Richard S Isaacson1, Hollie Hristov2, Nabeel Saif2, Katherine Hackett3, Suzanne Hendrix4, Juan Melendez5, Joseph Safdieh2, Matthew Fink2, Madhav Thambisetty6, George Sadek2, Sonia Bellara2, Paige Lee7, Cara Berkowitz2, Aneela Rahman2, Josefina Meléndez-Cabrero8, Emily Caesar9, Randy Cohen10, Pei-Lin Lu11, Samuel P Dickson4, Mu Ji Hwang2, Olivia Scheyer12, Monica Mureb2, Matthew W Schelke13, Kellyann Niotis2, Christine E Greer14, Peter Attia15, Lisa Mosconi2, Robert Krikorian16. 1. Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA. Electronic address: rii9004@med.cornell.edu. 2. Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA. 3. Department of Psychology, Temple University, Philadelphia, PA, USA. 4. Biostatistics, Pentara Corporation, Salt Lake City, UT, USA. 5. Jersey Memory Assessment Service, Health and Community Services, Jersey, United Kingdom. 6. Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA. 7. College of Letters and Science, University of California Los Angeles, Los Angeles, CA, USA. 8. Department of Neurology, Weill Cornell Medicine, San Juan, PR, USA. 9. Loyola School of Medicine, Chicago, IL, USA. 10. Department of Cardiology, Crystal Run Healthcare, Middletown, NY, USA. 11. Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. 12. School of Law, University of California Los Angeles, Los Angeles, CA, USA. 13. Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA. 14. Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 15. Attia Medical, New York, NY, USA. 16. Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Abstract
INTRODUCTION: Multidomain intervention for Alzheimer's disease (AD) risk reduction is an emerging therapeutic paradigm. METHODS: Patients were prescribed individually tailored interventions (education/pharmacologic/nonpharmacologic) and rated on compliance. Normal cognition/subjective cognitive decline/preclinical AD was classified as Prevention. Mild cognitive impairment due to AD/mild-AD was classified as Early Treatment. Change from baseline to 18 months on the modified Alzheimer's Prevention Cognitive Composite (primary outcome) was compared against matched historical control cohorts. Cognitive aging composite (CogAging), AD/cardiovascular risk scales, and serum biomarkers were secondary outcomes. RESULTS: One hundred seventy-four were assigned interventions (age 25-86). Higher-compliance Prevention improved more than both historical cohorts (P = .0012, P < .0001). Lower-compliance Prevention also improved more than both historical cohorts (P = .0088, P < .0055). Higher-compliance Early Treatment improved more than lower compliance (P = .0007). Higher-compliance Early Treatment improved more than historical cohorts (P < .0001, P = .0428). Lower-compliance Early Treatment did not differ (P = .9820, P = .1115). Similar effects occurred for CogAging. AD/cardiovascular risk scales and serum biomarkers improved. DISCUSSION: Individualized multidomain interventions may improve cognition and reduce AD/cardiovascular risk scores in patients at-risk for AD dementia.
INTRODUCTION: Multidomain intervention for Alzheimer's disease (AD) risk reduction is an emerging therapeutic paradigm. METHODS:Patients were prescribed individually tailored interventions (education/pharmacologic/nonpharmacologic) and rated on compliance. Normal cognition/subjective cognitive decline/preclinical AD was classified as Prevention. Mild cognitive impairment due to AD/mild-AD was classified as Early Treatment. Change from baseline to 18 months on the modified Alzheimer's Prevention Cognitive Composite (primary outcome) was compared against matched historical control cohorts. Cognitive aging composite (CogAging), AD/cardiovascular risk scales, and serum biomarkers were secondary outcomes. RESULTS: One hundred seventy-four were assigned interventions (age 25-86). Higher-compliance Prevention improved more than both historical cohorts (P = .0012, P < .0001). Lower-compliance Prevention also improved more than both historical cohorts (P = .0088, P < .0055). Higher-compliance Early Treatment improved more than lower compliance (P = .0007). Higher-compliance Early Treatment improved more than historical cohorts (P < .0001, P = .0428). Lower-compliance Early Treatment did not differ (P = .9820, P = .1115). Similar effects occurred for CogAging. AD/cardiovascular risk scales and serum biomarkers improved. DISCUSSION: Individualized multidomain interventions may improve cognition and reduce AD/cardiovascular risk scores in patients at-risk for AD dementia.
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