Mobile Health Intervention

Pat & Dennis Bender Early Dementia Diagnosis & Prognosis Fund

 

J. Dennis Bender

Office, Home & Cell Phone: 859-391-5226

5726 La Jolla Blvd. – Suite 311

La Jolla, CA 92037-7345

&

Office - 100 Riverside Pl. - Suite 303

Covington, KY 41011-5711

 

We support the development of improved diagnostic methods for the early detection and diagnosis of MCI, Alzheimer’s, vascular and other dementias, their likely prognosis, and best treatment options. We focus on the development of Bayesian-based, medical-decision-support systems, comparative-effectiveness research, and the better utilization of these for the above. (After incorporating in KY as a 501(c)3 in 2002, we dissolved that entity in favor of a simplified form of two entirely self-financed, private philanthropies utilizing a Vanguard Charitable Trust for making annual-research-grants for early-dementia-detection and its correct differential-diagnosis and likely-prognosis. They will continue on, after I am long gone, either mentally or physically, with annual grants. Scripps Foundation, Profs. Randall Bateman, James Brewer and others will be our fund’s future research grant advisors. KMK Law is our legal advisor and David J. Bender is my Estate Rep. (See: https://www.alz.org/alzheimers-dementia/research_progress/earlier-diagnosis)

 

 This email address is being protected from spambots. You need JavaScript enabled to view it.

www.JDBender.com – EMS/eVTOL & Educational Experimental Aviation Fund (Vanguard Charitable Trust)

www.JDBender.org – Dementia Diagnosis Fund (Vanguard Charitable Trust)

 

May 21, 2024

Study: Prevention of dementia using mobile phone applications (PRODEMOS): a multinational, randomized, controlled effectiveness–implementation trial. Image [Credit: Dragon Images/Shutterstock.com]

 

“This coach-supported mHealth intervention targeting dementia-risk-factors in low-socioeconomic-status-populations in the UK and the general-population in China shows modest-effectiveness in reducing these risk-factors. . . Up to 40% of dementia-cases are linked to modifiable-risk-factors like hypertension, diabetes, obesity, and smoking. . . The intervention-group showed a significant-improvement in the CAIDE-dementia-risk-score compared to the control-group and exhibited reductions in physical-inactivity, smoking, and uncontrolled-risk-factors. . . Combining individual-interventions with broader-structural-changes in the healthcare-system and society is needed to reduce-dementia-risk for current and future-generations significantly.”

 

See, there are simple things one can do to at least slow-down the likelihood of development of dementia, as we have been discussing and helping to fund for years now. These researchers conducted an open-label, hybrid effectiveness-implementation, blinded-endpoint randomized-controlled-trial (RCT) to evaluate whether a coach-supported mobile-health (mHealth) intervention can reduce dementia-risk-factors in high-risk, underserved-populations. This trial involved 1,488 participants aged 55-75-years, of any socioeconomic-status in China and low-socioeconomic-status in the UK, with at least two-dementia-risk-factors. Adherence to the intervention was high, with most-participants setting-goals, sending-messages, and reading-educational-materials. Coaches reported that 79% of interventions were fully-executed according to the protocol. They found that mHealth modestly-improved the dementia-risk-score in the test-group compared to the control-group, with high adoption and active-participation rates. This intervention was found to be cost-effective.

 

Can a Coach-Supported Mobile Health Intervention Reduce Dementia Risk?

By Dr. Sushama R. Chaphalkar, PhD.May 21 2024 Reviewed by Lily Ramsey, LLM - Download PDF Copy

Tags: Aging, Blood, Blood Pressure, Body Mass Index, Cardiovascular Disease, Cholesterol, Clinical-Trial, Coronavirus, Covid-19, Dementia, Depression, Diabetes, Dyslipidemia, Efficacy, Healthcare, Obesity, Smoking

In a recent study published in The Lancet Healthy Longevity, researchers conducted an open-label, hybrid effectiveness-implementation, blinded-endpoint randomized-controlled-trial (RCT) to evaluate whether a coach-supported mobile-health (mHealth) intervention can reduce dementia risk factors in high-risk, underserved populations.

They found that mHealth modestly-improved the dementia-risk-score in the test-group compared to the control-group, with high adoption and active-participation rates, although the implementation was challenging.

Background The prevalence of dementia is expected to exceed 150-million by 2050, primarily affecting low- and middle-income countries and those with a lower-socioeconomic-status in high-income countries.

