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Background: Dementia prevalence is increasing, and risk reduction is a priority. Online interventions that are useable and acceptable to people seeking to reduce their dementia risk are needed. We aimed to assess and explore end‐user perceptions of a large‐scale multidomain online intervention targeting modifiable lifestyle risk factors for dementia. Method: Mixed methods evaluation involving Maintain Your Brain (MYB) randomised controlled trial participants 55‐77 years of age at baseline who engaged in assessments, brain training, nutrition and physical activity, and mental health modules across three years. Of 5,260 participants invited, 2,386 completed online surveys at trial conclusion of whom 1,589 offered free‐text comments. Of survey respondents, 248 agreed to be contacted for interviews, 70 were invited and 40 were interviewed. Survey respondents rated ease of use and overall experience with MYB, endorsed whether they would recommend MYB, and provided comments. Interview completers further rated satisfaction with support, expressed online or face‐to‐face setting preference, answered open‐ended questions about participation, activities and modules, and provided further comments. Data were summarised using descriptive statistics and explored using multiple qualitative methods. Result: Respondents found computer‐based activities easy to use (92.2%), were satisfied with their overall experience (87.4%) and would recommend MYB (82.7%). Survey free‐text and interview comments addressed topics including computer literacy, health literacy, resource access, motivations, expectations, social relationships, and significant events. Perspectives on activities and information varied. Many enjoyed and/or appreciated the challenge of completing activities and assessments and the potential for health benefits from these activities. Others were disappointed by their own performance in activities and assessments, found testing and reporting repetitious, stressful and/or time‐consuming, and found educational information unhelpful. Many respondents would have preferred to access applications on phones or tablet devices and suggested that interventions should be available across platforms. Respondents wanted researchers to know that flexible and adaptive individually tailored goals and activities and timely feedback are important. Conclusion: The MYB online multidomain dementia risk reduction program was useable and acceptable. Similar programs should be accessible, well‐supported, cross‐IT platforms, and incorporate adaptive, individually tailored activities and feedback that is responsive to the varied and changing needs of older adults. [ABSTRACT FROM AUTHOR]

Background: Efforts to prevent cognitive decline with aging have had mixed results with successful interventions delivered in person. While online approaches are more scalable and feasible to deliver at a population level, no multimodal online intervention has yet been demonstrated efficacy. We aimed to reduce cognitive decline with ageing using an online package of interventions delivered intensively for 12 months followed by monthly boosters for 24 months. Method: Invitations were sent to people aged 55‐77 years from the 45 and Up study, a population‐based cohort study of one in ten people aged 45 years and older in New South Wales, Australia (n = 267,000). Participants were required to be eligible for at least two of four modules addressing physical inactivity and associated health risks (Physical Activity), adherence to a Mediterranean‐type diet and health risks associated with poor nutrition (Nutrition), cognitive activity (Brain Training) and mental well‐being (Peace of Mind). Participants received modules based on their risks, with 1:1 randomized allocation to active personalised coaching modules (intervention) or static information‐based modules (control). The primary outcome was change in an online combined multi‐domain cognitive score measured using COGSTATE and Cambridge Brain Sciences tests. Secondary outcomes included specific cognitive domain and ANU‐ADRI risk scores. Result: Of 96,418 invitations issued, 14,064 (14%) consented, 11,026 (11%) were eligible and 6,104 (6%) completed all baseline assessments. Over three years, using intention to treat analysis, the intervention group improved significantly more in the global composite cognition (p<0.001). Significant benefits were also found in complex attention, executive function and learning and memory (all p<0.001), as well as on a validated dementia risk instrument (p = 0.007). Results were similar when adjusted for baseline age, gender, dementia risk and number of modules eligible and when analysis was based on those completing follow‐up. Conclusion: An online platform tailored to individuals' risk factor profiles over three years significantly delayed cognitive decline in older adults. This platform is scalable; if delivered at a population level with may help reduce the prevalence of dementia globally. [ABSTRACT FROM AUTHOR]

