Harriet Demnitz-King, Mariam Adeleke, Julie A Barber, Michaela Poppe, Jessica Budgett, Sweedal Alberts, Larisa Duffy, Anne-Marie Minihane, Rachel Gillings, Hannah Chapman, Rosario Isabel Espinoza Jeraldo, Oliver Kelsey, Malvika Muralidhar, Sedigheh Zabihi, Elisa Aguirre, Nicholas Bass, Anna Betz, Henry Brodaty, Alexandra Burton, Paul Higgs, Rachael Maree Hunter, Jonathan Huntley, Helen C Kales, Iain Lang, Natalie L Marchant, Sarah Morgan-Trimmer, Penny Rapaport, Miguel Rio, Irene Petersen, Zuzana Walker, Kate Walters, Sube Banerjee, Joanne Rodda, Marina Palomo, Claudia Cooper
{"title":"Remote, lower-intensity, multidomain lifestyle intervention for subjective cognitive decline or mild cognitive impairment (APPLE-Tree): a multicentre, single-masked, randomised controlled trial.","authors":"Harriet Demnitz-King, Mariam Adeleke, Julie A Barber, Michaela Poppe, Jessica Budgett, Sweedal Alberts, Larisa Duffy, Anne-Marie Minihane, Rachel Gillings, Hannah Chapman, Rosario Isabel Espinoza Jeraldo, Oliver Kelsey, Malvika Muralidhar, Sedigheh Zabihi, Elisa Aguirre, Nicholas Bass, Anna Betz, Henry Brodaty, Alexandra Burton, Paul Higgs, Rachael Maree Hunter, Jonathan Huntley, Helen C Kales, Iain Lang, Natalie L Marchant, Sarah Morgan-Trimmer, Penny Rapaport, Miguel Rio, Irene Petersen, Zuzana Walker, Kate Walters, Sube Banerjee, Joanne Rodda, Marina Palomo, Claudia Cooper","doi":"10.1016/j.lanhl.2025.100777","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Trials of high-intensity, multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aimed to evaluate the effectiveness of a lower-intensity, personally-tailored dementia prevention programme in improving cognition in adults with subjective cognitive decline or mild cognitive impairment.</p><p><strong>Methods: </strong>We conducted a single-masked, multisite, randomised controlled clinical trial recruiting older adults with subjective cognitive decline or mild cognitive impairment across 11 sites in England. Participants were randomly assigned (1:1) to the 12-month Active Prevention in People at Risk of Dementia through Lifestyle, Behaviour Change and Technology to build Resilience (APPLE-Tree) intervention or to the control condition (usual care plus brief written information about dementia prevention). Randomisation was blocked and stratified by site, with allocations assigned via a remote web-based system. The intervention promoted healthy lifestyles, social connections, enjoyable activities, and self-management of long-term conditions. It comprised ten 1-h group video-call sessions over 6 months, supplemented with alternating, informal, 40-min video-call sessions (termed tea breaks) and individual goal-setting calls between sessions. From months 6 to 12, participants continued with monthly online tea breaks. The primary outcome was cognition (Neuropsychological Test Battery [NTB] score) at 24 months, analysed using an intention-to-treat approach. This trial was pre-registered with the ISRCTN Registry (ISRCTN17325135); further analyses are ongoing.</p><p><strong>Findings: </strong>Between Oct 5, 2020, and Dec 31, 2022, we screened 1287 individuals for eligibility and randomly assigned 746 to the APPLE-Tree intervention (n=374) or control treatment (n=372). There were 177 (47%) women and 194 (52%) men in the intervention group and 173 (47%) women and 198 (53%) men in the control group. The primary outcome analysis included 635 (85%) of 746 participants. Mean NTB scores increased in both groups over time, with greater improvement in the intervention group than in the control group (mean 24-month NTB 0·33 [SD 0·67] vs 0·21 [0·75]; adjusted mean difference 0·06 [95% CI -0·001 to 0·128]; p=0·055). Serious adverse events occurred in 35 (9%) participants in the intervention group and 30 (8%) participants in the control group; none were intervention-related.</p><p><strong>Interpretation: </strong>APPLE-Tree is an accessible intervention associated with small improvements in cognition, although these results were not statistically significant. Low-intensity interventions that can be delivered remotely by non-clinical facilitators have the potential for wide-scale implementation to support adults with memory concerns. However, further work is needed to optimise the intervention for delivery in routine settings.</p><p><strong>Funding: </strong>Economic and Social Research Council and National Institute for Health and Care Research programme grant.</p>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":" ","pages":"100777"},"PeriodicalIF":14.6000,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Healthy Longevity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.lanhl.2025.100777","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Trials of high-intensity, multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aimed to evaluate the effectiveness of a lower-intensity, personally-tailored dementia prevention programme in improving cognition in adults with subjective cognitive decline or mild cognitive impairment.
Methods: We conducted a single-masked, multisite, randomised controlled clinical trial recruiting older adults with subjective cognitive decline or mild cognitive impairment across 11 sites in England. Participants were randomly assigned (1:1) to the 12-month Active Prevention in People at Risk of Dementia through Lifestyle, Behaviour Change and Technology to build Resilience (APPLE-Tree) intervention or to the control condition (usual care plus brief written information about dementia prevention). Randomisation was blocked and stratified by site, with allocations assigned via a remote web-based system. The intervention promoted healthy lifestyles, social connections, enjoyable activities, and self-management of long-term conditions. It comprised ten 1-h group video-call sessions over 6 months, supplemented with alternating, informal, 40-min video-call sessions (termed tea breaks) and individual goal-setting calls between sessions. From months 6 to 12, participants continued with monthly online tea breaks. The primary outcome was cognition (Neuropsychological Test Battery [NTB] score) at 24 months, analysed using an intention-to-treat approach. This trial was pre-registered with the ISRCTN Registry (ISRCTN17325135); further analyses are ongoing.
Findings: Between Oct 5, 2020, and Dec 31, 2022, we screened 1287 individuals for eligibility and randomly assigned 746 to the APPLE-Tree intervention (n=374) or control treatment (n=372). There were 177 (47%) women and 194 (52%) men in the intervention group and 173 (47%) women and 198 (53%) men in the control group. The primary outcome analysis included 635 (85%) of 746 participants. Mean NTB scores increased in both groups over time, with greater improvement in the intervention group than in the control group (mean 24-month NTB 0·33 [SD 0·67] vs 0·21 [0·75]; adjusted mean difference 0·06 [95% CI -0·001 to 0·128]; p=0·055). Serious adverse events occurred in 35 (9%) participants in the intervention group and 30 (8%) participants in the control group; none were intervention-related.
Interpretation: APPLE-Tree is an accessible intervention associated with small improvements in cognition, although these results were not statistically significant. Low-intensity interventions that can be delivered remotely by non-clinical facilitators have the potential for wide-scale implementation to support adults with memory concerns. However, further work is needed to optimise the intervention for delivery in routine settings.
Funding: Economic and Social Research Council and National Institute for Health and Care Research programme grant.
期刊介绍：
The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.
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