An Internet-Based Intervention Augmented With a Diet and Physical Activity Consultation to Decrease the Risk of Dementia in At-Risk Adults in a Primary Care Setting: Pragmatic Randomized Controlled Trial

Kaarin J Anstey; Nicolas Cherbuin; Sarang Kim; Mitchell McMaster; Catherine D'Este; Nicola Lautenschlager; George Rebok; Ian McRae; Susan J Torres; Kay L Cox; Constance Dimity Pond

doi:10.2196/19431

An Internet-Based Intervention Augmented With a Diet and Physical Activity Consultation to Decrease the Risk of Dementia in At-Risk Adults in a Primary Care Setting: Pragmatic Randomized Controlled Trial

J Med Internet Res. 2020 Sep 24;22(9):e19431. doi: 10.2196/19431.

Authors

Kaarin J Anstey^{1

2

3}, Nicolas Cherbuin³, Sarang Kim⁴, Mitchell McMaster³, Catherine D'Este^{5

6}, Nicola Lautenschlager⁷, George Rebok⁸, Ian McRae³, Susan J Torres⁹, Kay L Cox¹⁰, Constance Dimity Pond¹¹

Affiliations

¹ School of Psychology, University of New South Wales, Sydney, Australia.
² Neuroscience Research Australia, Sydney, Australia.
³ Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia.
⁴ Wicking Dementia Resaerch & Education Centre, University of Tasmania, Hobart, Australia.
⁵ National Centre for Epidemiology and Public Health, Australian National University, Canberra, Australia.
⁶ School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
⁷ Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia.
⁸ Johns Hopkins Centre on Aging and Health, Johns Hopkins University, Baltimore, MD, United States.
⁹ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
¹⁰ Medical School, University of Western Australia, Perth, Australia.
¹¹ Department of General Practice, University of Newcastle, Newcastle, Australia.

PMID: 32969833
PMCID: PMC7545332
DOI: 10.2196/19431

Abstract

Background: There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course.

Objective: This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care.

Methods: A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m² or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician-led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF).

Results: Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means -3.86, 95% CI -6.81 to -0.90, P=.01; week 18: difference in means -4.05, 95% CI -6.81 to -1.28, P<.001; week 36: difference in means -4.99, 95% CI -8.04 to -1.94, P<.001; and week 62: difference in means -4.62, 95% CI -7.62 to -1.62, P<.001).

Conclusions: A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results.

Trial registration: Australian clinical trials registration number (ACTRN): 12616000868482; https://anzctr.org.au/ACTRN12616000868482.aspx.

Keywords: dementia prevention & control; pragmatic clinical trial; prevention; primary care; primary prevention; risk reduction behavior.

©Kaarin J Anstey, Nicolas Cherbuin, Sarang Kim, Mitchell McMaster, Catherine D'Este, Nicola Lautenschlager, George Rebok, Ian McRae, Susan J Torres, Kay L Cox, Constance Dimity Pond. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.09.2020.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Dementia / psychology*
Diet Therapy / methods*
Exercise / physiology*
Female
Humans
Internet-Based Intervention / trends*
Male
Middle Aged
Primary Health Care
Referral and Consultation
Risk Reduction Behavior

Associated data

ANZCTR/ACTRN12616000868482