Lifestyle Interventions for Dementia Prevention

(DDPP Trial)

Overseen By David K Johnson, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Davis

Must not be taking: Psychoactive medications, Opiate analgesics

Disqualifiers: Neurologic disease, Major depression, Bipolar, Schizophrenia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 24

Duration: 32 weeks

400 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two lifestyle changes to determine their effectiveness in preventing memory problems and dementia. One group will engage in regular aerobic exercise, such as walking with a personal trainer, while the other group will adopt a brain-healthy diet, like the MIND diet, which emphasizes fruits, vegetables, and fish. Residents of the East San Francisco Bay Area who lead mostly inactive lifestyles and have poor diets might be suitable candidates for this trial. Participants should be prepared to commit to the program for approximately 32 weeks. As an unphased trial, this study provides a unique opportunity to contribute to research that could enhance brain health through lifestyle changes.

Will I have to stop taking my current medications?

The trial requires that you stop using certain psychoactive medications, like tricyclic antidepressants and antipsychotics, within the last 3 months. However, stable doses of some antidepressants like SSRIs and SNRIs are allowed.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that both aerobic exercise and the MIND diet are generally safe and easy to follow. Studies have found that regular aerobic exercise can boost memory, improve mood, and enhance overall brain function. It may also help slow memory and thinking problems associated with aging. People who engage in moderate to vigorous exercise report good health benefits, with no major negative effects.

The MIND diet, which emphasizes fruits, vegetables, and whole grains, has been linked to a lower risk of dementia. Most people can follow this diet easily, as it promotes healthy eating and typically doesn't cause side effects.

Both the exercise and diet have been well-researched for their safety and effectiveness in reducing dementia risk. Participants in similar studies have managed both the exercise and diet programs well, with no major safety issues reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these lifestyle interventions because they offer a proactive approach to preventing dementia, focusing on holistic health improvements. Unlike traditional medical treatments that might involve medication, this trial emphasizes aerobic exercise and diet skills. The aerobic exercise component is tailored to individual needs, providing personalized physical activity plans with the guidance of a personal trainer, which can enhance both physical and mental well-being. Meanwhile, the diet skills program promotes heart-healthy eating habits through practical cooking classes led by professional chefs, encouraging sustainable dietary changes. These interventions aim to empower individuals to make lasting lifestyle changes that could reduce dementia risk, potentially offering a natural and accessible alternative to more conventional treatments.

What evidence suggests that this trial's lifestyle interventions could be effective for dementia prevention?

This trial will compare the effects of aerobic exercise and dietary interventions on dementia prevention. Studies have shown that aerobic exercise, such as walking, can help prevent memory problems and dementia, potentially lowering the risk by up to 20%. Participants in the Aerobic Exercise Group will engage in structured exercise programs. Additionally, research suggests that the MIND diet can slow memory loss, particularly in older adults, and might reduce the risk of Alzheimer's disease by as much as 53%. Participants in the Diet Skills Group will learn to incorporate heart-healthy foods into their diet. Both exercise and the MIND diet have shown promising results in supporting brain health. ^{6 7 8 9 10}

Who Is on the Research Team?

David K Johnson, PhD

Principal Investigator

University of California, Davis

Are You a Good Fit for This Trial?

This trial is for older African Americans and non-Hispanic whites at risk of cognitive decline, who are sedentary with a poor diet but without significant cognitive impairment or physical disabilities. Participants must not plan extensive travel during the study and be willing to join either lifestyle intervention group.

Inclusion Criteria

I am willing to follow a new lifestyle plan as part of the study.

Lives in a region where the DDPP interventions will be delivered

I will not travel outside my local area for more than 3 months during the study.

Exclusion Criteria

I haven't had treatment for cancer, except for certain skin or early stage cancers, in the last 2 years.

I have had weight loss surgery that affects how my body absorbs food.

I have not been diagnosed with major depression in the past year.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo an 8-month lifestyle intervention program including aerobic exercise and dietary counseling

32 weeks

Weekly visits for 20 weeks, then flexible scheduling

Follow-up

Participants are monitored for changes in fitness and cognitive performance

4 months

Follow-up visits at Month 4

What Are the Treatments Tested in This Trial?

Interventions

• Aerobic Exercise
• Diet Skills

Trial Overview The trial tests two interventions: an Aerobic Exercise program with in-class walking workouts, and dietary counseling based on the MIND diet aimed at improving brain health by eating more berries, vegetables, grains, nuts, fish, poultry, beans and olive oil while reducing unhealthy fats and red meat.

How Is the Trial Designed?

Group I: Aerobic Exercise Group Active Control 1 Intervention

Participants will follow a structured program that includes exercise 3 times per week for about 30 minutes each time. The type of aerobic exercise will vary, but will primarily focus on in-class walking tutorials. Participants will work with a Personal Trainer to create their own physical activity program that will fit their needs and schedule. The Personal Trainer will supervise the participants directly for the first 6 weeks. Once participants are consistently and safely meeting their goals, their Personal Trainer will allow unsupervised exercise sessions.

