DemenPrev

Dementia is considered a public health priority by WHO (2), and the possibility of its prevention is increasingly recognized. There is a window of opportunity to intervene on risk factors from middle age onwards with the possibility of preventing at least 40% of the risk. This prevention potential is high and may be even higher for low-income or middle-income countries (3,4). In Portugal, the estimated prevalence of dementia continues to increase (6) and the burden of vascular pathology in these conditions appears to be disproportionate when compared to that of other countries (5). This suggests that there are many modifiable lifestyle factors, namely those focused on vascular aspects. In this setting, aggravated by the effects of pandemic COVID-19 in this age group, it is a priority to explore various approaches for primary and secondary prevention of dementias. These interventions are difficult to implement and evaluate. The FINGER study was a landmark RCT providing first evidence that the multidomain approach is effective and feasible to prevent cognitive and functional decline among at risk older persons. The primary outcome was changes in cognition, and differences were found that suggested this intervention could help maintain, or even improve, the cognitive status of at-risk community-dwelling older adults (8). DemenPrev adopts the multidomain intervention principles proposed in the FINGERS study (7). The appropriateness of the intervention designed within the project will be evaluated by experts and focus group and feasibility will be studied. The one-year pilot study of the multidomain intervention, focusing on the five components: nutrition, exercise, cognitive training, social activity, and vascular risk factor management, will follow an RCT methodology. A relevant novelty of the proposal is that we intend to train, whenever possible, the technicians of the institutions. Primary outcomes of this pilot study will be feasibility (recruitment and retention rate; adherence). Cognitive status will be a secondary outcome. This project will work as a proof-of-concept that may lead to a solid intervention methodology, adapted to the Portuguese context and scalable to a clinical trial. This application has the support of The World-Wide- FINGERS in the planning, harmonization of methods and application, aligning the study with the international reference network of dementia prevention.