Online lifestyle trial points to improved cognition

Significantly better cognition in older adults was flagged following a clinical trial that implemented an online lifestyle intervention.

The landmark trial, known as Maintain Your Brain, is the largest internet-based trial ever conducted to attempt to prevent cognitive decline and dementia.

The research team, led by Professor Henry Brodaty AO, Co-Director of UNSW’s Centre for Healthy Brain Ageing (CHeBA), calculated a global cognition score from online tests that measured memory, reasoning and speed of information processing, and published their findings in Nature Medicine.

How was the trial conducted?

The researchers recruited over 6000 participants aged 55–77 for the trial through the Sax Institute’s 45 and Up Study, to target modifiable risk factors for dementia in general and Alzheimer’s disease in particular. Participants had not been diagnosed with dementia but carried at least two of the major risk factors for the disease.

Half of the participants received an active intervention which included personalised coaching in two to four modules — physical activity, brain training, nutrition or depression/anxiety — depending on their risk factors, while the control group received publicly available information. A Mediterranean diet with limited meat and dairy, an increase in moderate–vigorous intensity exercises and specific types of computerised brain training were among the changes that led to an improved cognition score.

The trial directly or indirectly tackled several of the 14 modifiable risk factors, reported by the Lancet Commission, accounting for approximately 45% of the risk of dementia. The researchers say the findings have international significance.

“This intervention is scalable with the potential for population-level rollout that may delay cognitive decline in the general community,” Brodaty said. “We could essentially reduce worldwide dementia prevalence if this trial were implemented to the wider population.”

The trial incorporated participants from metropolitan, rural and remote areas, and assessed an online lifestyle intervention to prevent cognitive decline over a three-year period, with follow-ups done at the end of each year. The team split participants in two groups.

The trial specifically tested whether improving lifestyle behaviours can slow cognitive decline.

“The outcome was a resounding yes — we can improve cognition over three years and therefore, likely enhance resilience to dementia,” Brodaty said.

“Both groups improved but the intervention group demonstrated the greatest benefit to date in a randomised control trial to prevent cognitive decline.”

Evidence to support a tailored prevention program

The findings recommend personalising prevention efforts and suggest that interventions focused on just one modifiable risk factor — for example, physical inactivity — are less effective in preventing dementia.

“Previous trials have largely not tailored interventions to match dementia risk factors of individual participants,” Brodaty said. “Our findings suggest personalising interventions and targeting a broad range of lifestyle factors are important for success.”

The estimate of the intervention effect is considered conservative, given the control group and the group that received personalised coaching both improved.

Through assessing self-reported change from baseline to the year three follow-up, researchers also noted significant improvements in aerobic activity, strength training, diet and depression scores.

“If we were able to compare the intervention with a control group that received no information at all, we would likely find out that the benefits of this trial would be even greater,” Brodaty said. “Participants aged 55–65 showed greater benefit than those aged 66–77, suggesting we should consider starting prevention programs earlier.”

This trial has several strengths, particularly in terms of the large population sample size and methodology. Limitations exist, including that participants were more likely to have university education, better self-rated quality of life and a family history of Alzheimer’s disease. There was also a lack of ethno-racial diversity among participants.

Brodaty said this research offers new hope for prevention of dementia.

“Future developments could focus on cultural adaptation, particularly targeting groups from lower socio-economic backgrounds and those with less education.”

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