Preventing Alzheimer's Disease through Behavior Change Research

Investigative teams led by Jeffrey A. Katula, Ph.D., are exploring the impact of multidomain interventions involving nutrition, exercise, cognitive training, and vascular risk monitoring on cognitive decline in older adults at risk for Alzheimer's disease. The study focuses on achieving and sustaining behavior change to benefit cognitive health in older populations.

• Alzheimers prevention
• Behavior change research
• Cognitive health
• Older adults
• Multidomain intervention

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1. CHANGING MULTIPLE BEHAVIORS TO PREVENT ALZHEIMER'S DISEASE JEFFREY A. KATULA, PH.D.FOR THE US POINTER INVESTIGATIVE TEAM

2. INVESTIGATIVE TEAM Karolinska Institutet & National Institute for Health & Welfare Wake Forest School of Medicine Coordinating Center WFSM Clinical Site USC/ATRI Jeff Williamson, MD Jo Cleveland, MD Ben Williams, MD Bonnie Sachs, PhD Rema Raman, PhD Gus Jimenez-Maggiora Robert Rissman, PhD Miia Kivipelto, MD PhD Tiia Ngandu, MD PhD Alina Solomon, MD PhD Laura Baker, PhD Mark Espeland, PhD Jeff Katula, PhD Nancy Woolard Jin Su, PhD Scott Rushing Julia Robertson Iris Leng, PhD Dan Beavers, PhD Sam Lockhart, PhD Rush U Medical Center U of California Davis *Clinical Site Brigham & Women s Hospital Alzheimer s Association Y-USA Martha Clare Morris, ScD Jennifer Ventrelle, MS Rachel Whitmer, PhD Sarah Farias, PhD, Charlie DeCarli, Kate Papp, PhD Dorene Rentz, PhD Yakeel Quiroz, PhD Maria Carrillo, PhD Heather Snyder, PhD Valerie Lawson, MS RD JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 MD JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

3. Subsequent Findings MULTIDOMAIN INTERVENTION Nutrition Exercise Cognitive training Vascular risk monitoring Intervention? vs.? Control? group Hazard Ratio? 95%? CI 0.80? ? ? 0.66? - 0.98 1+? chronic? disease 0.74? ? ? 0.51? - 1.06 2+? chronic? disease 0.38? ? ? 0.16? - 0.88 3+? chronic? disease 60% lower risk 1.2 1 1 Hazard? Ratio N = 1260 Age: 60-77 years 2 years 0.67* 0.8 0.6 0.4 0.2 REGULAR HEALTH ADVICE 0 Control Intervention 30% lower risk of ADL decline Kulmala et al., in press; Ngandu et al., Lancet 2015 Marengoni et al., JAMDA 2017 JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

4. OBJECTIVES Cohort: increased risk for cognitive decline: sedentary, poor diet, cardiovascular health status, 1st degree family history. Cognitively normal older adults (60-79 years) N=2000; 5 clinical networks Random allocation: Self-Guided Lifestyle Intervention Structured Lifestyle Intervention Primary Outcome: JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 Cognitive trajectory (global cognitive composite outcome) 24 months of follow up JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

5. COMMUNITY PARTNERSHIP Community Partners Research Clinic Intervention Delivery Participant Support & Encouragement Adherence Monitoring Screening Enrollment AE Monitoring Outcomes Alzheimer s Association Chapter Lead Intervention Director Interventionists Navigators Supervisory JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 Participants Partnership

6. SELF-GUIDED LIFESTYLE INTERVENTION Healthy Lifestyle Practices Education Group meetings 3 year 1 2 year 2 Physical Activity Diet Cognitive Activity CVD Risk Factors Annual guideline-based health monitoring Blood pressure CVD risk factors Body weight Incentives/Tools Resources to support behavior change JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

7. STRUCTURED LIFESTYLE INTERVENTION Guideline-based Health Coaching Cognitive Training Physical activity Nutrition JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

8. GROUP-MEDIATED COGNITIVE BEHAVIORAL MODULE Physical activity MIND Nutrition Cognitive Training Health Coaching Exercise Safety Nutrition Technology Behavioral Domain Roll out Education Self- Group- processes regulation Motivation Goal-setting Cohesion Reality sharing Normalizing JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 Relapse-prevention Success/Barriers JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

9. PARTICIPANT TRACKING/MANAGEMENT Technology Cognitive Training Wellpepper Interactive patient management system Integrates 3rd party vendors & study DMS Communication with participants Regular Contact Group meetings Telephone contacts JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

10. BEHAVIOR CHANGE Social Cognitive Theory Self-determination Theory Physical/Community Social/Interpersonal Communication Motivational Interviewing Theoretical Foundations Environment Accountability/ Support Groups/tribes Navigators Interventionists Group processes Relationships JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 Toolbox JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

11. OTHER CONCERNS Nonconscious processes Other behaviors (e.g., Sleep) Upstream Socio-cultural influences JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

12. FINGER Can-Thumb Netherlands U.K. FINGER U.S. POINTER MIND FINGER Germany, Spain, Italy Japan Mexico India SINGER Maintain Your Brain alz.org/wwfingers JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 Argentina

13. OUTCOMES Cognitive Domain Outcomes Tests Free and Cued Selective Reminding Test Immediate and Delayed Story Recall Memory Immediate and Delayed Visual Paired Associates Primary Composite Number Span Forward, Backward, Sequencing Word Fluency by Letter Executive Function & Processing Speed Word Fluency by Category Digit Symbol Substitution Test Trail-Making Test, Condition A Trail-Making Test, Condition B Mini-Mental Status Exam Global Cogstate One-Card Learning Cogstate Face Name Associative Memory Exam Memory Secondary / Experimental Cogstate Behavioral Pattern Separation of Objects Executive Function & Processing Speed Cogstate Detection and Identification Cogstate One Back Digital Cognition Technologies Clock Drawing JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

14. SELF-GUIDED ARM CONTACT SCHEDULE Self-guided Lifestyle Intervention JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018

15. CONTACT SCHEDULE JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018 JEFFREY KATULA, "ACHIEVING AND SUSTAINING BEHAVIOR CHANGE TO BENEFIT OLDER ADULTS" DEC 6-7, 2018