Exercise, intensive CV risk reduction minimally beneficial in people at high risk of dementia

Interventions such as aerobic exercise, intensive pharmacological reduction of cardiovascular (CV) risk factors, or both do not appear to provide significant improvements in cognitive function over 24 months in individuals at high risk of dementia, according to a randomized controlled trial.

The trial had a two-by-two factorial design and included 513 adults aged 60–85 years (mean [SD] age, 68.7 [6.0] years, 63 percent female) who had no dementia but had hypertension, family history of dementia, and/or self-reported subjective cognitive decline.

The participants were randomly assigned to undergo aerobic exercise training, lowering of systolic blood pressure to <130 mm Hg and serum low-density lipoprotein cholesterol with atorvastatin, pharmacological CV risk factor lowering plus exercise, or usual care for 24 months.

Global cognitive function at 24 months from baseline, the primary study outcome, was assessed using the Preclinical Alzheimer Cognitive Composite (PACC) score. Secondary outcomes included changes in the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) fluid composite score and individual test scores.

Of the participants, 443 completed the 24-month study, and 480 were included in the primary data analysis. No statistically significant interactions were observed between intervention groups and time of visits for the primary outcome (p=0.13). At 24 months, PACC scores increased by 0.2 units in the no-exercise group vs 0.3 units in the exercise group (p=0.37) and by 0.3 units in the no-intensive CV risk reduction group vs 0.2 units in the intensive CV risk reduction group (p=0.12).

Similar results were observed for the NIHTB-CB composite score and individual test scores.