Effects of a multidomain lifestyle modification on cognitive function in older adults: an eighteen-month community-based cluster randomized controlled trial.

Abstract

BACKGROUND: A healthy lifestyle may protect against cognitive decline. We

examined outcomes in elderly individuals after 18 months of a five-group

intervention program consisting of various modalities to prevent cognitive

decline. METHODS: We conducted a cluster randomized controlled trial assessing

460 community-dwelling individuals aged 60 years and older in a geriatric

community mental health center in Suwon, Republic of Korea, between 2008 and

2010. We developed an intervention program based on the principles of contingency

management, which could be delivered by ordinary primary health workers. Group A

(n = 81) received standard care services. Group B (n = 80) received bimonthly

(once every 2 months) telephonic care management. Group C (n = 111) received

monthly telephonic care management and educational materials similar to those in

group B. Group D (n = 93) received bimonthly health worker-initiated visits and

counseling. Group E (n = 94) received bimonthly health worker-initiated visits,

counseling, and rewards for adherence to the program. RESULTS: The primary

outcome was the change in Mini-Mental State Examination (MMSE) scores from

baseline to the final follow-up visit at 18 months. Group E showed superior

cognitive function to group A (adjusted coefficient beta = 0.99, p = 0.044), with

participation in cognitive activities being the most important determining factor

among several health behaviors (adjusted coefficient beta = 1.04, p < 0.01).

CONCLUSIONS: Engaging in cognitive activities, in combination with positive

health behaviors, may be most beneficial in preserving cognitive abilities in

community-dwelling older adults.