Cited by 124Dementia and Cognitive Impairment ResearchCognitive Abilities and TestingPharmaceutical Practices and Patient Outcomes

The DOI matches its Crossref record; 127 of the 128 references it cites were found in a registry or an index.

Multi-domain interventions for the prevention of dementia and cognitive decline

Open access
Hafdi, Melanie, Hoevenaar-Blom, Marieke P., Richard, Edo·2021·Cochrane Database of Systematic Reviews

Abstract

BACKGROUND: Dementia is a worldwide concern. Its global prevalence is increasing. Currently, no effective medical treatment exists to cure or to delay the onset of cognitive decline or dementia. Up to 40% of dementia is attributable to potentially modifiable risk factors, which has led to the notion that targeting these risk factors might reduce the incidence of cognitive decline and dementia. Since sporadic dementia is a multifactorial condition, thought to derive from multiple causes and risk factors, multi-domain interventions may be more effective for the prevention of dementia than those targeting single risk factors. OBJECTIVES: To assess the effects of multi-domain interventions for the prevention of cognitive decline and dementia in older adults, including both unselected populations and populations at increased risk of cognitive decline and dementia. SEARCH METHODS: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), and ClinicalTrials.gov on 28 April 2021. We also reviewed citations of reference lists of included studies, landmark papers, and review papers to identify additional studies and assessed their suitability for inclusion in the review. SELECTION CRITERIA: We defined a multi-domain intervention as an intervention with more than one component, pharmacological or non-pharmacological, but not consisting only of two or more drugs with the same therapeutic target. We included randomised controlled trials (RCTs) evaluating the effect of such an intervention on cognitive functioning and/or incident dementia. We accepted as control conditions any sham intervention or usual care, but not single-domain interventions intended to reduce dementia risk. We required studies to have a minimum of 400 participants and an intervention and follow-up duration of at least 12 months. DATA COLLECTION AND ANALYSIS: We initially screened search results using a 'crowdsourcing' method in which members of Cochrane's citizen science platform identify RCTs. We screened the identified citations against inclusion criteria by two review authors working independently. At least two review authors also independently extracted data, assessed the risk of bias and applied the GRADE approach to assess the certainty of evidence. We defined high-certainty reviews as trials with a low risk of bias across all domains other than blinding of participants and personnel involved in administering the intervention (because lifestyle interventions are difficult to blind). Critical outcomes were incident dementia, incident mild cognitive impairment (MCI), cognitive decline measured with any validated measure, and mortality. Important outcomes included adverse events (e.g. cardiovascular events), quality of life, and activities of daily living (ADL). Where appropriate, we synthesised data in random-effects meta-analyses. We expressed treatment effects as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). MAIN RESULTS: We included nine RCTs (18.452 participants) in this review. Two studies reported incident dementia as an outcome; all nine studies reported a measure for cognitive functioning. Assessment of cognitive functioning was very heterogeneous across studies, ranging from complete neuropsychological assessments to short screening tests such as the mini-mental state examination (MMSE). The duration of the interventions varied from 12 months to 10 years. We compared multi-domain interventions against usual care or a sham intervention. Positive MDs and RRs <1 favour multi-domain interventions over control interventions. For incident dementia, there was no evidence of a difference between the multi-domain intervention group and the control group (RR 0.94, 95% CI 0.76 to 1.18; 2 studies; 7256 participants; high-certainty evidence). There was a small difference in composite Z-score for cognitive function measured with a neuropsychological test battery (NTB) (MD 0.03, 95% CI 0.01 to 0.06; 3 studies; 4617 participants; high-certainty evidence) and with the Montreal Cognitive Assessment (MoCA) scale (MD 0.76 point, 95% CI 0.05 to 1.46; 2 studies; 1554 participants), but the certainty of evidence for the MoCA was very low (due to serious risk of bias, inconsistency and indirectness) and there was no evidence of an effect on the MMSE (MD 0.02 point, 95% CI -0.06 to 0.09; 6 studies; 8697participants; moderate-certainty evidence). There was no evidence of an effect on mortality (RR 0.93, 95% CI 0.84 to 1.04; 4 studies; 11,487 participants; high-certainty evidence). There was high-certainty evidence for an interaction of the multi-domain i

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This Cochrane review assessed whether multi-domain interventions prevent cognitive decline and dementia in older adults, pooling nine RCTs (18,452 participants). It found no evidence of an effect on incident dementia, but a small improvement in cognitive function measured by a neuropsychological test battery, with the strongest effects in trials that included cognitive training.

