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A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature264224
Source
Lancet. 2015 Jun 6;385(9984):2255-63
Publication Type
Article
Date
Jun-6-2015
Author
Tiia Ngandu
Jenni Lehtisalo
Alina Solomon
Esko Levälahti
Satu Ahtiluoto
Riitta Antikainen
Lars Bäckman
Tuomo Hänninen
Antti Jula
Tiina Laatikainen
Jaana Lindström
Francesca Mangialasche
Teemu Paajanen
Satu Pajala
Markku Peltonen
Rainer Rauramaa
Anna Stigsdotter-Neely
Timo Strandberg
Jaakko Tuomilehto
Hilkka Soininen
Miia Kivipelto
Source
Lancet. 2015 Jun 6;385(9984):2255-63
Date
Jun-6-2015
Language
English
Publication Type
Article
Keywords
Aged
Cognition Disorders - epidemiology - prevention & control
Diet
Double-Blind Method
Exercise
Exercise Therapy
Humans
Male
Middle Aged
Neuropsychological Tests
Risk assessment
Vascular Diseases - epidemiology - prevention & control
Abstract
Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), a proof-of-concept randomised controlled trial, we aimed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population.
In a double-blind randomised controlled trial we enrolled individuals aged 60-77 years recruited from previous national surveys. Inclusion criteria were CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age. We randomly assigned participants in a 1:1 ratio to a 2 year multidomain intervention (diet, exercise, cognitive training, vascular risk monitoring), or a control group (general health advice). Computer-generated allocation was done in blocks of four (two individuals randomly allocated to each group) at each site. Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation. The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery (NTB) Z score. Analysis was by modified intention to treat (all participants with at least one post-baseline observation). This trial is registered at ClinicalTrials.gov, number NCT01041989.
Between Sept 7, 2009, and Nov 24, 2011, we screened 2654 individuals and randomly assigned 1260 to the intervention group (n=631) or control group (n=629). 591 (94%) participants in the intervention group and 599 (95%) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis. Estimated mean change in NTB total Z score at 2 years was 0·20 (SE 0·02, SD 0·51) in the intervention group and 0·16 (0·01, 0·51) in the control group. Between-group difference in the change of NTB total score per year was 0·022 (95% CI 0·002-0·042, p=0·030). 153 (12%) individuals dropped out overall. Adverse events occurred in 46 (7%) participants in the intervention group compared with six (1%) participants in the control group; the most common adverse event was musculoskeletal pain (32 [5%] individuals for intervention vs no individuals for control).
Findings from this large, long-term, randomised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population.
Academy of Finland, La Carita Foundation, Alzheimer Association, Alzheimer's Research and Prevention Foundation, Juho Vainio Foundation, Novo Nordisk Foundation, Finnish Social Insurance Institution, Ministry of Education and Culture, Salama bint Hamdan Al Nahyan Foundation, Axa Research Fund, EVO funding for University Hospitals of Kuopio, Oulu, and Turku and for Seinäjoki Central Hospital and Oulu City Hospital, Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare, and af Jochnick Foundation.
Notes
Comment In: Nat Rev Neurol. 2015 May;11(5):24825799934
PubMed ID
25771249 View in PubMed
Less detail

Associations of CAIDE Dementia Risk Score with MRI, PIB-PET measures, and cognition.

https://arctichealth.org/en/permalink/ahliterature291154
Source
J Alzheimers Dis. 2017; 59(2):695-705
Publication Type
Journal Article
Observational Study
Date
2017
Author
Ruth Stephen
Yawu Liu
Tiia Ngandu
Juha O Rinne
Nina Kemppainen
Riitta Parkkola
Tiina Laatikainen
Teemu Paajanen
Tuomo Hänninen
Timo Strandberg
Riitta Antikainen
Jaakko Tuomilehto
Sirkka Keinänen Kiukaanniemi
Ritva Vanninen
Seppo Helisalmi
Esko Levälahti
Miia Kivipelto
Hilkka Soininen
Alina Solomon
Author Affiliation
Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.
Source
J Alzheimers Dis. 2017; 59(2):695-705
Date
2017
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Adult
Aged
Aniline Compounds
Brain - diagnostic imaging
Cognition - physiology
Dementia - diagnostic imaging - pathology - physiopathology
Female
Finland - epidemiology
Geriatric Assessment
Humans
Longitudinal Studies
Magnetic Resonance Imaging
Male
Middle Aged
Neuropsychological Tests
Positron-Emission Tomography
Thiazoles
Abstract
CAIDE Dementia Risk Score is the first validated tool for estimating dementia risk based on a midlife risk profile.
This observational study investigated longitudinal associations of CAIDE Dementia Risk Score with brain MRI, amyloid burden evaluated with PIB-PET, and detailed cognition measures.
FINGER participants were at-risk elderly without dementia. CAIDE Risk Score was calculated using data from previous national surveys (mean age 52.4 years). In connection to baseline FINGER visit (on average 17.6 years later, mean age 70.1 years), 132 participants underwent MRI scans, and 48 underwent PIB-PET scans. All 1,260 participants were cognitively assessed (Neuropsychological Test Battery, NTB). Neuroimaging assessments included brain cortical thickness and volumes (Freesurfer 5.0.3), visually rated medial temporal atrophy (MTA), white matter lesions (WML), and amyloid accumulation.
Higher CAIDE Dementia Risk Score was related to more pronounced deep WML (OR 1.22, 95% CI 1.05-1.43), lower total gray matter (ß-coefficient -0.29, p?=?0.001) and hippocampal volume (ß-coefficient -0.28, p?=?0.003), lower cortical thickness (ß-coefficient -0.19, p?=?0.042), and poorer cognition (ß-coefficients -0.31 for total NTB score, -0.25 for executive functioning, -0.33 for processing speed, and -0.20 for memory, all p?
Notes
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PubMed ID
28671114 View in PubMed
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The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): study design and progress.