Background: Technology and web‐based approaches potentially provide scalable population‐based interventions to reduce modifiable risk factors for dementia such as physical inactivity, suboptimal nutrition and low cognitive activity. Our aim was to reduce cognitive decline with ageing using an online package of interventions delivered intensively for 12 months followed by monthly boosters for 24 months. The trial was completed in November 2021. Method: Invitations were sent to people aged 55‐77 years from the 45 and Up study, a population‐based cohort study of one in ten people aged 45 years and older in New South Wales, Australia (n = 267,000). Participants were required to be eligible for at least two of four modules. The modules addressed physical inactivity and health risks associated with inactivity (Physical Activity), adherence to a Mediterranean‐type diet and health risks associated with poor nutrition (Nutrition), cognitive activity (Brain Training) and mental well‐being (Peace of Mind). All participants received modules based on their risks, with randomized allocation to active personalised coaching modules (intervention) or static information‐based modules (control). The primary outcome was change in an online combined multi‐domain cognitive score measured using COGSTATE and Cambridge Brain Sciences tests. Secondary outcomes included ANU‐ADRI risk score, specific cognitive domain scores and diagnoses of dementia. Result: From 96,418 invitations, 14,064 (14%) consented; 12,281 (13%) were eligible. Of these, 6,236 (6%) completed all 10 baseline assessments and were enrolled in the trial. Nearly 70% or 4,365 participants provided follow‐up data. At final 36‐months' follow‐up, 3,482 (55.8%) completed the primary outcome and 2594 (41.6%) had returned informant‐rated Amsterdam‐Instrumental Activities of Daily Living Scale questionnaires. Conclusion: Online strategies to prevent cognitive decline in 55‐77 year olds are feasible and appear acceptable for more than half of participants. Analysis of group*time effects will be presented. [ABSTRACT FROM AUTHOR]

Background: Technology and web‐based approaches potentially provide scalable population‐based interventions to reduce modifiable risk factors for dementia. Key issues in online interventions are recruitment and retention. To devise strategies to improve population reach We investigated which factors influence recruiting and maintaining participants in such an intervention, the in‐progress Maintain Your Brain trial. Method: Invitations were sent to people aged 55‐77 years from the 45 and Up study, a population‐based cohort study of one in ten people aged 45 years and older in New South Wales, Australia (n = 267,000). For MYB, participants were required to be eligible for at least one of four modules to be enrolled (physical activity, nutrition, brain training and mental wellbeing). All participants received modules based on their risks and were randomly allocated to either personalised coaching (intervention) or static information (control). Associations between participant characteristics (listed Table 1) and likelihood of completing set assessment tasks was assessed at two key stages – end of baseline and end of 12‐month follow‐up using stepwise (forward) regression. Results: Of 96,418 people invited, 12,281 (13%) participants started baseline and completed a mean of 6.2 (SD 4.3) of ten assessments. Of these, 6,236 (6%) were enrolled in the trial. At 12‐months participants completed a mean of 5.0 of 8 assessments (SD = 3.8). Completion rate of the primary outcome (two tasks) was 62% (3,869). In the final regression model for baseline (Table1), overall associations were weak even though statistically significant, with only years of education not entered in the final model. The follow‐up model included retirement status, gender, baseline dementia risk and baseline wellbeing. However, this model (df1 = 1, df2 =6231; R2 =.01) accounted for even less variation than baseline model (R2 =.04). Conclusion: Overall, regression models of participant characteristics accounted for a low amount of variation in task completion rates at both baseline and follow‐up. Participants were less likely to complete baseline tasks if they were older, male, not living with a spouse or alone and not retired or had lower dementia risk score and more psychological distress. [ABSTRACT FROM AUTHOR]

