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The Australian National University Alzheimer's Disease Risk Index (ANU-ADRI) score as a predictor for cognitive decline and potential surrogate outcome in the FINGER lifestyle randomized controlled trial.
Hall, A, Barbera, M, Lehtisalo, J, Antikainen, R, Huque, H, Laatikainen, T, Ngandu, T, Soininen, H, Stephen, R, Strandberg, T, et al
European journal of neurology. 2024;(5):e16238
Abstract
BACKGROUND AND PURPOSE The complex aetiology of Alzheimer's disease suggests prevention potential. Risk scores have potential as risk stratification tools and surrogate outcomes in multimodal interventions targeting specific at-risk populations. The Australian National University Alzheimer's Disease Risk Index (ANU-ADRI) was tested in relation to cognition and its suitability as a surrogate outcome in a multidomain lifestyle randomized controlled trial, in older adults at risk of dementia. METHODS In this post hoc analysis of the Finnish Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), ANU-ADRI was calculated at baseline, 12, and 24 months (n = 1174). The association between ANU-ADRI and cognition (at baseline and over time), the intervention effect on changes in ANU-ADRI, and the potential impact of baseline ANU-ADRI on the intervention effect on changes in cognition were assessed using linear mixed models with maximum likelihood estimation. RESULTS A higher ANU-ADRI was significantly related to worse cognition, at baseline (e.g., estimate for global cognition [95% confidence interval] was -0.028 [-0.032 to -0.025]) and over the 2-year study (e.g., estimate for 2-year changes in ANU-ADRI and per-year changes in global cognition [95% confidence interval] was -0.068 [-0.026 to -0.108]). No significant beneficial intervention effect was reported for ANU-ADRI, and baseline ANU-ADRI did not significantly affect the response to the intervention on changes in cognition. CONCLUSIONS The ANU-ADRI was effective for the risk prediction of cognitive decline. Risk scores may be crucial for the success of novel dementia prevention strategies, but their algorithm, the target population, and the intervention design should be carefully considered when choosing the appropriate tool for each context.
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A short history from Karelia study to biodiversity and public health interventions.
Haahtela, T, Alenius, H, Auvinen, P, Fyhrquist, N, von Hertzen, L, Jousilahti, P, Karisola, P, Laatikainen, T, Lehtimäki, J, Paalanen, L, et al
Frontiers in allergy. 2023;:1152927
Abstract
Contact with natural environments enriches the human microbiome, promotes immune balance and protects against allergies and inflammatory disorders. In Finland, the allergy & asthma epidemic became slowly visible in mid 1960s. After the World War II, Karelia was split into Finnish and Soviet Union (now Russia) territories. This led to more marked environmental and lifestyle changes in the Finnish compared with Russian Karelia. The Karelia Allergy Study 2002-2022 showed that allergic conditions were much more common on the Finnish side. The Russians had richer gene-microbe network and interaction than the Finns, which associated with better balanced immune regulatory circuits and lower allergy prevalence. In the Finnish adolescents, a biodiverse natural environment around the homes associated with lower occurrence of allergies. Overall, the plausible explanation of the allergy disparity was the prominent change in environment and lifestyle in the Finnish Karelia from 1940s to 1980s. The nationwide Finnish Allergy Programme 2008-2018 implemented the biodiversity hypothesis into practice by endorsing immune tolerance, nature contacts, and allergy health with favorable results. A regional health and environment programme, Nature Step to Health 2022-2032, has been initiated in the City of Lahti, EU Green Capital 2021. The programme integrates prevention of chronic diseases (asthma, diabetes, obesity, depression), nature loss, and climate crisis in the spirit of Planetary Health. Allergic diseases exemplify inappropriate immunological responses to natural environment. Successful management of the epidemics of allergy and other non-communicable diseases may pave the way to improve human and environmental health.
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Family socioeconomic status and childhood adiposity in Europe - A scoping review.