https://arctichealth.org/en/permalink/ahliterature117117
Source
Alzheimers Dement. 2013 Nov;9(6):657-65
Publication Type
Article
Date
Nov-2013
Author
Miia Kivipelto
Alina Solomon
Satu Ahtiluoto
Tiia Ngandu
Jenni Lehtisalo
Riitta Antikainen
Lars Bäckman
Tuomo Hänninen
Antti Jula
Tiina Laatikainen
Jaana Lindström
Francesca Mangialasche
Aulikki Nissinen
Teemu Paajanen
Satu Pajala
Markku Peltonen
Rainer Rauramaa
Anna Stigsdotter-Neely
Timo Strandberg
Jaakko Tuomilehto
Hilkka Soininen
Author Affiliation
Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Aging Research Center, Karolinska Institutet, Stockholm, Sweden; Alzheimer's Disease Research Center, Karolinska Institutet, Stockholm, Sweden. Electronic address: miia.kivipelto@ki.se.
Source
Alzheimers Dement. 2013 Nov;9(6):657-65
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Aged
Cognitive Therapy
Community Health Planning
Disabled Persons - rehabilitation
Exercise
Female
Finland - epidemiology
Geriatrics
Humans
Interpersonal Relations
Intervention Studies
Life Style
Male
Middle Aged
Mild Cognitive Impairment - diagnosis - epidemiology - prevention & control
Neuropsychological Tests
Nutrition Policy
Outcome Assessment (Health Care)
Abstract
Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a multi-center, randomized, controlled trial ongoing in Finland.
Participants (1200 individuals at risk of cognitive decline) are recruited from previous population-based non-intervention studies. Inclusion criteria are CAIDE Dementia Risk Score =6 and cognitive performance at the mean level or slightly lower than expected for age (but not substantial impairment) assessed with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery. The 2-year multidomain intervention consists of: nutritional guidance; exercise; cognitive training and social activity; and management of metabolic and vascular risk factors. Persons in the control group receive regular health advice. The primary outcome is cognitive performance as measured by the modified Neuropsychological Test Battery, Stroop test, and Trail Making Test. Main secondary outcomes are: dementia (after extended follow-up); disability; depressive symptoms; vascular risk factors and outcomes; quality of life; utilization of health resources; and neuroimaging measures.
Screening began in September 2009 and was completed in December 2011. All 1200 persons are enrolled and the intervention is ongoing as planned. Baseline clinical characteristics indicate that several vascular risk factors and unhealthy lifestyle-related factors are present, creating a window of opportunity for prevention. The intervention will be completed during 2014.
The FINGER is at the forefront of international collaborative efforts to solve the clinical and public health problems of early identification of individuals at increased risk of late-life cognitive impairment, and of developing intervention strategies to prevent or delay the onset of cognitive impairment and dementia.
PubMed ID
23332672 View in PubMed
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Genetic loci associated with Alzheimer's disease and cerebrospinal fluid biomarkers in a Finnish case-control cohort.

