LatAm FINGERS is a trial which includes 12 countries in Latin America designed for the prevention of cognitive impairment in older adults at risk of dementia. What we did is a five-domain intervention including diet, physical exercise, cardiovascular risk control, socialization, and cognitive stimulation. And we had one group who received a very structured intervention with a lot of frequency and intensity and then we had another group who received a flexible intervention that was simply health advice for these same factors...
LatAm FINGERS is a trial which includes 12 countries in Latin America designed for the prevention of cognitive impairment in older adults at risk of dementia. What we did is a five-domain intervention including diet, physical exercise, cardiovascular risk control, socialization, and cognitive stimulation. And we had one group who received a very structured intervention with a lot of frequency and intensity and then we had another group who received a flexible intervention that was simply health advice for these same factors. We recruited participants from 12 different countries and we had a total of more than 1,000 participants. What we found is that the systematic group, the one who received the structured and intensive intervention, improved 55% more than the group that received only health advice. Both groups improved, but the group that received the systematic lifestyle intervention improved a lot more, significantly more than the flexible lifestyle intervention over two years. They improved in global cognition, but they also improved in episodic memory, in processing speed, and in attention. And this is groundbreaking because this is the first multi-domain trial to find effects in all of these three domains. It’s the first one to find effects on memory. And we think that this has to do with our population being more deprived, having more risk factors for dementia. We had like a lower baseline functioning population than the other trials. So the clinical implications are barriers on the first place that if you provide a structured lifestyle intervention you can make significant improvements and that health advice is not enough; health advice helps you to improve people getting knowledge about what is good for the brain makes them improve, so that is something you should do always, but it’s not the optimal; the optimal thing is to give them the resources to do this in a structured way, and also the other implication is that it’s not about diet or it’s not about physical exercise cognition, it’s about the synergic effect of the five things; we have to work on the five things together. On the first hand, in our trial, what we tried to do was to test if it was feasible, it was possible to apply such a structured and such a complex multi-domain intervention across Latin America, and the answer was yes, we can do that; it was. We had a very high recruitment rate. We also had a high maintenance and high adherence. So feasibility is possible. But this was possible because we harmonized; we harmonized our trial to international trials like the original FINGER and the US POINTER. But we also harmonized it within Latin America. So what we did is to conserve the core components of the international trials, but we adapted its intervention to the local traditions of the countries. So, for example, countries like Bolivia, that don’t have a coastline, were not required to eat as much fish as other countries like Chile, that has a very big coastline. But the composition of the diet was the same; we replaced ingredients, but we stuck to the protocol. So harmonizing and feasibility are like two sides of the same coin; if you harmonize things well, then they become feasible.
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