IAGG Workshop: Health promotion program on prevention of late onset dementia

Prevention strategies for Alzheimer's disease (AD) are urgently needed due to its high and rising prevalence. Because of the multifactorial nature of AD, it now seems pertinent to propose a multi-domain intervention, combining interventions that target several factors associated with the onset of the disease, in order to examine their potential synergistic action in reducing risk. We have initiated the Multidomain Alzheimer Preventive Trial (MAPT), a 3-year prospective prevention study involving frail elderly subjects. The primary objective is to determine the effect of treatment with omega-3 and/or multi-domain intervention (nutritional, physical and cognitive training) on cognitive decline. The MAPT Study is a randomized controlled trial conducted by hospital practitioners specializing in memory disorders in thirteen French cities. Ambulatory subjects aged 70 years and over who experienced at least one of the following criteria: subjective memory complaint spontaneously expressed to a general practitioner, limitation in one instrumental activity of daily living (IADL), and slow walking speed, were included. Subjects with dementia, incapacities for basic activities of daily living (ADL) and depression (GDS) were excluded. Enrolled participants undergo a bi-annual visit. A series of tests are administered each year to assess cognitive function and functional status. Imaging data are collected in subgroups at baseline (PET for imaging beta-amyloid pathology and metabolism, MRI) and 3 years of follow-up (MRI). A total of 2574 subjects were screened for participation, of which 1680 fulfilled the eligibility criteria and were entered into the study. Subjects were randomized into one of the following four groups: omega 3 alone, multi-domain intervention alone, omega 3 plus multi-domain intervention, or placebo. The primary outcome is a change in cognitive function at 3 years, as determined by a memory test. The MAPT Study is the first preventive trial involving multi-domain interventions. Final results should be available in 2014.