Background: Dementia has no pharmacological cure. Therefore, lifestyle interventions targeting modifiable risk factors to reduce cognitive decline are of interest. This study examines the cross‐sectional relationships between two potentially protective behaviours: Mediterranean diet (MediDiet) adherence and physical activity (PA). Method: Participants were recruited from the Sax Institute's 45 and Up Study into the Maintain Your Brain trial. MediDiet adherence was assessed using the validated Mediterranean Diet and Culinary Index (MediCul) tool. The 50‐item tool consists of 17 sub‐categories focusing on key aspects of the MediDiet. Leisure time PA was assessed by a standard questionnaire and intensity was quantified using the BORG Rating of Perceived Exertion (RPE) scale, modified for strength and aerobic activities. Associations between the MediDiet and PA were investigated using hierarchical linear regression and analysis of covariance. Result: 6236 participants [55‐77 years; mean (SD)=65.0 (5.8)] completed baseline assessments and were included. Mean (SD) MediCul score was 53.2 (13.0)/100), indicating low adherence to the MediDiet. Only 5% of participants achieved a score consistent with better cognitive outcomes in The PREDIMED study. Almost one‐half of participants (48.4%) met aerobic PA (150 min/week) but less than one‐quarter (24.2%) met resistance training (RT) recommendations (2 days/week). Unadjusted MediCul score explained a small but significant amount of the variance for light (1.0%) and moderate‐vigorous (MV) (3.1%) PA, both p<0.001. For light PA, the final model, including MediCul, age, sex, BMI, CAGE (alcohol use) score and diabetes explained 2.8% of the variance. For MV PA, the final model including MediCul, age, sex, BMI, CAGE, depression, diabetes and education explained 10.9% of the variance. A 10‐point higher MediCul score was associated with an additional 3.3 seconds of light PA/wk and additional 7.5 seconds of MV aerobic PA/wk (both p<0.001). Additionally, MediCul score was significantly higher in participants engaging in 2+days/wk of RT compared to 1 or fewer days/wk (56.6/100 vs. 52.2/100, respectively; p<0.001). Conclusion: Both aerobic and RT PA are significantly but weakly associated with better diet, but the clinical meaningfulness, as well as any causal nature, of these relationships requires further exploration. The outcomes of the MYB trial will contribute substantively to this question. [ABSTRACT FROM AUTHOR]

Background: Following unsuccessful pharmacological interventions, momentum is increasing for prevention of cognitive decline and dementia strategies for which technology and web‐based non‐pharmacological applications provide a scalable population‐based approach1. We describe feasibility of a pilot study of an internet based randomised controlled trial targeting modifiable dementia risk factors. Method: Invitations to participate in the Maintain Your Brain (MYB) Pilot were emailed to 2,000 people aged 55‐77 years recruited from the 45 and Up study, a population‐based cohort study of one‐in‐ten people aged 45 years and older in NSW, Australia (n = 267,000). Modules were designed to address physical inactivity and inactivity‐associated health risks (Physical Activity), Mediterranean‐type diet adherence and poor nutrition associated health risks (Nutrition), cognitive activity (Brain Training) and mental wellbeing (Peace of Mind)2. The 10‐week Pilot aimed to test the procedures of the planned intervention including online system stability. Based on risk factors, participants were randomly allocated to one of four modules (coaching) or information, all delivered digitally. Active coaching participants received weekly module‐specific activities; information participants received static information. Online cognitive testing covered learning and memory, attention and executive function. Linear mixed models, including age, education and sex, were used to test interaction effects (time by group) on each domain. Result: Of 2,000 invitees, 425 (21%) consented of whom 271 (14%) started baseline and 144 (7%) were ultimately enrolled into the study. Participants were aged 55‐77 years (M = 65.9, SD = 5.2), and educated for 9‐29 years (M = 16.6, SD = 3.6); 56% were women (56%). Eighty‐seven (60%) participants were allocated to one of the coaching modules; 57 (40%) to information only. Of participants who completed baseline testing; 69% (n = 99) had a full dataset at follow‐up, (63% of coaching; 77% of information participants). Conclusion: The pilot tested the feasibility of the intervention in recruitment and retention of participants. Internet based interventions, while theoretically appealing, offer challenges eg user friendliness3, technology interface. We describe how these were met in recruitment of 6236 persons for the substantive MYB trial2, currently underway. [ABSTRACT FROM AUTHOR]