Group II: Diet Skills Group Active Control 1 Intervention

Participants will attend weekly classes focused on incorporating heart healthy foods (e.g., fruits and vegetables) into their existing dietary plan. We will ask them to limit the number of calories they take in and will show them how to use portion control with the goal of losing body weight. Participants will also learn hands-on skills for preparing healthy meals at home in cooking classes led by professional chefs.

Who Is Running the Clinical Trial?

University of California, Davis

Lead Sponsor

Trials

958

Recruited

4,816,000+

Tice Creek Fitness Center

Collaborator

Trials

1

Recruited

400+

East Oakland Sports Center

Collaborator

Trials

1

Recruited

400+

Published Research Related to This Trial

A study involving 3463 participants aged around 68 years found that combining high-intensity physical activity with the MIND diet significantly improved global cognition and reduced the odds of cognitive decline compared to not following either behavior.

While the MIND diet alone also showed benefits for cognition, the combination of both high-intensity physical activity and the MIND diet provided the most substantial cognitive health advantages, suggesting that promoting both lifestyle changes could be beneficial in preventing dementia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of adherence to high-intensity physical activity and the Mediterranean-dietary approaches to stop hypertension intervention for neurodegenerative delay diet with cognition: A cross-sectional study. Ahn, S., Lingerfelt, CN., Lee, CE., et al.[2022]

Engaging in moderate physical activity can improve cognitive function and may lower the risk of developing dementia, highlighting the importance of an active lifestyle for older adults.

While nutritional supplements may help with deficiencies, they are not recommended for enhancing cognitive performance beyond a healthy diet, indicating that a balanced diet is crucial for brain health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lifestyle change and the prevention of cognitive decline and dementia: what is the evidence? Lövdén, M., Xu, W., Wang, HX.[2018]

In a study of 943 patients with atherosclerotic cardiovascular disease (ASCVD) or stroke, those who adhered more closely to the MIND diet had a significantly lower risk of all-cause and cardiovascular (CV) death compared to those with lower adherence.

For each one-point increase in MIND diet score, there was a 10% reduction in all-cause mortality risk and a 16% reduction in CV mortality risk, highlighting the potential benefits of the MIND diet for improving health outcomes in patients with ASCVD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Better adherence to the MIND diet is associated with lower risk of all-cause death and cardiovascular death in patients with atherosclerotic cardiovascular disease or stroke: a cohort study from NHANES analysis. Song, Y., Chang, Z., Jia, L., et al.[2023]

The MIND diet shows promise as a long-term treatment option for improving cognitive function in individuals with various forms of dementia, based on a systematic review of 11 studies involving different dementia pathologies.

All studies reviewed indicated a positive correlation between adherence to the MIND diet and cognitive functioning, although the effects on specific cognitive domains varied, highlighting the need for further research to understand the underlying mechanisms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of the MIND Diet on Cognition in Individuals with Dementia. Healy, E.[2023]

In a study of 1,412 French older adults followed for nearly 10 years, higher adherence to a French-adapted MIND diet was linked to a significantly lower risk of developing dementia and Alzheimer's disease, suggesting its potential as a preventive strategy.

The study also found that a higher MIND diet score was associated with better white matter microstructure, as indicated by lower diffusivity values in the brain, although it did not show a significant impact on gray matter volumes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of a MIND Diet with Brain Structure and Dementia in a French Population. Thomas, A., Lefèvre-Arbogast, S., Féart, C., et al.[2022]

There is a strong consensus in the literature on the importance of preventive lifestyle measures to reduce the risk of developing dementia and Alzheimer's disease, but creating effective guidelines is challenging due to a lack of comparable randomized controlled trials.

Health professionals are urged to focus on early diagnosis of cognitive impairment and to implement strategies to manage vascular health and promote healthy lifestyle habits, as these are modifiable risk factors for dementia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A brief update on dementia prevention. Polidori, MC., Pientka, L.[2021]

The MIND diet is associated with improvements in various cardiometabolic outcomes, including better blood pressure, glycemic control, and lipid profiles, based on a systematic review of 23 studies involving adults.

The evidence supports the MIND diet as a beneficial strategy for reducing cardiometabolic risk, although more long-term and well-designed studies are needed to confirm its effects on cardiovascular diseases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Associations of the MIND Diet with Cardiometabolic Diseases and Their Risk Factors: A Systematic Review. Akbar, Z., Fituri, S., Ouagueni, A., et al.[2023]

In a 3-year randomized controlled trial involving 604 older adults at risk for dementia, the MIND diet did not show significant cognitive benefits compared to a control diet, with only a slight improvement in global cognition scores for the MIND diet group.

MRI results indicated no significant differences in brain characteristics, such as white-matter hyperintensities and hippocampal volumes, between participants following the MIND diet and those on the control diet.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons. Barnes, LL., Dhana, K., Liu, X., et al.[2023]

The Virtual Cognitive Health study aims to validate the effectiveness of a yearlong internet-delivered lifestyle intervention for older adults (aged 60-75) with subjective memory decline, focusing on improving cognitive function, mental health, and lifestyle behaviors.

