable risk factors can have a major impact on AD rates. Postponing onset by even two years could reduce AD prevalence by up to 20% and a 5-year delay could potentially halve AD prevalence. Interventions geared at reducing modifiable risk factors would result in significant impacts on worldwide prevalence.

The program is based on addressing modifiable risk factors for dementia in general and AD in particular, namely physical inactivity, cognitive inactivity, depression, overweight and obesity, diabetes (type 2), high blood pressure and smoking. Our intervention modules will be customised to individual risk profiles using modified tools developed by our team to assess the risk of developing AD and dementia.

Our aim is to determine the efficacy of a multi-modal targeted intervention delivered on the internet to reduce the rate of cognitive decline in non-demented community dwelling persons aged 55-75 years and in the long-term to delay the onset of dementia. We will examine the cost-effectiveness of the program with a view to making this a national and potentially a globally suitable program.

How will we do this?

We will invite 18,000 people from the 150,000 persons aged 55-75 years who are participants in the 45 and Up Study and meet our eligibility criteria. The 45 and Up Study is a long-term study of over a quarter of million people in NSW who were aged 45 or older when the study was started between 2006 and 2009; they are surveyed every few years.

The Intervention

Participants agreeing to be in trial will be screened, asked to complete a risk factor profile and then randomised into two groups. The Intervention group will be emailed a recommended menu of intervention modules tailored to individuals based on their risks. Modules will be completed in 3 monthly blocks. There will be automated weekly monitoring and reminders for non-completion. After completing module 1 at end of first 3 months, participants will be enrolled in further modules as indicated each 3 months. Modules will build sequentially over first 12 months. After each module is completed participants will receive boosters at 2 weeks and then monthly. Participants requiring medical treatment will be asked to see their GP. Participants will be asked to provide data from those visits. Participants will be expected to complete at least 2 modules (unless only one is indicated).

Modules comprise a tailored graded physical exercise program, computerised cognitive training, dietary advice, control of blood pressue and cholesterol (in conjunction with the participant's GP), exercise and diet to alleviate type 2 diabetes and reduce obesity, advice and helplines to stop smoking, advice about reducing alcohol excess, internet delivered cognitive behaviour therapy for depression and socialisation starting with internet buddies and virtual groups.

Control Group

Participants randomised to the control group will be emailed information about risk factors and how to minimise them and sent annual reminders including tips for exercise, cognitive stimulation, socialisation, diet and health checks. If they require medical treatment based on our screening, control participants will be asked to see their GP for management.

The Technology

e-Health is coming of age and will be key to helping people change their lifestyle and maintain these changes. As most people are internet connected we can employ new-state-of-the-art tools for internet and mobile device logging for behaviours, tracking of goal achievement, provision of feedback in real time, access to expert help lines and virtual and actual on-line trainers, creation of an online MYB community to offer additional support. We will monitor actual physical activity with mobile devices which sync to movement tracking devices or pedometers in 10% of the sample.

Outcomes

Most outcome measures will be reassessed annually for intervention and control participants. The primary outcome will be a computerised cognitive testing tool supplemented by more detailed examination if dementia is suspected. Secondary outcomes will reduction in dementia risk scores (e.g. depression, waistline, blood pressure and cholesterol - depending on individual risks), self-rated memory, self-reported exercise (with objective measures in sub-sample), self-reported diet, weight, BMI, depression and well-being, socialisation and use of health services.

The Study Team

Twenty specialists from around Australia, led by Scientia Professor Henry Brodaty from CHeBA at UNSW, includes experts in exercise, cognitive training, diet, IT platform design, general practice, research design and prevention, hypertension and depression and consumer representation. Ita Buttrose is the patron for the study.

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