Juliane Döhring

Background: Lifestyle interventions provide a promising approach to address higher body weight as a risk factor for dementia. Objective: The AgeWell.de-trial was primarily designed to preserve cognitive function and reduce dementia risk. In this post-hoc analysis, we investigated body weight following the multidomain intervention among older adults with overweight or obesity, as well as the role of motivation and confidence regarding weight loss. Methods: Analyses used data from the cluster-randomized AgeWell.de-trial, testing a multidomain intervention (dietary counselling, enhancement of physical, social and cognitive activity, medication review, intervention for cardiovascular risk factors, depressive symptoms/grief, if applicable) over 24 months in adults aged 60 to 77 years at risk for dementia. Associations between intervention allocation and body weight at follow-up were analyzed using linear regression, controlling for covariates, based on multiply imputed data. Results: The sample included n = 678 participants with a BMI ≥ 25 kg/m², mean age (SD): 68.9 (4.8), 52.1% female. Group allocation was not associated with body weight at 24-month follow-up (b (unstandardized regression coefficient) = -0.30, 95% CI: -0.51; 1.11). Older age (b = -0.14, 95% CI: -0.25; -0.03) and a high level of education (b = -1.28, 95% CI: -2.55; 0.00) were linked to lower body weight at follow-up, while higher baseline body weight predicted higher body weight at follow-up (b = 0.95, 95% CI: 0.91; 0.98). Levels of motivation and confidence regarding weight loss remained high but stable in both groups, regardless of group allocation. Conclusions: In this post-hoc analysis, group allocation was not associated with lower body weight at follow-up. Despite high levels of motivation and confidence regarding weight loss and favorable changes in diet and physical activity in the intervention group, these changes did not translate into measurable weight loss. Trial registration: AgeWell.de was prospectively registered in the German Clinical Trials Register on December 7th, 2017 (DRKS trial identifier DRKS00013555).

Background: Healthy dietary patterns have been linked to reduced risks for cardiovascular diseases and dementia, making nutrition an essential part of a comprehensive approach for dementia prevention. Knowledge about factors associated with a healthy diet in people with increased dementia risk is scarce. Objective: To analyze dietary habits and associated factors in older adults with increased dementia risk in Germany. Methods: We used baseline-data of the AgeWell.de-trial (n = 1001, % _female = 52.2, M _age = 69.0, SD = 4.9). Nutrition was assessed using a composite score, comprising 11 components covered by national recommendations for a healthy diet (range = 0–11 points). Linear regressions assessed associations of sociodemographic, social, health-related and psychological factors with consumption of a healthy diet. Further, we assessed stages of change based on the transtheoretical model of behavior change. Results: Consumption of a healthy diet was moderate (Median = 4, IQR = 2). Female sex (b = 0.64, 95% CI: 0.41, 0.88), higher levels of motivation for healthy eating (b = 0.22, 95% CI: 0.10, 0.34) and higher self-efficacy (b = 0.33, 95% CI: 0.20, 0.46) were linked to a healthy diet. Regarding the stages of behavior change, the majority were in the maintenance stage (45.2%), followed by the contemplation (21.5%) and precontemplation (21.2%) stages. Conclusions: Results suggest room for improvement regarding a healthy diet in our sample. Lifestyle-based interventions in older adults should be tailored towards current levels of motivation and self-efficacy of participants. Including modules targeting motivation and self-efficacy might help maximize intervention effectiveness.

Background: The aim of the study was to analyze the impact of adherence to the intervention components on the effectiveness of AgeWell.de, a multi-domain lifestyle intervention against cognitive decline, on function in everyday activities, quality of life, depressiveness and social isolation. Objective: Studying the effect of adherence on health-related outcomes. Methods: Participants were aged 60–77 years at baseline and at risk (Cardiovascular Risk Factors, Ageing and Dementia Score (CAIDE) ≥9). Adherence to the components nutrition, enhancement of physical and social activities and cognitive training was analyzed in two ways, first continual within the intervention group (n = 378, mean age = 69.1 years, 52.7% female) and second as dichotomous split (75% adherence) and in reference to the control group (received infomaterial and regular health advice; n = 441, mean age = 69 years, 53% female). Generalized linear regression models were then run on the health outcomes functioning in everyday activities, quality of life, depressive symptoms, and social inclusion. Results: Health-related quality of life and depressiveness were improved in participants with better adherence to nutritional counselling and enhancement of physical and social activities. Better adherence to social activities was relevant for function in everyday activities. Effects of high adherence to cognitive training was found for improvements in depressiveness when comparing it to the control group. No effect was found on social inclusion when considering the particular components. Conclusions: The extent of adherence to most components influenced health-related outcomes such as health-related quality of life and depressiveness. With this study, the effectiveness of AgeWell.de can be understood in greater depth. Trial Registration: German Clinical Trial Register (DRKS; ID: DRKS00013555).