Up to 40% of dementia-cases are linked to modifiable-risk-factors like hypertension, diabetes, obesity, and smoking, which remain prevalent in underserved-populations. Multidomain-interventions targeting these factors have shown mixed-results in randomized-controlled-trials, often involving healthier-populations in high-income-settings.

mHealth interventions via smartphone-applications could reach underserved, high-risk-populations effectively and cheaply. However, a 2022 systematic-review found inconclusive-evidence on the efficacy and implementation success of mHealth interventions for dementia-prevention, particularly in these underserved groups.

Therefore, in the present trial, researchers developed and tested a coach-supported mHealth intervention to reduce-dementia-risk in high-risk, underserved populations.

About the Study PRODEMOS (short for “prevention of dementia using mobile phone applications”) is a multinational, randomized, open-label, blinded-endpoint clinical-trial using a type-II-hybrid-effectiveness-implementation-design to assess a 12-18-month coach-supported mHealth intervention for reducing-dementia-risk in underserved-populations in the United Kingdom (UK) and China.

The trial involved 1,488 participants aged 55-75-years, of any socioeconomic-status in China and low-socioeconomic-status in the UK, with at least two-dementia-risk-factors.

The following risk-factors were considered: hypertension or hypertension-medication-use, dyslipidemia, diabetes, obesity, depression, current-smoking, and cardiovascular-disease.

The participants were randomized into two groups, the intervention-group (n = 734) and the control-group (n = 754). The mean-age of participants was 63-years, 40% were male, and the mean follow-up-period was 16-months.

The intervention-app facilitated self-management of risk-factors with remote-coaching, while the control-app provided generic-health-information.

Primary-outcomes included changes in CAIDE (short for Cardiovascular Risk Factors, Aging, and Dementia Study) risk-scores and implementation-metrics such as appropriateness, acceptability, coverage, adoption, sustainability, fidelity, feasibility, and costs.

Statistical-analysis involved using ANCOVA (short for analysis-of-covariance), linear-mixed-effects-models, sensitivity-analysis, and subgroup-analysis. Due to coronavirus-disease-2019 (COVID-19)-related delays, the study adjusted the intervention duration to 12-18-months and reduced the target-sample-size, optimizing participant-count and person-months.

Results and Discussion As per the study, the intervention-group showed a significant-improvement in the CAIDE-dementia-risk-score compared to the control-group (-0.16 points, p=0.02).

While there were no significant differences in systolic-blood-pressure, total-cholesterol, and body-mass-index (BMI), the intervention-group exhibited reductions in physical-inactivity, smoking, and uncontrolled-risk-factors.

Adherence to the intervention was high, with most-participants setting-goals, sending-messages, and reading-educational-materials. Coaches reported that 79% of interventions were fully-executed according to protocol.

The perceived-appropriateness and acceptability were rated positively at 85% and 81%, respectively, with overall-feasibility deemed fair, as reported by intervention participants and coaches. Additionally, the intervention was found to be cost-effective. No-significant-differences were observed in adverse-events between the study-arms.

Overall, the intervention effectively-reduced-dementia-risk-factors but encountered implementation-challenges. The study's strengths lie in its cross-country-design, enhancing generalizability, combined evaluation of effectiveness and implementation, substantial recruitment from socioeconomically-deprived-areas, and development of a user-friendly-app through co-creation with target-populations.

On-the-other-hand, limitations of the study were low-response-rates, especially in the UK, potential technological-inequalities, uncertainty about translating-risk-score-changes to dementia-incidence, reliance on self-reported-data, and a possible-selection-bias.

Conclusion In conclusion, the coach-supported mHealth intervention targeting dementia-risk-factors in low-socioeconomic-status-populations in the UK and the general-population in China shows modest-effectiveness in reducing these risk-factors.

However, whether this reduction will lead to dementia-prevention remains uncertain and requires larger, longer-term studies. Implementation is feasible but challenging, particularly in reaching the target-populations.

Given the small-effect-size and limited-reach, especially in the UK, the overall-population-impact will likely be minimal.

Combining individual-interventions with broader-structural-changes in the healthcare-system and society is needed to reduce-dementia-risk for current and future-generations significantly.

Journal reference: Van Charante et al. (2024) Prevention of dementia using mobile phone applications (PRODEMOS): a multinational, randomized, controlled effectiveness–implementation trial, The Lancet Healthy Longevity. doi: https://doi.org/10.1016/S2666-7568(24)00068-0.  https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00068-0/fulltext#seccestitle10

Draft

 

 

{Mobile Health Intervention}