Sares-Jäske, L, Grönqvist, A, Mäki, P, Tolonen, H, Laatikainen, T
Preventive medicine. 2022;:107095
Abstract
Childhood obesity is a considerable public health problem worldwide. In Europe, lower parental socioeconomic status (SES) relates to higher childhood adiposity. This scoping review strives to discover, which SES indicators are the most commonly used and meaningful determinants of childhood adiposity (greater level of continuous adiposity indicator, e.g. body mass index z-score, or overweight or obesity categorized by established definitions). The review focused on studies about European general populations from the 21st century (January 2000-April 2021) considering children and adolescents aged 0-17 years. PubMed and reference lists of articles were searched in February-April 2021. Total of 53 studies with 121 association analyses between different SES indicators and adiposity indicators, were identified and reviewed. Different SES indicators were grouped to 25 indicators and further to six indicator groups. The most used indicator was mother's education (n of association analyses = 24) and the most used indicator group was parental education (n of association analyses = 51). Of all association analyses, 55% were inverse, 36% were non-significant, and 8% were positive. Composite SES (80%), parental education (69%) and parental occupation (64%) indicators showed most frequently inverse associations with obesity measures (i.e. lower parental SES associating with higher adiposity), while parental income (50% inverse; 50% non-significant) and property and affluence (42% inverse; 50% nonsignificant) indicators showed approximately even number of inverse and non-significant associations. Instead, majority of parental employment (60%) indicators, showed non-significant associations and 33% showed positive associations (i.e. higher parental SES associating with higher adiposity). Despite some variation in percentages, majority of the associations were inverse in each age group and with different outcome categorizations. In girls and in boys, non-significant associations predominated. It seems that children with parents of higher SES have lower likelihood of adiposity in Europe. Parents' employment appears to differ from other SES indicators, so that having an employed parent(s) does not associate with lower likelihood of adiposity. Positive associations seem to occur more frequently in poorer countries. Criteria for uniform childhood SES and adiposity measures should be established and used in studies in order to be able to produce comparable results across countries.
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The effect of adherence on cognition in a multidomain lifestyle intervention (FINGER).
Ngandu, T, Lehtisalo, J, Korkki, S, Solomon, A, Coley, N, Antikainen, R, Bäckman, L, Hänninen, T, Lindström, J, Laatikainen, T, et al
Alzheimer's & dementia : the journal of the Alzheimer's Association. 2022;(7):1325-1334
Abstract
INTRODUCTION Lifestyle interventions may prevent cognitive decline, but the sufficient dose of intervention activities and lifestyle changes is unknown. We investigated how intervention adherence affects cognition in the FINGER trial (pre-specified subgroup analyses). METHODS FINGER is a multicenter randomized controlled trial examining the efficacy of multidomain lifestyle intervention (ClinicalTrials.gov NCT01041989). A total of 1260 participants aged 60 to 77 with increased dementia risk were randomized to a lifestyle intervention and control groups. Percentage of completed intervention sessions, and change in multidomain lifestyle score (self-reported diet; physical, cognitive, and social activity; vascular risk) were examined in relation to change in Neuropsychological Test Battery (NTB) scores. RESULTS Active participation was associated with better trajectories in NTB total and all cognitive subdomains. Improvement in lifestyle was associated with improvement in NTB total and executive function. DISCUSSION Multidomain lifestyle changes are beneficial for cognitive functioning, but future interventions should be intensive enough, and supporting adherence is essential.
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Psychosocial determinants for adherence to a healthy lifestyle and intervention participation in the FINGER trial: an exploratory analysis of a randomised clinical trial.
