Earlier this year, the Journal of American Medical Association (JAMA) published an article entitled “Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults." (Yaffe et al. 2024) The purpose of the study in this prestigious medical journal, was to determine if a multi-pronged program featuring health coaching might reduce dementia risk in group of at-risk adults averaging nearly 76 years of age. In the ever-growing body of research defining health and well-being coaching (HWC), this is one of the first studies to directly address dementia – a debilitating and feared condition associated with old age. The design of this study was unique in that it targeted a personalized approach to risk reduction and used HWC to deliver the intervention. Here are some of the details of this important and applicable work.
WHO: Participants in this study were dementia-free but had two or more dementia risk factors which include: 1) physical inactivity, 2) uncontrolled hypertension, 3) poor sleep, 4) prescription meds affecting cognition, 5) high depressive symptoms, 6) uncontrolled diabetes, 7) social isolation, and 8) currently smoking. These were all independently living older adults who were part of the Kaiser-Permanente Health Care System. Participants (N = 172) were randomized into the intervention or control group for this two-year randomized and controlled trial (RCT).
HOW: The study was conducted before and during the COVID pandemic making much of the intervention remotely delivery. Dementia risk was assessed for each participant and health coaches helped them prioritize related goals and then work toward achieving those goals. Sessions were initially about 45 minutes long every 4-6 weeks, and after three months, were reduced to about 20 minutes every six weeks for the next 15 months. A nurse was also part of the primary care team meeting every three months with those participants who had uncontrolled diabetes, hypertension, or risky meds.
MEASURED: The primary outcome was a neuropsychological test battery measuring attention, memory, language, and global cognition. The authors also measured physical activity using a written scale and a waist-worn accelerometer. Blood pressure and A1C (diabetes indicator) were measured along with quality of life, sleep quality, social isolation, depression, and smoking. These measures were made every six months.
FINDINGS: When the composite cognitive outcome measure was assessed, the HWC group improved substantially more than the control group. The intervention participants also had a significantly better dementia risk profile at the end of the study than the control group. In general, most other outcome measures (quality of life, sleep, social satisfaction, depression) showed the HWC participants to be better off than the control participants who did not receive HWC. Finally, those who received HWC expressed greater satisfaction with the study protocol than the controls, who were given relevant health education materials to read and apply.
WOW: This study demonstrated that an intervention featuring HWC could very possibly alter the trajectory for the development of dementia in older adults. Alzheimer's and other related dementia diseases are some of the most feared and dreaded conditions associated with aging. When asked, most people would rather not live than to go on with severe cognitive decline. This is not the first study to show that risk factor reduction can improve cognition. What makes this RCT unique is the personalized, or client-centered approach, ……AND the extensive of use of health coaches to deliver the intervention. According to the authors, this approach appears to be more effective than what is seen in other studies that emphasize a general and directed risk reduction for all participants.
The authors go on to say that COVID may have affected some of their outcome measures (e.g., social isolations) and the delivery of the intervention (remote rather than in-person sessions). BUT …..they guess the HWC treatment effects might have been better if not for this interruption in their protocol.
WRAP-UP: The application of HWC continues to grow. Prolonging a lifespan with effective cognitive function is the hope of just about every aging person. Doing this without extensive medication and medical intervention is a further goal that may be considered icing on the cake. This JAMA-published study asks if HWC can be part of the solution to this pressing problem. What we see is that It appears HWC has the potential to be of great help to older adults, especially those with greater risk for cognitive decline. This is just another great example of how applying HWC can successfully assist with prevention of a life-threatening medical condition (see diabetes, heart disease, obesity) through lifestyle modification. As the client base for HWC expands, it becomes clear how important this strategy may be as a global healthcare intervention.
References
Yaffe K, Vittinghoff E, Dublin S, Peltz CB, Fleckenstein LE, Rosenberg DE, Barnes DE, Balderson BH, Larson EB. Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults: The SMARRT Randomized Clinical Trial. JAMA Intern Med. 2024 Jan 1;184(1):54-62. doi: 10.1001/jamainternmed.2023.6279.