https://arctichealth.org/en/permalink/ahliterature114855
Source
PLoS One. 2013;8(4):e59676
Publication Type
Article
Date
2013
Author
Lyzel S Elias-Sonnenschein
Seppo Helisalmi
Teemu Natunen
Anette Hall
Teemu Paajanen
Sanna-Kaisa Herukka
Marjo Laitinen
Anne M Remes
Anne M Koivisto
Kari M Mattila
Terho Lehtimäki
Frans R J Verhey
Pieter Jelle Visser
Hilkka Soininen
Mikko Hiltunen
Author Affiliation
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
Source
PLoS One. 2013;8(4):e59676
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - cerebrospinal fluid - genetics
Amyloid beta-Peptides - cerebrospinal fluid
Apolipoprotein E4 - genetics
Biological Markers - cerebrospinal fluid
Case-Control Studies
Clusterin - genetics
Female
Finland
Genetic Loci
Genetic Predisposition to Disease
Genome-Wide Association Study
Humans
Logistic Models
Male
Membrane Proteins - genetics
Middle Aged
Peptide Fragments - cerebrospinal fluid
Phosphorylation
Polymorphism, Single Nucleotide
Protein Processing, Post-Translational
Risk factors
tau Proteins - cerebrospinal fluid
Abstract
To understand the relation between risk genes for Alzheimer's disease (AD) and their influence on biomarkers for AD, we examined the association of AD in the Finnish cohort with single nucleotide polymorphisms (SNPs) from top AlzGene loci, genome-wide association studies (GWAS), and candidate gene studies; and tested the correlation between these SNPs and AD markers A?(1-42), total tau (t-tau), and phosphorylated tau (p-tau) in cerebrospinal fluid (CSF).
We tested 25 SNPs for genetic association with clinical AD in our cohort comprised of 890 AD patients and 701-age matched healthy controls using logistic regression. For the correlational study with biomarkers, we tested 36 SNPs in a subset of 222 AD patients with available CSF using mixed models. Statistical analyses were adjusted for age, gender and APOE status. False discovery rate for multiple testing was applied. All participants were from academic hospital and research institutions in Finland.
APOE-e4, CLU rs11136000, and MS4A4A rs2304933 correlated with significantly decreased A?(1-42) (corrected p0.05).
We provide evidence that APOE-e4, CLU and MS4A4A, which have been identified in GWAS to be associated with AD, also significantly reduced CSF A?1-42 in AD. None of the other AlzGene and GWAS loci showed significant effects on CSF tau. The effects of other SNPs on CSF biomarkers and clinical AD diagnosis did not reach statistical significance. Our findings suggest that APOE-e4, CLU and MS4A4A influence both AD risk and CSF A?1-42.
Notes
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PubMed ID
23573206 View in PubMed
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Recruitment and baseline characteristics of participants in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)-a randomized controlled lifestyle trial.

https://arctichealth.org/en/permalink/ahliterature266334
Source
Int J Environ Res Public Health. 2014 Sep;11(9):9345-60
Publication Type
Article
Date
Sep-2014
Author
Tiia Ngandu
Jenni Lehtisalo
Esko Levälahti
Tiina Laatikainen
Jaana Lindström
Markku Peltonen
Alina Solomon
Satu Ahtiluoto
Riitta Antikainen
Tuomo Hänninen
Antti Jula
Francesca Mangialasche
Teemu Paajanen
Satu Pajala
Rainer Rauramaa
Timo Strandberg
Jaakko Tuomilehto
Hilkka Soininen
Miia Kivipelto
Source
Int J Environ Res Public Health. 2014 Sep;11(9):9345-60
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Aged
Cognition
Cognition Disorders - etiology - prevention & control
Demography
Female
Finland
Health status
Humans
Intervention Studies
Life Style
Male
Middle Aged
Neuropsychological Tests
Risk factors
Abstract
Our aim is to describe the study recruitment and baseline characteristics of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study population. Potential study participants (age 60-77 years, the dementia risk score = 6) were identified from previous population-based survey cohorts and invited to the screening visit. To be eligible, cognitive performance measured at the screening visit had to be at the mean level or slightly lower than expected for age. Of those invited (n = 5496), 48% (n = 2654) attended the screening visit, and finally 1260 eligible participants were randomized to the intervention and control groups (1:1). The screening visit non-attendees were slightly older, less educated, and had more vascular risk factors and diseases present. The mean (SD) age of the randomized participants was 69.4 (4.7) years, Mini-Mental State Examination 26.7 (2.0) points, systolic blood pressure 140.1 (16.2) mmHg, total serum cholesterol 5.2 (1.0) mmol/L for, and fasting glucose 6.1 (0.9) mmol/L for, with no difference between intervention and control groups. Several modifiable risk factors were present at baseline indicating an opportunity for the intervention. The FINGER study will provide important information on the effect of lifestyle intervention to prevent cognitive impairment among at risk persons.
Notes
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PubMed ID
25211775 View in PubMed
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