Neuvonen, E, Lehtisalo, J, Solomon, A, Antikainen, R, Havulinna, S, Hänninen, T, Laatikainen, T, Lindström, J, Rautio, N, Soininen, H, et al
Aging clinical and experimental research. 2022;(8):1793-1805
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BACKGROUND AND AIMS Psychosocial factors may affect adherence to lifestyle interventions and lifestyle changes. The role of psychosocial factors in dementia prevention needs more research. We aimed at clarify the issue in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). METHODS The population included 1260 participants aged 60-77 years at risk for cognitive decline, randomised to a multidomain lifestyle intervention or regular health advice for 2 years. Adherence was evaluated as participation in the provided activities and actual lifestyle changes, separately for each domain (diet, exercise, social/cognitive activity, vascular risk management) and combined into multidomain. Psychosocial factors were measured at trial baseline (depressive symptoms; study perception; health-related quality of life, HRQoL) and earlier life (hopelessness; satisfaction with family life, achievements, and financial situation). RESULTS Depressive symptoms, hopelessness, and nonpositive study perception were negatively and HRQoL positively associated with participation in the multidomain intervention. Depressive symptoms, lower HRQoL, hopelessness and dissatisfaction with financial situation were associated with unhealthier lifestyles at baseline. Baseline depressive symptoms and lower HRQoL predicted less improvement in lifestyle, but did not modify the intervention effect on lifestyle change. DISCUSSION AND CONCLUSIONS Several psychosocial factors were associated with participation in lifestyle intervention, while fewer of them contributed to lifestyle changes. Although the intervention was beneficial for lifestyle changes independent of psychosocial factors, those most in need of lifestyle improvement were less likely to be active. Tailoring lifestyle-modifying strategies based on the need for psychosocial support may add efficacy in future trials. TRIAL REGISTRY ClinicalTrials.gov NCT01041989 2010-01-05.
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Effect of a multi-domain lifestyle intervention on cardiovascular risk in older people: the FINGER trial.
Lehtisalo, J, Rusanen, M, Solomon, A, Antikainen, R, Laatikainen, T, Peltonen, M, Strandberg, T, Tuomilehto, J, Soininen, H, Kivipelto, M, et al
European heart journal. 2022;43(21):2054-2061
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Older people are at high risk of cardiovascular disease, and 90% of the risk factors can be modified, including an unhealthy diet, poor physical activity, obesity, smoking, and obesity-related comorbidities. This randomised controlled trial examined a multifactorial approach combining several lifestyle modifications in 1259 older adults between 60 and 77 years of age to reduce the risk of cardiovascular disease. Participants were randomly assigned to intensive multi-domain lifestyle intervention or regular health advice control groups. The multifactorial lifestyle intervention incorporated dietary counselling, exercise training, cognitive training, and managing CVD and metabolic risk factors. Dietary interventions included tailored strategies that considered increased consumption of fruits, berries, vegetables, whole grains, margarine, oil, and fish. Physical exercise interventions included strength training, balance exercises, and aerobic exercises. Cognitive interventions and intensive strategies to manage metabolic factors were also implemented. In the multifactorial lifestyle intervention group, cerebrovascular events were lower after two years than in the control group. In addition, cardiovascular disease and stroke incidence were lower in the elderly with a history of cardiovascular disease. Healthcare professionals can use the results from this study to understand the benefits of multifactorial lifestyle interventions on cardiovascular disease. However, there is a need for longer-term robust studies since the evidence is sparse.
Abstract
AIMS: Joint prevention of cardiovascular disease (CVD) and dementia could reduce the burden of both conditions. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated a beneficial effect on cognition (primary outcome) and we assessed the effect of this lifestyle intervention on incident CVD (pre-specified secondary outcome). METHODS AND RESULTS FINGER enrolled 1259 individuals aged 60-77 years (ClinicalTrials.gov NCT01041989). They were randomized (1:1) to a 2-year multi-domain intervention with diet, physical and cognitive activity, and vascular monitoring (n = 631), or general health advice (n = 628). National registries provided data on CVD including stroke, transient ischaemic attack (TIA), or coronary heart event. During an average of 7.4 years, 229 participants (18%) had at least one CVD diagnosis: 107 in the intervention group and 122 in the control group. The incidence of cerebrovascular events was lower in the intervention than the control group: hazard ratio (HR) for combined stroke/TIA was 0.71 [95% confidence interval (CI): 0.51-0.99] after adjusting for background characteristics. Hazard ratio for coronary events was 0.84 (CI: 0.56-1.26) and total CVD events 0.80 (95% CI: 0.61-1.04). Among those with history of CVD (n = 145), the incidence of both total CVD events (HR: 0.50, 95% CI: 0.28-0.90) and stroke/TIA (HR: 0.40, 95% CI: 0.20-0.81) was lower in the intervention than the control group. CONCLUSION A 2-year multi-domain lifestyle intervention among older adults was effective in preventing cerebrovascular events and also total CVD events among those who had history of CVD.
