Cognition in older adults improved in clinical trial using 45 and Up participants

An online lifestyle intervention has significantly improved cognition in older adults, according to findings from a landmark clinical trial using 6000 participants from the Sax Institute’s 45 and Up Study. 

Findings from the Maintain Your Brain trial, published in Nature Medicine, showed that an internet-delivered coaching program that targeted physical activity, brain training, nutrition and mental health prevented cognitive decline in older adults at risk of dementia over a three-year period.

The intervention is cost effective and scalable on a population level, said Professor Henry Brodaty AO, Chief Investigator of the Maintain Your Brain trial and Co-Director of UNSW’s Centre for Healthy Brain Ageing (CHeBA). “We could essentially reduce worldwide dementia prevalence if this trial were implemented to the wider population.”

The findings have received widespread media attention, including coverage on ABC News, Channel 7 and SBS News, plus in-depth interviews with Professor Brodaty on programs such as The Health Report.

There are currently more than 400,000 Australians living with dementia, with that figure predicted to jump to more than 800,000 people over the next 30 years.   

Dr Martin McNamara, Chief Investigator of the 45 and Up Study and Sax Institute CEO, welcomed the findings. “We’re grateful to the thousands of 45 and Up Study participants who took part in this important trial. They’ve helped to create powerful evidence that could make a difference to the health of many Australians.”

The 45 and Up Study has followed 250,000 Australians since 2005 and is one of the largest ongoing studies into health and ageing. More than 100,000 people from the 45 and Up Study have taken part in trials and sub-studies over the past 15 years.

How the trial worked

The Maintain Your Brain trial is the largest internet-based trial ever conducted to attempt to prevent cognitive decline and dementia, with involvement from numerous research institutions including UNSW, University of Sydney, Western Sydney University, University of Melbourne, Monash University, and Flinders University.

Researchers recruited more than 6000 participants from the 45 and Up Study, who were from metropolitan, rural and remote areas and aged 55-77. Participants were without dementia but carried at least two of the major risk factors for dementia.

The Maintain Your Brain trial specifically tested whether improving lifestyle behaviours can slow cognitive decline. Half of the participants received an intervention for 12 months which included personalised lifestyle coaching on up to four areas – physical activity, brain training, nutrition and depression/anxiety – while the control group received publicly available information.

Cognition was measured every 12 months over three years, using online tests that measured memory, reasoning and speed of information processing.

Key findings from the trial

Both groups in the trial showed improved cognition, but the intervention group demonstrated the greatest benefit to date in a randomised control trial to prevent cognitive decline.

A Mediterranean diet with limited meat and dairy, an increase in moderate-vigorous intensity exercises and specific types of computerised brain training were among the changes that led to an improved cognition score.

The findings suggest personalising interventions and targeting a broad range of lifestyle factors are important for success, said Professor Brodaty. “Participants aged 55-65 showed greater benefit than those aged 66-77, suggesting we should consider starting prevention programs earlier.”

Chair of CHeBA’s Advisory Committee, Ita Buttrose AC OBE, said these findings should be celebrated. “We now have clear evidence to support a national dementia prevention program,” said Buttrose. “It is now time for Australia to think seriously about long term goals, to acknowledge the evidence and embrace the need for investment in prevention.”