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Mobile health apps are useful tools for research and disease management. However, implementation of mHealth apps is lacking in many areas. While mHealth apps offer various advantages to researchers and patients, their effectiveness depends on its actual use by the intended population. Barriers to the adoption of mHealth apps often stem from human factors such as usability or technology acceptance. Objective: This study explores user perceptions of two mHealth apps in the setting of an observational technology evaluation study with the goal to investigate technology acceptance as a barrier to the implementation of mHealth apps in research. Methods: Patients with chronic diseases as well as healthy participants used a symptom and activity e-diary (SAD) and a Cognitive Test App (CTA) over the course of four weeks within the IDEA-FAST Feasibility study. Thereafter, 61 qualitative interviews were conducted, recorded and transcribed. A qualitative content analysis using the Unified Theory of Acceptance and Use of Technology (UTAUT) was performed. Results: As the apps did not directly impact the participants’ health, motivation and adherence to schedule were issues with actual use. Some users perceived the SAD as a burden, while others enjoyed tracking their symptoms. The three tests of the CTA differed in popularity. While one test was described as repetitive, another was perceived as too hard and frustrated users. An important aspect of motivation for participants was feedback on their data and performance. While using the apps was quick, the fixed periods of use were more problematic, as they could lead to conflicts with a user’s daily life. Participants preferred using their own phone. The support provided by written instructions and the study team was sufficient for most participants. Participants stressed the importance of good relations with the study team. Conclusions: In choosing suitable applications, one size will certainly not fit all. For medical research, pre-testing of all materials with the potential users is of utmost importance. When an app seemingly does not provide direct impact on the users’ health, other factors can motivate usage, e.g. feedback, gamification, adjustable functions, applicability on all smartphone operating systems and good relations to the study team.

Purpose: Quality of Life (QoL) is associated with a bandwidth of lifestyle factors that can be subdivided into fixed and potentially modifiable ones. We know too little about the role of potentially modifiable factors in comparison to fixed ones. This study examines four aspects of QoL and its associations with 15 factors in a sample of elderly primary care patients with a high risk of dementia. The main objectives are (a) to determine the role of the factors in this particular group and (b) to assess the proportion of fixed and potentially modifiable factors. Method: A high-risk group of 1030 primary care patients aged between 60 and 77 years (52.1% females) were enrolled in “AgeWell.de,” a cluster-randomized, controlled trial. This paper refers to the baseline data. The multi-component intervention targets to decrease the risk of dementia by optimization of associated lifestyle factors. 8 fixed and 7 modifiable factors potentially influencing QoL served as predictors in multiple linear regressions. Results: The highest proportion of explained variance was found in psychological health and age-specific QoL. In comparison to health-related QoL and physical health, the modifiable predictors played a major role (corr. R²: 0.35/0.33 vs. 0.18), suggesting that they hold a greater potential for improving QoL. Conclusion: Social engagement, body weight, instrumental activities of daily living, and self-efficacy beliefs appeared as lifestyle factors eligible to be addressed in an intervention program for improving QoL. Trial registration: German Clinical Trials Register, reference number: DRKS00013555. Date of registration: 07.12.2017.

