In a recent study published within the Journal of Alzheimer’s Disease, researchers discussed the protocol and current progress of a study that investigates the effectiveness of normal walking and adherence to a Mediterranean-style weight-reduction plan in decreasing the chance of dementia and age-related cognitive decline in independently living older adults without existing cognitive impairments.

Study: A Mediterranean Food regimen and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians: The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics. Image Credit: Lightspring / Shutterstock

Background

A decline in cognitive functions resembling spatial working and episodic memory is a natural function of age. Nevertheless, a rapid decline in cognitive abilities often indicates a neuropathological deterioration that may lead to dementia. Lifestyle aspects resembling physical activity and weight-reduction plan are essential modifiable risk aspects for dementia. Moreover, risk aspects related to heart problems, resembling arterial stiffness and hypertension, also contribute to an increased risk of dementia and cognitive decline. Targeting these risk aspects through weight-reduction plan and exercise could lower the chance of dementia.

The Lancet Commission and World Health Organization’s report on the prevention, interventions, and care related to dementia has indicated the importance of physical activity and adherence to the Mediterranean weight-reduction plan to focus on the modifiable risk aspects of dementia. Studies investigating the impact of the Mediterranean weight-reduction plan on health have reported improvements in cardiovascular risk measures, cognitive function, and memory amongst older individuals. Similar results have also been observed for physical activity interventions, however the evidence for each these interventions has primarily been from preclinical and prospective cohort studies.

Concerning the study

In the current study, the researchers conducted a randomized controlled trial to find out the effectiveness of the MedWalk intervention, which promotes adherence to the Mediterranean weight-reduction plan and walking as a technique of physical activity, implemented using proven psychosocial techniques resembling motivational interviewing and cognitive-behavioral therapy (MI-CBT) to bring about behavioral change. The researchers hypothesized that the MedWalk intervention will lead to a slower decline in cognitive function as in comparison with the control group, where participants will proceed with their habitual lifestyles.

The study also aimed to look at the impact of the MedWalk intervention on aspects resembling quality of life, mood, arterial stiffness, cardiovascular health, and biomarkers resembling inflammation, glucose regulation, nutrient status, and oxidative stress, that are linked to cognitive decline. Moreover, the study’s secondary goals included evaluating the intervention’s impact on aspects resembling health economy and cost-effectiveness.

This randomized controlled trial was conducted over two years amongst older adults living in retirement villages in Australia. These retirement villages provided a homogenous and consistent study set-up as in comparison with the broader community, which can be heterogeneous across various aspects. These residential set-ups also encouraged mutual support conducive to fostering group walk sessions and adherence to dietary plans.

The MedWalk intervention was implemented over a yr, with the primary six months involving more frequent group walking and weight-reduction plan consultations, which became less frequent over the second half of the yr. Primary and secondary outcomes were assessed after the baseline measurements occurred at six and 12 months. Resulting from the onset of the coronavirus disease 2019 (COVID-19) pandemic, the study needed to be modified and significantly abbreviated. Nevertheless, the researchers stated that while the duration of measurements of the first and secondary outcomes needed to be restricted on account of the pandemic, the main hypotheses and goals of the study remained unchanged.

Progress

Despite the COVID-19 pandemic-associated reduction within the sample size and timeline of the study, the progress to date indicated that baseline testing had been accomplished for 157 participants, who were being followed up for a yr. The cognitive testing at baseline and through the half-yearly and yearly follow-ups is being conducted by blinded testers or researchers.

The MI-CBT approach is used to develop adherence to the Mediterranean-style weight-reduction plan, with a dietitian providing instructions, meal planning, and recipes to assist improve adherence to the weight-reduction plan. Supervised group walking sessions with accredited exercise physiologists are provided to extend physical activity levels.

The Cambridge Neuropsychological Test Automated Battery’s Paired Associated Learning task, which evaluates learning and visual memory, is getting used to check the first final result of cognitive decline. Other tests included within the automated battery are getting used for measuring secondary outcomes resembling motor learning, spatial working memory, rapid visual information processing, and response time.

Questionnaires on anxiety, depression, stress, and general health are getting used to evaluate mood, while the Pittsburgh Sleep Quality Index is being employed to judge sleep quality. Moreover, arterial stiffness and central and peripheral blood pressures are also being recorded at baseline and through follow-ups, and various other indices are getting used to evaluate the standard of life and the expanse of the participant’s social network.

Conclusions

To summarize, the MedWalk intervention has been designed to look at the impact of a mix of a modified Mediterranean-style weight-reduction plan and increased physical activity in the shape of group walks to lower cognitive decline rates amongst older adults. Resulting from the onset of the COVID-19 pandemic and associated social restrictions, the study is in progress with participants recruited from retirement village communities in Australia and a wider community.

If the outcomes from this study are promising, the MedWalk intervention could potentially be applied to broader communities to diminish cognitive decline and the chance of dementia amongst older adults, which might also significantly reduce the health-related economic burden.