MIND food and speed of processing training in older adults with low education, the MINDSpeed Alzheimer's disease prevention pilot trial.

BACKGROUND: Multiple national organizations and leaders have called for increased attention to dementia prevention in those most vulnerable, for example persons with limited formal education. Prevention recommendations have included calls for multicomponent interventions that have the potential to improve both underlying neurobiological health and the ability to function despite neurobiological pathology, or what has been termed cognitive reserve. OBJECTIVES: Test feasibility, treatment modifier, mechanism, and cognitive function effects of a multicomponent intervention consisting of foods high in polyphenols (i.e., MIND foods) to target neurobiological health, and speed of processing training to enhance cognitive reserve. We refer to this multicomponent intervention as MINDSpeed. DESIGN: MINDSpeed is being evaluated in a 2 × 2 randomized factorial design with 180 participants residing independently in a large Midwestern city. Qualifying participants are 60 years of age or older with no evidence of dementia, and who have completed 12 years or less of education. All participants receive a study-issued iPad to access the custom study application that enables participants, depending on randomization, to select either control or MIND food, and to play online cognitive games, either speed of processing or control games. METHODS: All participants complete informed consent and baseline assessment, including urine and blood samples. Additionally, up to 90 participants will complete neuroimaging. Assessments are repeated immediately following 12 weeks of active intervention, and at 24 weeks post-randomization. The primary outcome is an executive cognitive composite score. Secondary outcomes include oxidative stress, pro-inflammatory cytokines, and neuroimaging-captured structural and functional metrics of the hippocampus and cortical brain regions. SUMMARY: MINDSpeed is the first study to evaluate the multicomponent intervention of high polyphenol intake and speed of processing training. It is also one of the first dementia prevention trials to target older adults with low education. The results of the study will guide future dementia prevention efforts and trials in high risk populations.

Apolipoprotein E: implications for AD neurobiology, epidemiology and risk assessment.

Alzheimer disease (AD) is a common and devastating dementing illness for which there is no effective neuroprotective therapy or cure. The presence of the apolipoprotein E (apoE) ε4 allele is a well-established genetic modifier (risk factor) of sporadic AD. In this review, we provide an update on the implications of apoE for the neurobiology and epidemiology of AD. Moreover, recent evidence is adduced indicating that (i) many AD risk factors are potentially modifiable by adaptive lifestyle changes and pharmacotherapy and (ii) the potency of these modifiable AD determinants and responsiveness to intervention are often significantly impacted by the presence or absence of the ε4 allele. Delineation of the influences of the APOE genotype on modifiable AD risk factors and prevention may spur consideration of APOE testing for presymptomatic individuals seeking to define their personal risk.