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

…the ideal interventions should be multi-dimensional...

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

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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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

FINGER intervention

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

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

Current status (06.03.2012)

Invited 5496

ScreenedIncluded

2654 (48%)1282 (23%)

Randomized: Intervention Control

1250626624

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

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

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

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

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)

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

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