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The promise of transcranial direct-current stimulation (tDCS) as a modulator of cognition has appealed to researchers, media, and the general public. Researchers have suggested that tDCS may increase effects of cognitive training. In this study of 123 older adults, we examined the interactive effects of 20 sessions of anodal tDCS over the left prefrontal cortex (vs. sham tDCS) and simultaneous working memory training (vs. control training) on change in cognitive abilities. Stimulation did not modulate gains from pre- to posttest on latent factors of either trained or untrained tasks in a statistically significant manner. A supporting meta-analysis ( n = 266), including younger as well as older individuals, showed that, when combined with training, tDCS was not much more effective than sham tDCS at changing working memory performance ( g = 0.07, 95% confidence interval, or CI = [-0.21, 0.34]) and global cognition performance ( g = -0.01, 95% CI = [-0.29, 0.26]) assessed in the absence of stimulation. These results question the general usefulness of current tDCS protocols for enhancing the effects of cognitive training on cognitive ability.

Introduction: Lifetime exposure to occupational complexity is linked to late-life cognition, and may affect benefits of preventive interventions. Methods: In the 2-year multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we investigated, through post hocThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Background: Interventions simultaneously targeting multiple risk factors and mechanisms are most likely to be effective in preventing cognitive impairment. This was indicated in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) testing a multidomain lifestyle intervention among at-risk individuals. The importance of medical food at the early symptomatic disease stage, prodromal Alzheimer’s disease (AD), was emphasized in the LipiDiDiet trial. The feasibility and effects of multimodal interventions in prodromal AD are unclear. Objectives: To evaluate the feasibility of an adapted FINGER-based multimodal lifestyle intervention, with or without medical food, among individuals with prodromal AD. Methods: MIND-ADmini is a multinational proof-of-concept 6-month randomized controlled trial (RCT), with four trial sites (Sweden, Finland, Germany, France). The trial targeted individuals with prodromal AD defined using the International Working Group-1 criteria, and with vascular or lifestyle-related risk factors. The parallel-group RCT includes three arms: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); 2) multimodal lifestyle intervention+medical food (Fortasyn Connect); and 3) regular health advice/care (control group). Primary outcomes are feasibility and adherence. Secondary outcomes are adherence to the individual intervention domains and healthy lifestyle changes. Results: Screening began on 28 September 2017 and was completed on 21 May 2019. Altogether 93 participants were randomized and enrolled. The intervention proceeded as planned. Conclusions: For the first time, this pilot trial tests the feasibility and adherence to a multimodal lifestyle intervention, alone or combined with medical food, among individuals with prodromal AD. It can serve as a model for combination therapy trials (non-pharma, nutrition-based and/or pharmacological interventions).

BackgroundOlder adults have a higher risk of Alzheimer´s disease (AD) and dementia. In terms of morbidity and mortality, they also represent the group most severely affected by the SARS‐CoV‐2 (COVID‐19) pandemic. Since February 2020, the Swedish government recommended different general measures limiting mobility and social contact, to contain the spread of infection. Pandemic‐related changes in lifestyle and access to healthcare could have a negative impact on modifiable factors for AD and dementia.MethodsA digital survey was distributed to the general population (multiple distribution channels, voluntary participation) during the last waves of the COVID‐19 pandemic in Sweden (May/2021 – December/2021). Participants were people aged 60+ years, free of dementia, and living in Sweden. The survey aimed to measure changes in lifestyle (e.g., diet, physical activity), care of vascular/metabolic risk factors (e.g., diabetes, hypertension), as well as psychosocial factors (e.g., depressive symptoms, sleep quality, social isolation) relevant for AD and dementia. The survey is part of the World‐Wide‐FINGERS‐SARS‐CoV‐2 initiative.Results6,918 participants completed the survey, mean age was 67.9 (5.11 SD), 58% were female, 71.6% were from urban areas. Preliminary results showed that, during the pandemic, 27% of participants decreased their physical activity, 26.3% increased intake of unhealthy snacks, 25.7% experienced increased sleep problems. Also, 58.7% had less contact with family, 40.4% experienced loneliness, 24.7% experienced worsening of memory, and 26.8% rated their health worse than before the pandemic. On the other hand, the reported increase in consumption of vegetables and fruits was 14.1% and 15.7%, respectively, and 65.2% of people had increased the use of digital services to keep in contact with family and friends. Also, 2.6% of participants decreased smoking, and 11.2% reduced their alcohol consumption. The occurrence of chronic vascular and metabolic diseases and related disruption in access to healthcare is presented in Table 1.ConclusionThe COVID‐19 pandemic has had an effect on modifiable factors for AD and dementia in Swedish older adults. These changes can affect future AD/dementia occurrence and should be addressed in forthcoming interventions for AD/dementia risk reduction and prevention. The survey can also be used for pre‐screening participants for prevention trials.