Background: The Mediterranean‐style diet (MD) is promoted as one of the healthiest dietary patterns and has been shown to reduce cognitive decline in some randomised controlled trials (RCTs). This pattern is plant‐based with a focus on vegetables, legumes, fish, and olive oil, with low intake of red meats and foods high in sugar and saturated fats. The Maintain Your Brain (MYB) study is an online multi‐domain RCT targeting modifiable risk factors for dementia, including diet. This study investigated cross‐sectional associations between adherence to a MD pattern and cognition. Methods: Participants enrolled in MYB were recruited from the Sax Institute's larger 45 and Up Study, and included those with all baseline MYB assessments (n=6236). Diet was assessed using the validated Mediterranean Diet and Culinary Index tool. This 50‐item tool assesses intake of nine desirable and four undesirable features of the MD diet and allows derivation of the Mediterranean Diet Adherence Screener (MEDAS). Computerised cognitive tests, administered through the MYB digital platform, were used to assess domains of executive function, complex attention, learning and memory and global cognition. Results: Participants were 46% male, with mean (SD) age 65.0 (5.8) years, BMI 26.6 (4.9) kg/m2 and well educated (46% with tertiary education). Higher MEDAS scores were associated with being female, younger, better educated and having a lower BMI (all p<0.001). Overall participant adherence to a MD pattern was low; MEDAS score 6.1 (2.1)/14. After covariate adjustment and correction for multiple analyses in hierarchical linear regression models, better MEDAS scores were significantly associated with worse (lower) z‐scores for executive function (β ‐0.018, p=0.003). For every 1‐point higher MEDAS score, executive function z‐scores were 0.018 lower. This unexpected negative association was clinically very small. There were no significant associations with other cognitive domains. Conclusion: Adherence to a MD was sub‐optimal in this well‐educated Australian sample. The one unexpected finding is likely not clinically meaningful given its size. Additionally, as this was a cross‐sectional study, reverse causality cannot be ruled out. Results from the main MYB RCT will provide data on MD acceptance and impact in a Western dietary environment. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mild cognitive impairment (MCI) is associated with an increased dementia risk. This study reports incidence of MCI subtypes, rates of progression to dementia, and stability of MCI classification. Methods: We examined 873 community-dwelling adults aged 70 to 90 years over 2 years as part of an ongoing population-based longitudinal study, the Sydney Memory and Ageing Study. Neuropsychological testing assessed five cognitive domains, and a diagnosis of no cognitive impairment, MCI, or dementia (follow-up only) was made according to published criteria. Results: The incidence of MCI was 104.6 (95% confidence interval: 81.6–127.7) per 1000 person-years, with higher incidence in men (men, 156.8; women, 70.3). Incidence rates for single-domain amnestic, multiple-domain amnestic, single-domain nonamnestic, and multiple-domain nonamnestic MCI were 47.7, 7.9, 45.0, and 3.9 per 1000 person-years, respectively. The 2-year rate of progression from MCI at baseline to dementia was 4.8%, being highest for multidomain amnestic MCI (9.1%). Of those with MCI at baseline, 28.2% reverted to no cognitive impairment at follow-up. Sensitivity analyses by redefining criteria for cognitive impairment did not affect stability of diagnosis, although changing the threshold of domain impairment reduced baseline MCI prevalence from 36.7% to 5.7% and incidence to 23.5, and increased 2-year progression rate from MCI to dementia to 14.3%. Conclusions: Incidence rates for MCI are higher than previously reported, particularly in men and for single-domain MCI; rates for amnestic and nonamnestic MCI were comparable. Multidomain amnestic MCI was the most likely subtype to progress to dementia, but overall, the diagnosis of MCI, particularly single-domain MCI, shows considerable instability. [Copyright &y& Elsevier]