With 82 participants enrolled, the study will assess changes in cognitive function and mental health over time, providing crucial evidence for the scalability of remote interventions in preventing or delaying Alzheimer's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Remote Intervention to Prevent or Delay Cognitive Impairment in Older Adults: Design, Recruitment, and Baseline Characteristics of the Virtual Cognitive Health (VC Health) Study. Bott, N., Kumar, S., Krebs, C., et al.[2020]

Adherence to the MIND diet is associated with a significantly reduced risk of developing multiple sclerosis (MS), with an adjusted odds ratio of 0.10, indicating a strong protective effect based on a study of 77 patients with relapsing-remitting MS and 148 healthy controls.

Specific components of the MIND diet, such as high consumption of green leafy vegetables, other vegetables, and beans, are linked to lower odds of MS, while higher intake of unhealthy foods like pastries, sweets, and fried foods is associated with increased odds of the disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

MIND Diet Adherence Might be Associated with a Reduced Odds of Multiple Sclerosis: Results from a Case-Control Study. Noormohammadi, M., Ghorbani, Z., Naser Moghadasi, A., et al.[2022]

In a study of 339 individuals with obesity, those who adhered more closely to the MIND diet showed lower levels of stress and higher insulin sensitivity, suggesting potential mental health and metabolic benefits.

The highest MIND diet scores were linked to increased intake of brain-healthy foods and a significant reduction in the consumption of unhealthy sweets and pastries, indicating a positive dietary shift.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluating the association between the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, mental health, and cardio-metabolic risk factors among individuals with obesity. Ardekani, AM., Vahdat, S., Hojati, A., et al.[2023]

The My Healthy Brain program, an 8-week group-based lifestyle intervention delivered via live video, effectively targets multiple lifestyle risk factors for dementia in older adults with cognitive decline or mild cognitive impairment.

Participants reported that the program was feasible and acceptable, suggesting it has the potential to improve lifestyle, cognitive, and psychosocial outcomes for at-risk older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

My Healthy Brain: Rationale and Case Report of a Virtual Group Lifestyle Program Targeting Modifiable Risk Factors for Dementia. Mace, RA., Hopkins, SW., Reynolds, GO., et al.[2023]

Higher adherence to the Mediterranean diet is linked to better cognitive function and a lower risk of Alzheimer's disease (AD), supported by evidence from 9 of 12 cross-sectional studies and 6 of 8 longitudinal studies.

The MIND diet shows the strongest association with reduced cognitive decline and lower AD risk, with positive results in 2 of 3 longitudinal studies, indicating that these dietary patterns may serve as effective preventive strategies against dementia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer's Disease-A Review. van den Brink, AC., Brouwer-Brolsma, EM., Berendsen, AAM., et al.[2023]

Citations

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Preventive Strategies for Cognitive Decline and Dementia Several studies have reported that physical activity and exercise interventions are effective in preventing cognitive decline and dementia.

2. alzheimers.org.uk alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/reduce-your-risk-of-dementia/physical-activity

Physical activity and the risk of dementia Research has shown that people who take regular exercise may be up to 20% less likely to develop dementia than those who don't take regular exercise.

3. sciencedirect.com sciencedirect.com/science/article/pii/S053155652500097X

Comparative efficacy of exercise interventions for cognitive ... Conversely, aerobic exercise showed the strongest effect on memory function, outperforming resistance training, multimodal exercise, and physical-mental ...

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Midlife cardiovascular fitness and dementia A high midlife fitness, assessed by a maximal treadmill test, was associated with lower risk of developing dementia over a mean follow-up period of 24 years.

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Effectiveness of exercise interventions to improve long ... A growing body of literature reports that exercise and physical activity (EXPA) can slow down the onset of dementia and prevent problems ...

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Physical Activity to Counter Age-Related Cognitive Decline Regular aerobic exercise enhances executive function, memory, and mood regulation while mitigating age-related cognitive decline. These benefits ...

8. sciencedirect.com sciencedirect.com/science/article/pii/S2274580724006204

Lifestyle interventions for dementia risk reduction: A review ... Older adults are recommended to engage in 150–300 min of moderate-intensity aerobic exercise or physical activity per week, or 75–150 min of vigorous-intensity ...

9. bmjgroup.com bmjgroup.com/high-cardiorespiratory-fitness-linked-to-lower-risk-of-dementia/

High cardiorespiratory fitness linked to lower risk of dementia People with a genetic predisposition for dementia could reduce their risk by up to 35% through increased cardiorespiratory fitness.

10. frontiersin.org frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2023.1243869/full

Exercise therapy to prevent and treat Alzheimer's disease Aerobic exercise (with an intensity of 50–75% of VO2 max) prevents hippocampal volume reduction, spatial memory reduction, and learning reduction.