期刊
JAMA NEUROLOGY
卷 75, 期 4, 页码 462-+出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jamaneurol.2017.4365
关键词
-
资金
- Academy of Finland's Responding to Public Health Challenges Research Programme [129395, 129397, 129459, 129421, 129416, 129511, 129401]
- Alzheimer Association [HAT-10-173121]
- Alzheimer's Research and Prevention Foundation
- Juho Vainio Foundation
- Novo Nordisk Foundation
- Finnish Social Insurance Institution
- Ministry of Education and Culture Research
- MIND-AD Academy of Finland [291803]
- Swedish Research Council (EU Joint Programme-Neurodegenerative Disease Research) [529-2014-7503]
- Axa research grant
- EVO/VTR from the University Hospital of Kuopio
- Seinajoki Central Hospital
- Center for Innovative Medicine at Karolinska Institutet Sweden
- Knut and Alice Wallenberg Foundation Sweden
- Stiftelse Stockholms Sjukhem
- Academy of Finland [120676, 11745, 287490, 294061, 259615, 278457]
- Finnish Medical Foundation
- Gustaf o.Victoria Frimurarestiftelse
- Swedish Research Council
- Swedish Research Council for Health, Working Life, and Welfare
- Alexander von Humboldt Research award
- Swedish Research Council for Health, Working Life, and Welfare [2009-0772]
- La Carita Foundation
- Oulu City Hospital
- EVO/VTR from the University Hospital of Oulu
- EVO/VTR from the University Hospital of Turku
IMPORTANCE The role of the apolipoprotein E (APOE) epsilon 4 allele as an effect modifier in lifestyle interventions to prevent cognitive impairment is still unclear. OBJECTIVE To examine whether the APOE epsilon 4 allele modifies the previously reported significant cognitive benefits of a multidomain lifestyle intervention (prespecified subgroup analysis). DESIGN, SETTING, AND PARTICIPANTS The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was a randomized clinical trial in 6 centers across Finland (screening and randomization performed from September 7, 2009, through November 24, 2011; intervention duration, 2 years). Data analysis was performed from August 1, 2015, to March 31, 2016. The study population was at-risk older individuals from the general population. Inclusion criteria were age of 60 to 77 years; Cardiovascular Risk Factors, Aging, and Dementia risk score of at least 6 points; and cognition at a mean level or slightly lower than expected for age. Individuals with dementia or substantial cognitive impairment and conditions that prevented cooperation or safe engagement in the intervention were excluded. APOE genotype data were available for 1175 of the 1260 participants. INTERVENTIONS Participants were randomly assigned in a 1: 1 ratio to a multidomain intervention group (diet, exercise, cognitive training, and vascular risk management) or a control group (general health advice). Group allocation was not actively disclosed to participants, and outcome assessors were masked to group allocation. MAIN OUTCOMES AND MEASURES Primary outcome was change in cognition measured through a comprehensive neuropsychological test battery. Analysis was based on modified intention to treat (participants with at least 1 postbaseline assessment). RESULTS A total of 1109 participants (mean [SD] age, 69.3 [4.7] years; 514 [46.3%] female) were included in the analysis: 362 APOE epsilon 4 allele carriers (173 intervention and 189 control) and 747 noncarriers (380 intervention and 367 control). The APOE epsilon 4 carriers and noncarriers were not significantly different at baseline (except for serum cholesterol level). The difference between the intervention and control groups in annual neuropsychological test battery total score change was 0.037 (95% CI, 0.001 to 0.073) among carriers and 0.014 (95% CI, -0.011 to 0.039) among noncarriers. Intervention effect was not significantly different between carriers and noncarriers (0.023; 95% CI, -0.021 to 0.067). CONCLUSIONS AND RELEVANCE Healthy lifestyle changesmay be beneficial for cognition in older at-risk individuals even in the presence of APOE-related genetic susceptibility to dementia. Whether such benefits are more pronounced in APOE epsilon 4 carriers compared with noncarriers should be further investigated. The findings also emphasize the importance of early prevention strategies that target multiple modifiable risk factors simultaneously.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据