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Occupational complexity and cognition in the FINGER multidomain intervention trial.
Rydström, A, Darin-Mattsson, A, Kåreholt, I, Ngandu, T, Lehtisalo, J, Solomon, A, Antikainen, R, Bäckman, L, Hänninen, T, Laatikainen, T, et al
Alzheimer's & dementia : the journal of the Alzheimer's Association. 2022;(12):2438-2447
Abstract
INTRODUCTION Lifetime exposure to occupational complexity is linked to late-life cognition, and may affect benefits of preventive interventions. METHODS In the 2-year multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we investigated, through post hoc analyses (N = 1026), the association of occupational complexity with cognition. Occupational complexity with data, people, and substantive complexity were classified through the Dictionary of Occupational Titles. RESULTS Higher levels of occupational complexity were associated with better baseline cognition. Measures of occupational complexity had no association with intervention effects on cognition, except for occupational complexity with data, which was associated with the degree of intervention-related gains for executive function. DISCUSSION In older adults at increased risk for dementia, higher occupational complexity is associated with better cognition. The cognitive benefit of the FINGER intervention did not vary significantly among participants with different levels of occupational complexity. These exploratory findings require further testing in larger studies.
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Change in CAIDE Dementia Risk Score and Neuroimaging Biomarkers During a 2-Year Multidomain Lifestyle Randomized Controlled Trial: Results of a Post-Hoc Subgroup Analysis.
Stephen, R, Ngandu, T, Liu, Y, Peltonen, M, Antikainen, R, Kemppainen, N, Laatikainen, T, Lötjönen, J, Rinne, J, Strandberg, T, et al
The journals of gerontology. Series A, Biological sciences and medical sciences. 2021;(8):1407-1414
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The CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Risk Score is a validated tool estimating dementia risk. It was previously associated with imaging biomarkers. However, associations between dementia risk scores (including CAIDE) and dementia-related biomarkers have not been studied in the context of an intervention. This study investigated associations between change in CAIDE score and change in neuroimaging biomarkers (brain magnetic resonance imaging [MRI] and Pittsburgh Compound B-positron emission tomography [PiB-PET] measures) during the 2-year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) (post-hoc analyses). FINGER targeted at-risk older adults, aged 60-77 years, from the general population. Participants were randomized to either multidomain intervention (diet, exercise, cognitive training, and vascular risk management) or control group (general health advice). Neuroimaging (MRI and PiB-PET) data from baseline and 2-year visits were used. A toal of 112 participants had repeated brain MRI measures (hippocampal, total gray matter, and white matter lesion volumes, and Alzheimer's disease signature cortical thickness). Repeated PiB-PET scans were available for 39 participants. Reduction in CAIDE score (indicating lower dementia risk) during the intervention was associated with less decline in hippocampus volume in the intervention group, but not the control group (Randomization group × CAIDE change interaction β coefficient = -0.40, p = .02). Associations for other neuroimaging measures were not significant. The intervention may have benefits on hippocampal volume in individuals who succeed in improving their overall risk level as indicated by a reduction in CAIDE score. This exploratory finding requires further testing and validation in larger studies.
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Long-term trends in blood pressure and hypertension in Russia: an analysis of data from 14 health surveys conducted in 1975-2017.
