Tags

Type your tag names separated by a space and hit enter

Modifiable dementia risk score to study heterogeneity in treatment effect of a dementia prevention trial: a post hoc analysis in the preDIVA trial using the LIBRA index.
Alzheimers Res Ther. 2018 06 30; 10(1):62.AR

Abstract

BACKGROUND

Selecting high-risk participants for dementia prevention trials based on a modifiable dementia risk score may be advantageous, as it increases the opportunity for intervention. We studied whether a multi-domain intervention can prevent all-cause dementia and cognitive decline in older people across three different levels of a modifiable dementia risk score.

METHODS

Prevention of Dementia by Intensive Vascular Care (preDIVA) is a randomised controlled trial studying the effect of multi-domain vascular care during 6-8 years on incident all-cause dementia in community-dwelling people aged 70-78 years. For this post hoc analysis, we stratified preDIVA participants in tertiles based on their baseline LIfestyle for BRAin Health (LIBRA) index, a modifiable dementia risk score. With Cox proportional hazards regression, the intervention effect on dementia was assessed. The effect on cognition was measured every 2 years with the Mini-Mental State Examination and Visual Association Test.

RESULTS

Dementia developed in 220 of 3274 (6.7%) participants. In participants with a low, intermediate and high LIBRA index, the hazard ratio (HR) of the intervention on incident dementia was respectively 0.71 (95% CI 0.45-1.12), 1.06 (95% CI 0.66-1.69) and 1.02 (95% CI 0.64-1.62). Also, when adding the non-modifiable risk factors age, education and sex to the index, results were comparable (respectively HR 0.88, 95% CI 0.54-1.43; HR 0.91, 95% CI 0.57-1.47; HR 0.92, 95% CI 0.59-1.41). There was no statistically significant intervention effect on cognition during follow-up across the LIBRA groups.

CONCLUSIONS

In the preDIVA study population aged 70-78 years, the LIBRA modifiable dementia risk score did not identify a (high-)risk group in whom the multi-domain intervention was effective in preventing dementia or cognitive decline.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number registry, ISRCTN29711771 . Registered on 14 February 2006.

Authors+Show Affiliations

Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. t.vanmiddelaar@amc.uva.nl. Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands. t.vanmiddelaar@amc.uva.nl.Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.Department of General Practice, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), Amsterdam, the Netherlands.Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands.Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands.Department of Neurology, Academic Medical Center (AMC), Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29960597

Citation

van Middelaar, Tessa, et al. "Modifiable Dementia Risk Score to Study Heterogeneity in Treatment Effect of a Dementia Prevention Trial: a Post Hoc Analysis in the preDIVA Trial Using the LIBRA Index." Alzheimer's Research & Therapy, vol. 10, no. 1, 2018, p. 62.
van Middelaar T, Hoevenaar-Blom MP, van Gool WA, et al. Modifiable dementia risk score to study heterogeneity in treatment effect of a dementia prevention trial: a post hoc analysis in the preDIVA trial using the LIBRA index. Alzheimers Res Ther. 2018;10(1):62.
van Middelaar, T., Hoevenaar-Blom, M. P., van Gool, W. A., Moll van Charante, E. P., van Dalen, J. W., Deckers, K., Köhler, S., & Richard, E. (2018). Modifiable dementia risk score to study heterogeneity in treatment effect of a dementia prevention trial: a post hoc analysis in the preDIVA trial using the LIBRA index. Alzheimer's Research & Therapy, 10(1), 62. https://doi.org/10.1186/s13195-018-0389-4
van Middelaar T, et al. Modifiable Dementia Risk Score to Study Heterogeneity in Treatment Effect of a Dementia Prevention Trial: a Post Hoc Analysis in the preDIVA Trial Using the LIBRA Index. Alzheimers Res Ther. 2018 06 30;10(1):62. PubMed PMID: 29960597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modifiable dementia risk score to study heterogeneity in treatment effect of a dementia prevention trial: a post hoc analysis in the preDIVA trial using the LIBRA index. AU - van Middelaar,Tessa, AU - Hoevenaar-Blom,Marieke P, AU - van Gool,Willem A, AU - Moll van Charante,Eric P, AU - van Dalen,Jan-Willem, AU - Deckers,Kay, AU - Köhler,Sebastian, AU - Richard,Edo, Y1 - 2018/06/30/ PY - 2018/02/08/received PY - 2018/05/27/accepted PY - 2018/7/2/entrez PY - 2018/7/2/pubmed PY - 2019/8/3/medline KW - Dementia KW - Patient selection KW - Prevention KW - Prognosis KW - Randomised controlled trial KW - Risk factors SP - 62 EP - 62 JF - Alzheimer's research & therapy JO - Alzheimers Res Ther VL - 10 IS - 1 N2 - BACKGROUND: Selecting high-risk participants for dementia prevention trials based on a modifiable dementia risk score may be advantageous, as it increases the opportunity for intervention. We studied whether a multi-domain intervention can prevent all-cause dementia and cognitive decline in older people across three different levels of a modifiable dementia risk score. METHODS: Prevention of Dementia by Intensive Vascular Care (preDIVA) is a randomised controlled trial studying the effect of multi-domain vascular care during 6-8 years on incident all-cause dementia in community-dwelling people aged 70-78 years. For this post hoc analysis, we stratified preDIVA participants in tertiles based on their baseline LIfestyle for BRAin Health (LIBRA) index, a modifiable dementia risk score. With Cox proportional hazards regression, the intervention effect on dementia was assessed. The effect on cognition was measured every 2 years with the Mini-Mental State Examination and Visual Association Test. RESULTS: Dementia developed in 220 of 3274 (6.7%) participants. In participants with a low, intermediate and high LIBRA index, the hazard ratio (HR) of the intervention on incident dementia was respectively 0.71 (95% CI 0.45-1.12), 1.06 (95% CI 0.66-1.69) and 1.02 (95% CI 0.64-1.62). Also, when adding the non-modifiable risk factors age, education and sex to the index, results were comparable (respectively HR 0.88, 95% CI 0.54-1.43; HR 0.91, 95% CI 0.57-1.47; HR 0.92, 95% CI 0.59-1.41). There was no statistically significant intervention effect on cognition during follow-up across the LIBRA groups. CONCLUSIONS: In the preDIVA study population aged 70-78 years, the LIBRA modifiable dementia risk score did not identify a (high-)risk group in whom the multi-domain intervention was effective in preventing dementia or cognitive decline. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number registry, ISRCTN29711771 . Registered on 14 February 2006. SN - 1758-9193 UR - https://www.unboundmedicine.com/medline/citation/29960597/Modifiable_dementia_risk_score_to_study_heterogeneity_in_treatment_effect_of_a_dementia_prevention_trial:_a_post_hoc_analysis_in_the_preDIVA_trial_using_the_LIBRA_index_ L2 - https://alzres.biomedcentral.com/articles/10.1186/s13195-018-0389-4 DB - PRIME DP - Unbound Medicine ER -