BRAIN-Diabetes: Border Region Area Lifestyle Intervention Study for Healthy Neurocognitive Ageing in Diabetes. A Feasibility Randomised Controlled Trial

Dementia is the most frequent neurodegenerative condition and poses a major health burden with high socioeconomic costs. Attempts to find pharmacologic treatments have been largely unsuccessful, prompting a focus on interventions aimed at modifying risk factors for dementia that occur throughout the life course. In terms of risk factors for dementia, strongest support is for depression, (midlife) hypertension, physical inactivity, DM, (midlife) obesity, hyperlipidaemia, and smoking. The incidence of any dementia was approximately two-to three-fold higher in people with than in those without DM, leading to suggestions that interventions addressing lifestyle changes and DM treatment could be beneficial.

A number of intervention studies in DM have focused on reduction of cardiovascular outcomes. These results suggest that intensive treatment does not adversely affect patient-reported outcomes. There have been few cognition studies. Identification of cognitive domains most affected by DM can lead to targeted risk modification, possibly through lifestyle interventions (diet/physical activity) and may reduce risk of cognitive dysfunction and possibly dementia. An overview of cognitive testing in DM showed impairment in tests of executive function, working memory, psychomotor and attentional functions. Impairments of executive function and choice reaction time may have consequences for everyday functioning. Trail Making Task, Symbol Digit Modalities Test, Verbal Fluency Task and tests of reaction time and processing speed could be included as core components of test batteries in future intervention studies.

However there are few studies with a multifactorial intervention and cognition as an endpoint in DM.

FINGER showed that an intensive multi-domain lifestyle intervention programme (nutrition, exercise, cognitive stimulation and social activity, intensive vascular risk factor control) applied in older people (60-77 years) at higher risk for dementia produced significant cognitive benefits after 2 years.

There are concerns whether the intensive nature of the FINGER intervention are translatable/applicable to clinical practice in different healthcare systems. Further studies are required to evaluate the efficacy of multi-domain lifestyle interventions in targeted high-risk populations including a need to develop a practical and feasible program which is deliverable in community settings.