Background Higher occupational complexity has been associated with better cognition in late life, but associations with brain changes remain unclear. We assessedwhether occupational complexity was associated with baseline brain structural MRI measures and PIB‐PET amyloid burden in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Method FINGER is a two‐year, population‐based, multicenter, multidomain randomized controlled trial. Inclusion criteria included age 60‐77 years; Cardiovascular Risk Factors, Aging and Dementia Risk Score of at least 6; cognition at a mean level or slightly lower than expected for age. Participants (n=1260) were randomly assigned in a 1:1 ratio to a multidomain intervention group (diet, exercise, cognitive training, vascular risk management) or a group receiving general health advice. Primary outcome was change in cognition (Neuropsychological Test Battery). Occupational complexity with data, people, and substantive complexity were classified through the Dictionary of Occupational Titles. The MRI analyses included a subgroup of 126 participants from three different FINGER study sites and the PiB‐PET measures included 42 participants from one study site. MRI regional cortical thickness and volumes were measured using the Freesurfer image analysis suite (version 5.0.3). Linear, logistic, and ordinal logistic regression models were used to assess the association between occupational complexity and neuroimaging measures, adjusting for age, sex, education, intracranial volume, and study site. Neuroimaging assessments included hippocampal and total gray matter volume, Alzheimer´s disease signature thickness, visually rated medial temporal atrophy (MTA), and amyloid accumulation. Result There was no association between occupational complexity and brain cortical thickness, volume measures, or PiB‐PET measures. Conclusion No association between occupational complexity and brain structure and amyloid burden was found in older adults at increased risk of dementia. These findings should be verified in larger cohorts.

Background Life‐long mental stimulation through occupational complexity has been associated with late‐life cognition and might affect the rate of cognitive changes in randomized controlled trials (RCTs) testing preventive interventions for dementia. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER, ClinicalTrials.gov NCT01041989) is a landmark RCT that tested a lifestyle‐based multidomain intervention in 1260 community‐dwellers aged 60‐77 years at increased risk of dementia. Participants were randomized to either a group that received general health advice, or a 2‐year multidomain intervention that incorporated dietary counselling, exercise, cognitive training, and vascular/metabolic risk monitoring. The intervention improved global cognition (primary outcome) and cognitive sub‐domains including executive function, processing speed, and memory. This study aimed to test if the cognitive benefits of the 2‐year multimodal intervention were linked to baseline levels of occupational complexity. Method Study participants: all randomized FINGER participants with at least one cognitive outcome assessment after the baseline visit (modified intention‐to treat population), available data on last held occupation, and who were retired (N: 1026). Occupational complexity was assessed through a validated rating system, identifying three domains: complexity with data; complexity with people; and substantive complexity. Cognition was assessed at baseline, 1‐year and 2‐year with the Neuropsychological Test Battery (NTB). The following cognitive outcomes were considered: global cognition, executive function, processing speed, and memory. Data analysis: Mixed‐model repeated‐measures analyses with maximum likelihood estimation were used to analyse change in cognitive scores as a function of randomization group, time, levels of occupational complexity (standardized Z‐scores), their interaction (randomization group × time × occupational complexity), age, sex, education, study site. Result Subjects with higher levels of occupational complexity with data (i.e., occupations more mentally demanding) benefitted most in terms of improvement in executive function (interaction coefficient group × time × occupational complexity: ß[SE]: .03 (.01), p= .044) and global cognition (ß[SE]: .02 (.01), p= .060). Conclusion The cognitive change in a multidomain preventive intervention can be affected by previous occupational complexity. This facet of mental stimulation should be further investigated within RCTs for cognitive impairment.

Background global population aging and forecasted trends of modifiable risk factors for dementia and Alzheimer’s disease (AD) make prevention of these conditions an urgent priority. The World‐Wide FINGERS (WW‐FINGERS) global network of multidomain trials for dementia risk reduction and prevention is at the forefront of efforts to find effective and sustainable solutions for diverse population. The COVID‐19 pandemic has caused changes in the mental and physical health of older adults, which can influence dementia risk and prevention opportunities. Methods The WW‐FINGERS‐SARS‐CoV‐2 survey was developed to assess direct and indirect effects of the COVID‐19 pandemic in older adults. The questionnaire measures changes in lifestyle factors (e.g., diet, physical activity), management of chronic noncommunicable diseases (e.g., diabetes, hypertension), and psychosocial factors ‐including depressive symptoms, sleep disorders, social isolation‐ that are relevant to cognition. Both a pen‐and‐paper and a digital version of the survey have been developed in several languages. The digital version is supported through REDCap (Research Electronic Data Capture), which is used also for harmonized data collection. Results 30 countries are participating in the survey. As for January 2022, data have been collected from 20 countries, with 23000+ participants. Local adaptations and piloting were done to optimize implementation in clinical‐based and population‐based settings. Participants are in the at‐risk spectrum for dementia: from normal cognition to pre‐dementia cognitive symptoms. Timing of the survey implementation varies across populations, allowing to capture short, medium and long‐term effects of the pandemic and restrictions measures. Some countries have used the survey to recruit participants in multimodal prevention trials. An updated report of the survey status and main results will be presented. Conclusion The WW‐FINGERS‐SARS‐CoV2 survey is a joint global action of the WW‐FINGERS network which can inform better care of older adults in the context of a pandemic. The survey is also a valuable tool for pre‐screening of participants for prevention trials, and results can inform adaptions to ensure successful recruitment and adherence in forthcoming multidomain trials for dementia prevention in older adults.