Churilova, E, Shkolnikov, VM, Shalnova, SA, Kudryavtsev, AV, Malyutina, S, Nilssen, O, Laatikainen, T, Leon, DA
BMC public health. 2021;(1):2226
Abstract
BACKGROUND Hypertension is recognized as an important contributor to high cardiovascular mortality in Russia. A comprehensive analysis of data from Russian studies that measured blood pressure in population-based samples has not been previously undertaken. This study aims to identify trends and patterns in mean blood pressure and the prevalence of hypertension in Russia over the most recent 40 years. METHODS We obtained anonymized individual records of blood pressure measurements from 14 surveys conducted in Russia in 1975-2017 relating to a total of 137,687 individuals. For comparative purposes we obtained equivalent data from 4 surveys in the USA and England for 23,864 individuals. A meta-regression on aggregated data adjusted for education was undertaken to estimate time trends in mean systolic and diastolic blood pressure, the prevalence of elevated blood pressure (> 140/90 mmHg), and hypertension (defined as elevated blood pressure and/or the use of blood pressure-lowering) medication. A meta-analysis of pooled individual-level data was used to assess male-female differences in blood pressure and hypertension. RESULTS During the period 1975-2017 mean blood pressure, the prevalence of elevated blood pressure and hypertension remained stable among Russian men. Among Russian women, mean systolic blood pressure decreased at an annual rate of 0.25 mmHg (p < 0.1) at age 35-54 years and by 0.8 mmHg (p < 0.01) at ages 55 and over. The prevalence of elevated blood pressure also decreased by 0.8% per year (p < 0.01), but the prevalence of hypertension remained stable. Mean blood pressure and prevalence of hypertension were higher in Russia compared to the USA and England at all ages and for both sexes. CONCLUSIONS In contrast to the generally observed downward trend in elevated blood pressure in many other countries, levels in Russia have changed little over the past 40 years, although there are some positive trends among women. Improved strategies to bring down the high levels of mean blood pressure and hypertension in Russia compared to countries such as England and the USA are important to further reduce the high burden of CVD in Russia.
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Quantifying dementia prevention potential in the FINGER randomized controlled trial using the LIBRA prevention index.
Deckers, K, Köhler, S, Ngandu, T, Antikainen, R, Laatikainen, T, Soininen, H, Strandberg, T, Verhey, F, Kivipelto, M, Solomon, A
Alzheimer's & dementia : the journal of the Alzheimer's Association. 2021;17(7):1205-1212
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Lifestyle interventions are being increasingly recognised to delay or prevent the onset of dementia. Scientific research targeting one lifestyle factor has continually failed to show any benefits and therefore interventions targeting several lifestyle factors, before disease onset may be more beneficial. The Lifestyle for BRAin Health (LIBRA) score is a tool which assesses peoples risk of dementia based on several lifestyle factors and this trial used this tool to determine the dementia risk of individuals who entered The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). This study was the first randomised control trial showing benefits to cognition following multi-domain lifestyle interventions. The results showed that higher LIBRA score at the start of the trial was associated with poorer brain function over time and that the multi-domain lifestyle intervention was effective at decreasing LIBRA score, regardless of the risk at the start of the trial. It was concluded that LIBRA may be a useful tool to determine risk of dementia and that the FINGER intervention was of benefit to individuals regardless of their risk of dementia.
Abstract
INTRODUCTION Individuals in early dementia prevention trials may differ in how much they benefit from interventions depending on their initial risk level. Additionally, modifiable dementia risk scores might be used as surrogate/intermediate outcomes. METHODS In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we investigated in post hoc analyses (N = 1207) whether the cognitive benefits of the 2-year multi-domain lifestyle intervention differed by baseline dementia risk measured with the "LIfestyle for BRAin Health" (LIBRA) score. We also investigated intervention effects on change in LIBRA score over time. RESULTS Overall, higher baseline LIBRA was related to less cognitive improvement over time. This association did not differ between the intervention and control groups. The intervention was effective in decreasing LIBRA scores over time, regardless of baseline demographics or cognition. DISCUSSION The cognitive benefit of the FINGER intervention was similar across individuals with different LIBRA scores at baseline. Furthermore, LIBRA may be useful as a surrogate/intermediate endpoint and surveillance tool to monitor intervention success during trial execution.