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Having an apolipoprotein E (APOE)-related genetic susceptibility to dementia did not make futile the cognitive benefits of a multidomain intervention comprising diet, exercise, cognitive training, and vascular risk management, a study found.

The FINGER trial randomized participants with slightly reduced cognition for their age (60-77 years) to 2 years of a multidomain intervention or the control of general health advice. A substudy of 1,109 participants with APOE genotype data found that one-third were APOE ε4 allele carriers, according to the study published online in.

Alina Solomon, MD, PhD, of the University of Eastern Finland, and colleagues found that APOE ε4 allele carriers subjected to the intervention did better than controls on annual cognitive tests, an extended version of the Neuropsychological Test Battery (difference 0.037, 95% CI 0.001-0.073). Meanwhile, non-carriers had no significant cognitive advantage with the intervention (difference 0.014, 95% CI -0.011-0.039).

Such an improvement observed among APOE ε4 allele carriers highlights "the importance of early prevention strategies that target multiple modifiable risk factors simultaneously," the team wrote. However, "given the nonsignificant tests of interaction, the promising within-group findings cannot be considered as definitive evidence that the FINGER intervention was significantly more effective among APOE ε4 carriers."

The FINGER investigators previously reported that their lifestyle program in question helped slow cognitive decline among the elderly.

"One of the main concerns regarding dementia prevention strategies is whether genetically susceptible individuals can still benefit from preventive lifestyle interventions. Thus, the current findings have positive practical implications because the APOE ε4 allele did not seem to hinder the intervention benefits," the authors concluded.

Allele carriers and non-carriers in FINGER differed by serum cholesterol level only at baseline. Among APOE ε4 allele carriers, the intervention group had higher baseline diastolic blood pressure and a worse memory.

At month 24, ε4 carriers had worse memory performance than non-carriers.

Whether a multidomain intervention can help those with substantial cognitive impairment is yet to be determined, since this group was excluded from the trial, the researchers noted, adding that they now await the 7-year dataset from the study.

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