Key findings

  • No evidence of a difference in incident dementia between multi-domain intervention and control groups (RR 0.94, 95% CI 0.76 to 1.18; 2 studies; 7256 participants; high-certainty evidence).
  • Small improvement in composite Z-score for cognitive function on a neuropsychological test battery (MD 0.03, 95% CI 0.01 to 0.06; 3 studies; 4617 participants; high-certainty evidence), and on the MoCA (MD 0.76 point, 95% CI 0.05 to 1.46; 2 studies; 1554 participants; very low-certainty evidence).
  • No evidence of an effect on MMSE (MD 0.02 point, 95% CI -0.06 to 0.09; 6 studies; 8697 participants; moderate-certainty evidence) or on mortality (RR 0.93, 95% CI 0.84 to 1.04; 4 studies; 11,487 participants; high-certainty evidence).
  • High-certainty evidence for an interaction with ApoE4 status on NTB cognitive function (carriers MD 0.14, 95% CI 0.04 to 0.25; noncarriers MD 0.04, 95% CI -0.02 to 0.10; P for interaction 0.09); no clear interaction with baseline MMSE (P for interaction 0.12) or clear effect in those with CAIDE score > 6 (MD 0.07, 95% CI -0.00 to 0.15).

Methods

  • Systematic review and random-effects meta-analysis of RCTs; multi-domain intervention defined as more than one component (pharmacological or non-pharmacological), excluding two or more drugs with the same therapeutic target; controls were sham intervention or usual care.
  • Searched ALOIS, MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, LILACS, and ClinicalTrials.gov on 28 April 2021; required ≥400 participants and ≥12 months intervention/follow-up.
  • Two review authors independently screened, extracted data, assessed risk of bias, and applied GRADE; effects expressed as risk ratios and mean differences with 95% CIs.

Limitations

  • Stated: incident dementia conclusions rest on only two trials; cognitive assessment was very heterogeneous (from full neuropsychological batteries to short screening tests); interventions varied in components and intensity; the NTB effect was strongest in trials offering cognitive training, making a learning effect difficult to rule out.
  • Stated: MoCA evidence was very low certainty due to serious risk of bias, inconsistency, and indirectness.
  • Evident from the text: intervention durations ranged widely (12 months to 10 years), and the review's conclusions on dementia prevention are limited by the small number of trials reporting that outcome.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/14651858.cd013572.pub2

Cites

127 of 127 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

13 Own result · 4 Own method · 2 Own interpretation · 1 No basis given

Show all 10 claims

  • It may state two separate claims as one. 2
  • The quote only partly states this claim. 1
  • Probably not a substantial claim. 7
10 of 10
  • The paper relies on this without support.

    Up to 40% of dementia is attributable to potentially modifiable risk factors.

    “Up to 40% of dementia is attributable to potentially modifiable risk factors”
  • The paper relies on this without support.

    Sporadic dementia is a multifactorial condition deriving from multiple causes and risk factors.

    “Since sporadic dementia is a multifactorial condition, thought to derive from multiple causes and risk factors”
  • The paper relies on this without support.

    Multi-domain interventions may be more effective for the prevention of dementia than interventions targeting single risk factors.

    “multi-domain interventions may be more effective for the prevention of dementia than those targeting single risk factors”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

1 retracted

Show all 128 references

Research works printed but not linked: 5

  1. Hayden, 2018, The action for health in diabetes clinical trial: does a 10-year intensive multidomain lifestyle intervention provide cognitive benefits?, Journal of Prevention of Alzheimer's Disease, Conference: 11t, S64
  2. Manfredi, 2013, Non-pharmacological treatment in cognitive decline: cognitive and behavioural outcomes, Behavioural Neurology, 27 (3), 373
  3. Solomon, 2018, Effects of a multidomain lifestyle intervention on overall risk for dementia: the Finger randomized controlled trial, Alzheimer's and Dementia, 14 (7 Supplemen, P1024
  4. Peters, 2013, Republished research: Implementation research: what it is and how to do it, BMJ, 347, 731
  5. Review Manager Web (RevMan Web) The Cochrane Collaboration 2021

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Metadata

Authors
Hafdi, M., Hoevenaar-Blom, M. P., & Richard, E.
Affiliations
  • Amsterdam University Medical Centers (NL)
  • Department of Public and Occupational Health; Amsterdam UMC, University of Amsterdam; Amsterdam Netherlands
  • Radboud University Nijmegen (NL)
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2021-11-08
Volume
2021
Issue
11
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
OpenAlex
W4200308390
Cited by
124
References
128
Citations by year
2026: 21 · 2025: 33 · 2024: 30 · 2023: 27 · 2022: 11 · 2021: 2
FWCI
3.13
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
dementia prevention, cognitive decline, multidomain intervention, older adults, mild cognitive impairment, dementia risk factors, lifestyle intervention, cognitive function, incident dementia, mortality, adverse events, cardiovascular events, risk of bias, quality of evidence, citizen science, non-pharmacological treatment, pharmacological interventions

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