An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial

Henry Brodaty¹, Tiffany Chau², Megan Heffernan², Jeewani A Ginige³, Gavin Andrews⁴, Michael Millard⁴, Perminder S Sachdev², Kaarin J Anstey^{5

6

7}, Nicola T Lautenschlager^{8

9}, John J McNeil¹⁰, Louisa Jorm¹¹, Nicole A Kochan², Anthony Maeder¹², Heidi Welberry¹¹, Juan Carlo San Jose^{13

2}, Nancy E Briggs¹⁴, Gordana Popovic¹⁴, Yorgi Mavros^{15

16}, Carolina Almendrales Rangel¹⁵, Yian Noble¹⁵, Sue Radd-Vagenas¹⁵, Victoria M Flood^{15

17}, Fiona O'Leary^{18

19}, Amit Lampit⁸, Courtney C Walton²⁰, Polly Barr²¹, Maria Fiatarone Singh^#^{15

22

23}, Michael Valenzuela^#²

Affiliations

¹ Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia. h.brodaty@unsw.edu.au.
² Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia.
³ School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, New South Wales, Australia.
⁴ Clinical Research Unit for Anxiety and Depression, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia.
⁵ School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia.
⁶ UNSW Ageing Futures Institute, UNSW Sydney, Sydney, New South Wales, Australia.
⁷ Neuroscience Research Australia, Sydney, New South Wales, Australia.
⁸ Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.
⁹ Royal Melbourne Hospital Mental Health Services, Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹⁰ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹¹ Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
¹² College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
¹³ Research Technology Services (ResTech), UNSW Sydney, Sydney, New South Wales, Australia.
¹⁴ Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, New South Wales, Australia.
¹⁵ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁶ Heat and Health Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Noth South Wales, Australia.
¹⁷ University Centre for Rural Health, Northern Rivers, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁸ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁹ The Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
²⁰ Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
²¹ School of Psychological Science, University of Bristol, Bristol, UK.
²² Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
²³ Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

^# Contributed equally.

PMID: 39875685
DOI: 10.1038/s41591-024-03351-6

Randomized Controlled Trial

An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial

Henry Brodaty et al. Nat Med. 2025 Feb.

. 2025 Feb;31(2):565-573.

doi: 10.1038/s41591-024-03351-6. Epub 2025 Jan 28.

Authors

Affiliations

¹ Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia. h.brodaty@unsw.edu.au.
² Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia.
³ School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, New South Wales, Australia.
⁴ Clinical Research Unit for Anxiety and Depression, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia.
⁵ School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia.
⁶ UNSW Ageing Futures Institute, UNSW Sydney, Sydney, New South Wales, Australia.
⁷ Neuroscience Research Australia, Sydney, New South Wales, Australia.
⁸ Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.
⁹ Royal Melbourne Hospital Mental Health Services, Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹⁰ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹¹ Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia.
¹² College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
¹³ Research Technology Services (ResTech), UNSW Sydney, Sydney, New South Wales, Australia.
¹⁴ Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, New South Wales, Australia.
¹⁵ School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁶ Heat and Health Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Noth South Wales, Australia.
¹⁷ University Centre for Rural Health, Northern Rivers, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁸ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
¹⁹ The Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
²⁰ Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
²¹ School of Psychological Science, University of Bristol, Bristol, UK.
²² Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
²³ Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

^# Contributed equally.

PMID: 39875685
DOI: 10.1038/s41591-024-03351-6

Abstract

Effective, scalable dementia prevention interventions are needed to address modifiable risk factors given global burden of dementia and challenges in developing disease-modifying treatments. A single-blind randomized controlled trial assessed an online multidomain lifestyle intervention to prevent cognitive decline over 3 years. Participants were dementia-free community-dwelling Australians aged 55-77 years with modifiable dementia risk factors. Eligible participants (n = 6,104, 64% female) were randomized 1:1 to a personalized schedule of online coaching in two to four modules (targeting physical activity, nutrition, cognitive activity and depression or anxiety) or a control group that received module-eligible information only. At 3 years, the mean change in a global cognitive composite, the primary outcome, was met. The mean changes in z scores were 0.28 (95% confidence interval (CI): 0.25-0.32) for intervention, 0.10 (95% CI: 0.07-0.13) for control and 0.18 (95% CI: 0.13-0.23, P < 0.001) for the between-group difference. Trial-related adverse events occurred in 19 (0.60%) intervention and 1 (0.03%) control participant. Randomization of this internet-delivered lifestyle intervention tailored to individual dementia risk factors resulted in significantly better cognition in older adults over 3 years. This intervention is scalable with the potential for population-level rollout that may delay cognitive decline in the general community. Australian New Zealand ClinicalTrials.gov registration: ACTRN12618000851268.

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Conflict of interest statement

Competing interests: H.B. has been an advisory board member or consultant to Biogen, Eisai, Eli Lilly, Medicines Australia, Roche, Skin2Neuron Pty, Cranbrook Care and Montefiore Homes. P.S.S. was a member of expert panels for Biogen and Roche in 2020 and 2021. M.V. has a financial interest in and is cofounder and CEO of Skin2Neuron Pty, unrelated to this work. The other authors declare no competing interests.

References

1. World Health Organization. Global status report on the public health response to dementia. www.who.int/publications/i/item/9789240033245 (2021).
1. Kivipelto, M., Mangialasche, F. & Ngandu, T. Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nat. Rev. Neurol. 14, 653–666 (2018). - PubMed
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association, 2013).
1. World Health Organization. International Classification of Diseases, 11th Revision (ICD-11) (World Health Organization, 2019).
1. Livingston, G. et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 396, 413–446 (2020). - PubMed - PMC

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An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial

Affiliations

An online multidomain lifestyle intervention to prevent cognitive decline in at-risk older adults: a randomized controlled trial

Authors

Affiliations

Abstract

Conflict of interest statement

References

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LinkOut - more resources

Full Text Sources

Medical

Miscellaneous