To develop effective dementia prevention strategies, it is necessary to understand risk factors, associated factors and early signs of dementia. Subjective cognitive decline (SCD) is the earliest form of dementia. The aim of this study is to assess depression as a factor that is significantly associated with SCD. The data of 1030 general practitioner patients from the AgeWell.de-study (60–77 years; CAIDE dementia risk score ≥ 9) were analysed. A descriptive analysis was conducted using validated instruments like the Geriatric depression scale (GDS), Lubben social network scale (LSNS-6) and education classes according to CASMIN (Comparative Analysis of Social Mobility in Industrial Nations). A multivariate regression model with the dependent variable SCD was calculated. Of the 1030 participants, 5.9% had depressive symptoms and 31.3% SCD. The group with depressive symptoms showed significantly higher body-mass-index (p = 0.005), lower education class (p = 0.022), lower LSNS-6 score (p < 0.001), higher sports activity (p < 0.001), and more sleeping problems (p = 0.026). In the regression model a higher GDS-score [Odds ratio (OR): 1.219 (p < 0.001)], more sleeping problems [OR: 1.550 (p = 0.017)] and higher education class [middle/high: OR: 1.474/1.875 (p = 0.037/0.004)] were significantly associated with SCD. This study identified depressive symptoms, sleeping problems, and higher education classes as factors associated with SCD, which can represent an early form of dementia.

Our study aims to examine the associations of sociodemographic factors, social support, resilience, and perceptions of the COVID-19 pandemic with late-life depression and anxiety symptoms in a cardiovascular risk group and a matched sample from the German general population during the beginning of the pandemic and draw a comparison regarding psychosocial characteristics. Data of n = 1236 participants (aged 64–81 years) were analyzed, with n = 618 participants showing a cardiovascular risk profile, and n = 618 participants from the general population. The cardiovascular risk sample had slightly higher levels of depressive symptoms and felt more threatened by the virus due to pre-existing conditions. In the cardiovascular risk group, social support was associated with less depressive and anxiety symptoms. In the general population, high social support was associated with less depressive symptoms. Experiencing high levels of worries due to COVID-19 was associated with more anxiety in the general population. Resilience was associated with less depressive and anxiety symptoms in both groups. Compared to the general population, the cardiovascular risk group showed slightly higher levels of depressive symptomatology even at the beginning of the pandemic and may be supported by addressing perceived social support and resilience in prevention programs targeting mental health.

This study aims to describe social network and social participation and to assess associations with depressive symptoms in older persons with increased risk for dementia in Germany. We conducted a cross-sectional observational study in primary care patients (aged 60–77) as part of a multicenter cluster-randomized controlled trial (AgeWell.de). We present descriptive and multivariate analyses for social networks (Lubben Social Network Scale and subscales) and social participation (item list of social activities) and analyze associations of these variables with depressive symptoms (Geriatric Depression Scale). Of 1030 included patients, 17.2% were at risk for social isolation (Lubben Social Network Scale < 12). Looking at the subscales, a reduced non-family network was found almost twice as often as a reduced family network. Patients with depressive symptoms had significantly smaller social networks than patients without depression (p < 0.001). They rather engaged in social activities of low involvement level or no weekly social activity at all (p < 0.001). The study shows associations of depressive symptoms with a decreased social network and less social participation in elderly participants. Sufficient non-family contacts and weekly social activities seem to play an important role in mental health and should be encouraged in elderly primary care patients.

Targeting dementia prevention, first trials addressing multiple modifiable risk factors showed promising results in at-risk populations. In Germany, AgeWell.de is the first large-scale initiative investigating the effectiveness of a multi-component lifestyle intervention against cognitive decline. We aimed to investigate the recruitment process and baseline characteristics of the AgeWell.de participants to gain an understanding of the at-risk population and who engages in the intervention. General practitioners across five study sites recruited participants (aged 60–77 years, Cardiovascular Risk Factors, Aging, and Incidence of Dementia/CAIDE dementia risk score ≥ 9). Structured face-to-face interviews were conducted with eligible participants, including neuropsychological assessments. We analyzed group differences between (1) eligible vs. non-eligible participants, (2) participants vs. non-participants, and (3) between intervention groups. Of 1176 eligible participants, 146 (12.5%) dropped out before baseline; the study population was thus 1030 individuals. Non-participants did not differ from participants in key sociodemographic factors and dementia risk. Study participants were M = 69.0 (SD = 4.9) years old, and 52.1% were women. The average Montreal Cognitive Assessment/MoCA score was 24.5 (SD = 3.1), indicating a rather mildly cognitively impaired study population; however, 39.4% scored ≥ 26, thus being cognitively unimpaired. The bandwidth of cognitive states bears the interesting potential for differential trial outcome analyses. However, trial conduction is impacted by the COVID-19 pandemic, requiring adjustments to the study protocol with yet unclear methodological consequences.