Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)
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Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and
Disability (FINGER)
Miia Kivipelto, MD, PhDProfessor
Karolinska Institutet Alzheimer Disease Research Center (KI-ADRC) and Aging Research Center,
Sweden and University of Eastern Finland
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…the ideal interventions should be multi-dimensional...
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Objective: To reduce cognitive impairment in an at risk population through a 2-year multi-domain life-style intervention
Target population: 60-77 year old persons (n= 1200) from previous population-based non-intervention studies (FINRISK, D2D)
Time schedule: Screening began in September 2009 and was completed in 2011. The intervention will be completed in 2013
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INCLUSION CRITERIA: persons at risk of cognitive decline/dementia
Dementia Risk score > 6 Based on risk factors assessed in earlier
population surveys: Age, Education, Sex, SBP, Cholesterol, BMI, Physical Activity (Kivipelto et al., Lancet Neurology 2006)
AND Cognitive performance at mean level or slightly lower than expected for age (based on CERAD test battery)
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Scre
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NINTENSIVE INTERVENTION
REGULAR HEALTH ADVICE
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MINI-INTERVENTION
3 6 9 12 15 18 21 24
NUTRITION: 7 group sessions,
3 individual sessions
COGNITIVE TRAINING:9 group sessions
Independent training
EXERCISE:1-2x/wk muscle2-4x/wk aerobic
EXERCISE:2x/wk muscle
4-5x/vk aerobic
EXERCISE:2x/wk muscle strength training
5x/wk aerobic training
MONITORING AND MANAGEMENT OF METABOLIC AND VASCULAR RISK FACTORS
Nurse: Visit every 3 months, Physician: 3 additional visits
months
INTERVENTION SCHEDULE
COGNITIVE TRAINING:2 group sessios
Independent training
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FINGER intervention
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FINLAND
Kuopio cohort
H.Soininen
Oulu cohortT. Strandberg
Seinäjoki cohort
J. Tuomilehto
Turku cohortA. Jula
Helsinki cohort
M. Kivipelto
Vantaa cohort
T. Laatikainen
FINGER StudyPI: M. Kivipelto
Coordination Group/THL:Heads: T. Laatikainen, J.Lindström,
Coordinators: T. Ngandu, S. Ahtiluoto Field coordinator: J. Lehtisalo
Data manager, Statistician, Administrator
Volunteer organizationsPractices in the community
Safety CommitteeMonitoring Committee
Supervision:Nutrition: J. Lindström
Exercise: R. Rauramaa, S.PajalaCognitive&social activation: T.Hänninen,
T.NganduVascular factors: J. Tuomilehto, T.Strandberg,
R. Antikainen
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Primary:Cognitive impairment (Neuropsychological Test
Battery, Trail Making & Stroop tests)
Secondary:Dementia (after 7 years)Depressive symptoms (Zung scale)Vascular risk factors, morbidity and mortalityDisability (questionnaire, ADL + IADL) Quality of life (RAND-36, 15D)Utilization of health resourcesBlood markers (i.e. inflammation, redox status, lipid and
glucose metabolism, NMR metabonomics) Brain MRI measures (n=100) and PET (n=90)
OUTCOMES
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Current status (06.03.2012)
Invited 5496
ScreenedIncluded
2654 (48%)1282 (23%)
Randomized: Intervention Control
1250626624
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Drop outs and refusals (06.03.2012)
All Interv. Control
Drop out after randomization: Health issue Lack of time/motivation Moved away Died Unknown Several reasons
79 (6.3%)2118131125
48101201717
311161248
Refusing part of intervention: Diet (groups) Exercise/ gym Cognition
721/2463
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Demographic and baseline medical data of the first participants
All screenedN=2516
Interv.N=557
ControlN=559
p-value(interv vs. ctr)
Age, y 68.1 (4.8) 68.4 (4.6) 68.0 (4.6) 0.11
Men/ Women, % 49 / 51 55 / 45 52 / 48 0.40
Education, y 10.8 (3.8) 10.0 (3.1) 10.0 (3.6) 0.96
MMSE 27.4 (2.1) 26.7 (2.1) 26.8 (2.0) 0.48
SBP, mmHg 141.2 (16.3) 141.5 (16.8) 140.9 (15.8) 0.54
BMI, kg/m2 28.8 (4.4) 28.5 (4.7) 28.9 (4.3) 0.48
% Impaired fasting glucose (≥6.1 mmol/L)
38.7 38.3 39.0 0.82
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1st year preliminary results
Group N Baseline 12 month p-value
Weight, kg Intervention 213 81.8 80.6 0.04Control 216 81.9 81.6
BMI, kg/m2 Intervention 213 28.9 28.5 0.04Control 216 28.9 28.7
SBP, mmHg Intervention 212 142.1 138.0 0.81
Control 215 142.4 138.2
DBP, mmHg Intervention 212 81.9 80.6 0.33
Control 215 81.6 80.9
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1st year preliminary results
Group N Baseline 12 month p-valueFasting glucose Intervention 209 6.13 6.14 0.32
mmol/L Control 216 6.10 6.24OGTT 120min Intervention 179 7.03 6.97 0.09
mmol/L Control 181 6.99 7.23
Total cholesterol Intervention 209 5.13 5.05 0.04mmol/L Control 216 5.12 5.19HDL Intervention 209 1.42 1.42 0.61
mmol/L Control 216 1.43 1.42
LDL Intervention 209 3.07 3.04 0.03mmol/L Control 216 3.06 3.15Triglycerides Intervention 209 1.40 1.32 0.44
mmol/L Control 216 1.38 1.37
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Experience of the participants
”I have friends who are jealous when they hear all that I have been offered to do at this course”
”Right amount of everything”
”Nice experience”
”Coming here has always given me reinforcement and strength to take care of myself and others” (participant from the control group)
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European Dementia Prevention Initiative
• FINGER Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability
• preDIVA Prevention of Dementia by Intensive Vascular Care
• MAPT Multidomain Alzheimer Preventive Trial
EDPI
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Tiina LaatikainenAntti JulaJaana LindströmMarkku PeltonenTiia NganduSatu AhtiluotoJenni Lehtisalo
Hilkka SoininenRainer RauramaaRaimo SulkavaMerja HallikainenTuomo HänninenTeemu PaajanenAlina SolomonMinna RusanenMarjo EskelinenMiika Vuorinen
Timo StrandbergRiitta Antikainen
Bengt WinbladLaura FratiglioniLars BäckmanIngemar KåreholtKrister HåkansonBabak HooshmandFrancesca Mangialasche
ACKNOWLEDGEMENTSGrant support: Academy of Finland, Novo Nordisk Foundation, FAS, Alzheimer Association, La Carita säätiö
Jaakko Tuomilehto