On behalf of the preDIVA and MAPT/DSA groups
Cardiovascular risk factors and lifestyle factors are associated with an increased risk of cognitive decline and dementia in observational studies. We pooled individual participant data from two multi-domain intervention trials on cognitive function and symptoms of depression to increase power and facilitate subgroup analyses.
We used individual participant data from preDIVA and MAPT, two multidomain intervention trials focusing on cardiovascular and lifestyle related risk factors in community-dwelling, non-demented individuals, or care as usual. Crude scores on cognitive functioning (Mini Mental State Examination [MMSE]) and symptoms of depression and apathy (15-item Geriatric Depression Scale) collected at baseline, 2 and 3-4 years of follow-up were analyzed using linear mixed models. Prespecified subgroup analyses were performed for sex, educational level, baseline MMSE<26, history of hypertension, cardiovascular disease and study.
We included 4162 individuals (median age 74 years, IQR 72, 76) with a median follow-up duration of 3.7 years (IQR 3.0 to 4.1 years). No differences between intervention and control groups were observed on change in scores for cognitive functioning and symptoms of depression and apathy. The MMSE declined less in the intervention groups in those with MMSE<26 at baseline (N=250; MD=0.84; 95%CI=0.15 -1.54; p<0.001).
We found no conclusive evidence that multidomain interventions targeting cardiovascular risk factors reduce the risk of global cognitive decline, symptoms of depression or apathy in a mixed older population. These interventions may be more effective in those with lower baseline cognitive functioning. Extended follow-up for dementia occurrence is important to inform on the potential long-term effects of multidomain interventions.