Adherence and intensity in multimodal lifestyle-based interventions for cognitive decline prevention: state-of-the-art and future directions

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• dc.contributor.author Soldevila-Domenech, Natalia
• dc.contributor.author Ayala García, Amaya
• dc.contributor.author Barbera, Mariagnese
• dc.contributor.author Lehtisalo, Jenni
• dc.contributor.author Forcano, Laura
• dc.contributor.author Diaz-Ponce, Ana
• dc.contributor.author Zwan, Marissa
• dc.contributor.author van der Flier, Wiesje M.
• dc.contributor.author Ngandu, Tiia
• dc.contributor.author Kivipelto, Miia
• dc.contributor.author Solomon, Alina
• dc.contributor.author Torre Fornell, Rafael de la
• dc.date.accessioned 2025-10-03T06:21:05Z
• dc.date.available 2025-10-03T06:21:05Z
• dc.date.issued 2025
• dc.description.abstract Preventing dementia and Alzheimer's disease (AD) is a global priority. Multimodal interventions targeting several risk factors and disease mechanisms simultaneously are currently being tested worldwide under the World-Wide FINGERS (WW-FINGERS) network of clinical trials. Adherence to these interventions is crucial for their success, yet there is significant heterogeneity in adherence reporting across studies, hindering the understanding of adherence barriers and facilitators. This article is a narrative review of available evidence from multimodal dementia prevention trials. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: nonpharmacological multimodal interventions (i.e., combining three or more intervention domains), targeting individuals without dementia, and using changes in cognitive performance and/or incident mild cognitive impairment or dementia as primary outcomes. Based on the findings, we propose future adherence reporting to encompass both participation (average attendance to each intervention component) and lifestyle change using dementia risk scores (e.g., the LIBRA index). Moreover, we provide an estimation of the expected intensity of multimodal interventions, defined as the ratio of the expected dose (i.e., the overall amount of the intervention offered specified in the trial protocol) to duration (in months). Adjusting the expected dose by average adherence enables estimation of the observed dose and intensity, which could be informative for identifying optimal dosage thresholds that maximize cognitive benefits across different populations. Finally, this article provides an overview of the determinants of adherence to multimodal interventions, emphasizing the need for improved adherence reporting to inform the design and implementation of precision prevention interventions.
• dc.description.sponsorship EU Joint Program—Neurodegenerative Disease Research (JPND) Multi-MeMo grant (National Institute of Health Carlos III, Spain [Grant AC22/00004]; Research Council of Finland, Finland; The Netherlands Organization for Health Research and Development, Netherlands). RTF led the Consolidated Research Group “Clinical Research Group in Pharmacology and Development of Biomarkers and New Drugs”, a Research Group supported by the Generalitat de Catalunya (2021 SGR 00253). This research was also supported by CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB06/03/0028), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – European Regional Development Fund. FINGER-NL was supported by a Crossover grant (MOCIA 17611) from the Dutch Research Council (NWO). The MOCIA program is a public-private partnership (see https://mocia.nl/scientific/). MK received funding from the Alzheimer’s Disease Data Initiative (ADDI), Region Stockholm (ALF, Sweden); Center for Innovative Medicine (CIMED) at Karolinska Institute (Sweden); Stiftelsen Stockholms Sjukhem (Sweden); Swedish research council for health, working life and welfare (FORTE). AS was also supported by the European Research Council grant 804371, Alzheimerfonden (Sweden). Grant AC22/00004 funded by Instituto de Salud Carlos III (ISCIII), and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR). The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.
• dc.format.mimetype application/pdf
• dc.identifier.citation Soldevila-Domenech N, Ayala-Garcia A, Barbera M, Lehtisalo J, Forcano L, Diaz-Ponce A, et al. Adherence and intensity in multimodal lifestyle-based interventions for cognitive decline prevention: state-of-the-art and future directions. Alzheimers Res Ther. 2025 Mar 17;17(1):61. DOI: 10.1186/s13195-025-01691-0
• dc.identifier.doi http://dx.doi.org/10.1186/s13195-025-01691-0
• dc.identifier.issn 1758-9193
• dc.identifier.uri http://hdl.handle.net/10230/71352
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof Alzheimers Res Ther. 2025 Mar 17;17(1):61
• dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/804371
• dc.rights © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Adherence
• dc.subject.keyword Alzheimer’s disease
• dc.subject.keyword Intensity
• dc.subject.keyword Lifestyle intervention
• dc.subject.keyword Multimodal intervention
• dc.subject.keyword Prevention
• dc.subject.keyword Review
• dc.title Adherence and intensity in multimodal lifestyle-based interventions for cognitive decline prevention: state-of-the-art and future directions
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion