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INTRODUCTION: We assessed a genetic risk score for Alzheimer's disease (AD‐GRS) and apolipoprotein E (APOE4) in an exploratory neuroimaging substudy of the FINGER trial. METHODS: 1260 at‐risk older individuals without dementia were randomized to multidomain lifestyle intervention or health advice. N = 126 participants underwent magnetic resonance imaging (MRI), and N = 47 positron emission tomography (PET) scans (Pittsburgh Compund B [PiB], Fluorodeoxyglucose) at baseline; N = 107 and N = 38 had repeated 2‐year scans. RESULTS: The APOE4 allele, but not AD‐GRS, was associated with baseline lower hippocampus volume (β = −0.27, p = 0.001), greater amyloid deposition (β = 0.48, p = 0.001), 2‐year decline in hippocampus (β = −0.27, p = 0.01), total gray matter volume (β = −0.25, p = 0.01), and cortical thickness (β = −0.28, p = 0.003). In analyses stratified by AD‐GRS (below vs above median), the PiB composite score increased less in intervention versus control in the higher AD‐GRS group (β = −0.60, p = 0.03). DISCUSSION: AD‐GRS and APOE4 may have different impacts on potential intervention effects on amyloid, that is, less accumulation in the higher‐risk group (AD‐GRS) versus lower‐risk group (APOE). Highlights: First study of neuroimaging and AD genetics in a multidomain lifestyle intervention.Possible intervention effect on brain amyloid deposition may rely on genetic risk.AD‐GRS and APOE4 allele may have different impacts on amyloid during intervention. [ABSTRACT FROM AUTHOR]

Background: Lifestyle interventions for preventing cognitive decline have provided promising results in older at‐risk individuals. Two modifiable risk factors are insulin resistance and diabetes mellitus, since they've been associated with higher risk of cognitive decline. However, it remains unclear if healthy individuals with higher normal glucose levels are free from suffering the negative effect of pathological glucose values on brain and cognition. The Oral Glucose Tolerance Test (OGTT) is a sensitive measurement for non‐detected glucose metabolism disorders and might be related with changes in brain structure and cognition. In this study we hypothesised that changes in glucose parameters will be associated with brain structural changes. Method: 1.259 participants of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) were included [Table 1]. A sample of 132 participants had brain MRI scans, and 47 also underwent PiB‐PET and FDG‐PET scans. Global GMv, hippocampal volumes, WMHv and cortical thickness measurements were analysed to assess the association between brain structural changes and glucose homeostasis. AD‐signature composites were also calculated from FDG‐PET and PiB‐PET scans data for the analysis. SPSS was used for linear regression models. Results: Baseline AUC‐OGTT, 120min‐OGTT and fasting glucose were negatively associated (p<0.05) with 2‐year change in hippocampal volume [Table 2]. A negative association was also found between baseline AUC and change in FDG‐PET‐AD‐composite (p = 0.028). Three negative associations were additionally found at baseline between AUC‐OGTT and cortical thickness (p = 0.015), fasting glucose and total GMv (p = 0.015), and HbA1c and FDG‐PET‐AD‐composite (p = 0.033) [Table 3]. Interestingly, a positive association was found in a smaller sample (n = 38) between the TyG index and change in PiB‐PET‐AD‐composite (0.014). No associations were found between glucose parameters and the remaining imaging data. Conclusion: In a sample of participants at risk for dementia, baseline higher measures of peripheral glucose metabolism such as AUC‐OGTT and 120min‐OGTT glucose were related to greater decline in hippocampal volume, irrespective of the randomisation group and after considering abnormal glucose metabolism. These results suggest that glucose homeostasis might have an impact on brain structure in participants with higher normal glucose parameters measurements. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to estimate the potential cost‐effectiveness of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) program. Methods: A life‐time Markov model with societal perspective, simulating a cohort of people at risk of dementia reflecting usual care and the FINGER program. Results: Costs were 1,653,275 and 1,635,346 SEK and quality‐adjusted life years (QALYs) were 8.636 and 8.679 for usual care and the FINGER program, respectively, resulting in savings of 16,928 SEK (2023 US$) and 0.043 QALY gains per person, supporting extended dominance for the FINGER program. A total of 1623 dementia cases were avoided with 0.17 fewer person‐years living with dementia. The sensitivity analysis confirmed the conclusions in most scenarios. Discussion: The model provides support that programs like FINGER have the potential to be cost‐effective in preventing dementia. Results at the individual level are rather modest, but the societal benefits can be substantial because of the large potential target population. [ABSTRACT FROM AUTHOR]

Introduction: Lifetime exposure to occupational complexity is linked to late‐life cognition, and may affect benefits of preventive interventions. Methods: In the 2‐year multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we investigated, through post hoc analyses (N = 1026), the association of occupational complexity with cognition. Occupational complexity with data, people, and substantive complexity were classified through the Dictionary of Occupational Titles. Results: Higher levels of occupational complexity were associated with better baseline cognition. Measures of occupational complexity had no association with intervention effects on cognition, except for occupational complexity with data, which was associated with the degree of intervention‐related gains for executive function. Discussion: In older adults at increased risk for dementia, higher occupational complexity is associated with better cognition. The cognitive benefit of the FINGER intervention did not vary significantly among participants with different levels of occupational complexity. These exploratory findings require further testing in larger studies. [ABSTRACT FROM AUTHOR]

Background and aims: Psychosocial factors may affect adherence to lifestyle interventions and lifestyle changes. The role of psychosocial factors in dementia prevention needs more research. We aimed at clarify the issue in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Methods: The population included 1260 participants aged 60–77 years at risk for cognitive decline, randomised to a multidomain lifestyle intervention or regular health advice for 2 years. Adherence was evaluated as participation in the provided activities and actual lifestyle changes, separately for each domain (diet, exercise, social/cognitive activity, vascular risk management) and combined into multidomain. Psychosocial factors were measured at trial baseline (depressive symptoms; study perception; health-related quality of life, HRQoL) and earlier life (hopelessness; satisfaction with family life, achievements, and financial situation). Results: Depressive symptoms, hopelessness, and nonpositive study perception were negatively and HRQoL positively associated with participation in the multidomain intervention. Depressive symptoms, lower HRQoL, hopelessness and dissatisfaction with financial situation were associated with unhealthier lifestyles at baseline. Baseline depressive symptoms and lower HRQoL predicted less improvement in lifestyle, but did not modify the intervention effect on lifestyle change. Discussion and conclusions: Several psychosocial factors were associated with participation in lifestyle intervention, while fewer of them contributed to lifestyle changes. Although the intervention was beneficial for lifestyle changes independent of psychosocial factors, those most in need of lifestyle improvement were less likely to be active. Tailoring lifestyle-modifying strategies based on the need for psychosocial support may add efficacy in future trials. Trial Registry: ClinicalTrials.gov NCT01041989 2010-01-05 [ABSTRACT FROM AUTHOR]

Introduction: Lifestyle interventions may prevent cognitive decline, but the sufficient dose of intervention activities and lifestyle changes is unknown. We investigated how intervention adherence affects cognition in the FINGER trial (pre‐specified subgroup analyses). Methods: FINGER is a multicenter randomized controlled trial examining the efficacy of multidomain lifestyle intervention (ClinicalTrials.gov NCT01041989). A total of 1260 participants aged 60 to 77 with increased dementia risk were randomized to a lifestyle intervention and control groups. Percentage of completed intervention sessions, and change in multidomain lifestyle score (self‐reported diet; physical, cognitive, and social activity; vascular risk) were examined in relation to change in Neuropsychological Test Battery (NTB) scores. Results: Active participation was associated with better trajectories in NTB total and all cognitive subdomains. Improvement in lifestyle was associated with improvement in NTB total and executive function. Discussion: Multidomain lifestyle changes are beneficial for cognitive functioning, but future interventions should be intensive enough, and supporting adherence is essential. [ABSTRACT FROM AUTHOR]

Background: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial that showed beneficial effect on cognition with a 2‐year multidomain lifestyle intervention. One of the four multidomain intervention components was diet and we have earlier shown that overall adherence to the FINGER dietary intervention goals was associated with better cognition. Here our aim is to investigate how the individual components of the dietary adherence score are associated with cognitive performance during the 2‐year period. Method: The FINGER cohort included 1259 individuals at risk of dementia aged 60‐77 years at baseline, randomized into the multidomain intervention (n = 631) or the control group (n = 628). They underwent extensive data collection annually (total of 3 assessments), including detailed neuropsychological test battery (NTB) and a 3‐day food record. Adherence to dietary intervention was evaluated on 9 items based on dietary recommendations: intake of saturated fat, polyunsaturated fat, sucrose, fiber, protein, alcohol, vegetables, fruits, and fish. Data analyses were completed with mixed‐effects regression. Result: The goal for low alcohol intake was inversely associated with cognition at baseline, but no other dietary items showed cross‐sectional associations. Reaching the goal for saturated fat, fiber, vegetables, fruits, and fish predicted better cognitive change at two years (p <0.05 for goal*time each). Results were similar when continuous variables rather than dichotomized goals were investigated. Intake of polyunsaturated fats additionally predicted better cognitive change and vegetable intake showed positive cross‐sectional association with cognition. There were no significant interactions with the study group. Conclusion: Six out of nine FINGER dietary goals predicted a favorable cognitive change over time, indicating that a dietary pattern adherence with general dietary recommendations is beneficial for brain health. However, alcohol intake goal, i.e. lower alcohol intake, was associated with worse cognition; and cut‐offs for polyunsaturated fats based on the recommendations appeared suboptimal. The FINGER dietary adherence score should be compared with food‐based dietary patterns like Mediterranean Diet to investigate if nutrient intakes should be better taken into account when analyzing diet in relation to cognitive performance. [ABSTRACT FROM AUTHOR]

Background: The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) was a 2‐year multidomain lifestyle intervention to prevent cognitive decline. We have earlier reported that lifestyles improved during the original intervention period, both as participation in the intervention during the 2‐year period and adherence to goals of the intervention. Our aim was to study how these lifestyle changes are maintained during the long‐term period following the active intervention. Method: Total of 1259 older adults aged 60‐77 participated in the FINGER trial and were randomized into multidomain intervention (n = 631) or control groups (n = 628). A multidomain lifestyle index (MHLI) was calculated based on self‐reported questionnaire using 12 items to obtain a total score representing all four domains of the intervention: diet, physical activity, cognitive activity, and cardiovascular risk factors (range 0 to 24). The questionnaire was repeated annually during the active intervention period and three times thereafter, total of 6 assessments over 11 years. Mixed‐effects regression analyses were executed. Result: Among the 1259 participants 1117 (88%) completed the original study period and preliminary data were available for 484 at the 11‐year visit (38% of the original cohort; 58% of those invited). Mean MHLI was 13.5 at baseline and lower MHLI score predicted drop‐out during the post‐intervention follow‐up. In the intervention group the MHLI improved during the active period and maintained higher up to 7 years (within‐group change and difference compared with the control group p <0.05 for each year) but no longer at the 11‐year follow‐up. There were no changes in the control group. Age, education, sex, and baseline cognition were all associated with MHLI but did not modify the intervention effect. Conclusion: A multidomain lifestyle intervention among at‐risk older adults can have an impact on multidomain healthy lifestyle up to 5 years after the active intervention. Interestingly, average lifestyle did not decrease in the control group either, which would have been expected due to aging. Ongoing detailed analyses will show if this is explained by selective dropout or if participation in the control group may have had some benefits from the participation as well. [ABSTRACT FROM AUTHOR]

Background: Dementia prevention is a global public health priority. The FINGER multimodal lifestyle intervention is the only intervention model so far that has demonstrated significant cognitive and other health benefits in at‐risk older adults. LETHE proposes a new multimodal precision prevention approach where FINGER intervention is complemented with digital tools to optimize intervention delivery, personalize recommendations based on individual risk profile, and support risk factor self‐management. The multinational 2‐year randomized controlled LETHE pilot trial aims to test the feasibility of a digitally supported, adapted FINGER intervention among older adults at risk of cognitive decline and dementia. Method: A total of 160 individuals aged 60‐77 years and with risk factors for dementia but no substantial cognitive impairment are recruited at four sites (Austria, Finland, Italy, Sweden; N = 40 per country). Digital readiness and experience with smart devices are required. Participants are randomized 1:1 to 1) structured multimodal lifestyle intervention (dietary guidance, exercise, cognitive training, vascular/metabolic risk management, social stimulation, sleep/stress management) where in‐person individual and group‐based activities are supported with the LETHE smartphone app developed in the project; or 2) self‐guided lifestyle intervention (regular health advice and access to a simplified app with no personalized/interactive content). Both groups wear a smartwatch to gather passive data (e.g., activity, sleep). Primary outcomes are retention rate, adherence to intervention and engagement with the app, and change in dementia risk based on validated risk scores (CAIDE, LIBRA). Secondary outcomes are lifestyle changes and changes in cognition, stress‐related symptoms, sleep, health‐related quality of life, and health literacy. Participant experiences will also be explored. The LETHE Advisory Board (members of the public) provided feedback on the trial protocol. Result: Trial is registered at ClinicalTrials.gov (NCT05565170), and ethical approval has been obtained in each country. Recruitment started in September 2022 and will be completed in Spring 2023. Updates and results on study progress will be presented. Conclusion: LETHE pilot trial will inform about the feasibility of technological solutions and a digitally assisted lifestyle program to support brain health among older adults. If proved to induce sustained behavioural changes, digital tools could offer potential for large‐scale, cost‐effective dementia prevention programs. [ABSTRACT FROM AUTHOR]

Background: The successful FINGER multidomain intervention model combined dietary intervention (healthy Nordic diet) with exercise, cognitive training, social activities, and cardiovascular risk monitoring. The FINGER model is being tested and optimized in the World‐Wide FINGERS network of multidomain dementia prevention trials (45+ countries). Advanced FINGER 2.0 models combine lifestyle interventions with multi‐nutrients and/or putative disease‐modifying drugs. Method: The 11‐year extended follow‐up of FINGER trial participants (N:1260, at‐risk general population) was completed in Q1‐2023. The MIND‐AD pilot‐trial (N:93, prodromal Alzheimer's disease (AD)) included medical food (Fortasyn Connect), tested alone or in combination with multidomain lifestyle intervention for 6 months. The MET‐FINGER trial (N:600, at‐risk general population enriched with APOE4‐carriers, 2‐year intervention) includes different dosages of metformin (in combination with upgraded FINGER lifestyle intervention). Result: New nutrition/metabolic related data will be presented from FINGER where eg. adherence to healthier diet was still relatively high in the multidomain arm after the extended follow‐up. Higher adherence was also related to better cognition. Several dietary and metabolic biomarkers have been analyzed revealing underlying mechanisms and responders (eg persons with insulin resistance, higher HOMA, responded less). In the MIND‐AD trial, participants from 4 European countries were randomized to the multidomain lifestyle intervention alone (N:32), or in combination with medical food (N:31), and 30 to the control group. Adherence was high for all intervention domains (78‐87%). Compared with the control group, the group with lifestyle+medical food showed a decrease in vascular risk burden (P = 0.027) and an increase in healthy diet patterns (P = 0.045), and better cognition after the intervention (CDR‐SOB). There were no significant differences between the lifestyle only and control group. MET‐FINGER trial recruitment started in January 2023 (preliminary data presented). Conclusion: Longer‐term dietary and lifestyle changes are feasible and effective in older adults in the at‐risk spectrum of AD/dementia. Beneficial effects (adherence to and effects of interventions) seemed to improve with the inclusion of medical food in prodromal AD. The unique long follow‐up of FINGER provides important information about long‐term effects and methodological aspects. The MET‐FINGER trial will provide data on synergistic effects between FINGER intervention and a drug targeting both glucose metabolism and AD pathology. [ABSTRACT FROM AUTHOR]

Background: A comprehensive genetic risk score (GRS) for Alzheimer's disease (AD‐GRS) was recently developed based on 83 genome‐wide significant variants (Bellenguez et al. Nat Genet. 2022), excluding APOE. This study investigated AD‐GRS and APOE4 in relation to neuroimaging biomarkers in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Method: FINGER included at‐risk individuals without dementia from the general population, aged 60‐77 years. Participants were randomized to either 2‐year multidomain lifestyle‐based intervention or regular health advice. At baseline, 132 participants underwent MRI scans, of which 48 also underwent PET scans (PiB/FDG). Two years later, 112 and 39 repeated their scans, respectively. MRI measures included hippocampus, total gray matter and white matter lesion volumes, and cortical thickness. Composite indices were calculated for PiB and FDG uptake values. We report preliminary results from linear regressions (standardized β‐coefficients, p‐values). Result: At baseline, higher AD‐GRS tended to relate to lower hippocampus volume (β = ‐0.15, p = 0.07) and FDG‐PET index (β = ‐0.23, p = 0.08); this remained after APOE adjustment. APOE4 was associated with lower hippocampus volume (β = ‐0.27, p = 0.001) and higher PiB‐PET index (β = 0.48, p = 0.001). Overall, AD‐GRS was not related to the 2‐year change in neuroimaging measures, while APOE4 was related to decreasing hippocampus (β = ‐0.27, p = 0.01) and total gray matter (β = ‐0.25, p = 0.01) volumes, and cortical thickness (β = ‐0.28, p = 0.003). There were no significant interactions of AD‐GRS or APOE4 with randomization group in relation to neuroimaging changes. However, in analyses stratified by AD‐GRS (below vs above median), there was less PIB index increase in intervention vs control in the higher AD‐GRS group (β = ‐0.60, p = 0.03); no intervention control‐difference was found in the lower AD‐GRS group (β = 0.04, p = 0.86). In analyses stratified by APOE4, PIB index tended to increase less in intervention vs control in non‐carriers (β = ‐0.38, p = 0.078), with no intervention‐control difference in carriers (β = 0.05, p = 0.89). Conclusion: Unlike APOE4, AD‐GRS was not related to 2‐year change in AD‐related neuroimaging measures. AD‐GRS and APOE4 may also have very different impact on potential intervention effects on amyloid, i.e. less accumulation in the higher‐risk group (AD‐GRS) vs lower‐risk group (APOE). However, these exploratory findings need to be verified in larger studies. [ABSTRACT FROM AUTHOR]

Background: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial aiming to prevent cognitive decline with a 2‐year multidomain lifestyle intervention. Beneficial effects were detected not only in cognition, but also for co‐morbidity, as reported earlier. Aim of this work was to investigate, if the multidomain intervention also had an impact on the health care use and to evaluate possible cost‐effectiveness of the interventions in terms of health care costs. Method: The FINGER trial recruited a population‐based cohort of 1259 at‐risk individuals aged 60‐77 living in six areas of Finland. They were randomized into a multidomain lifestyle intervention consisting of diet, exercise, cognitive training and vascular risk management (n = 631) or a regular health advice (control) (n = 628) group for two years and followed on average for 8 years. Health care use was obtained from nationwide registers where all primary and specialized care visits are recorded. We calculated days spent in hospital, ambulatory visits, outpatient visits in hospitals and primary care, and home care. Costs will be evaluated based on national reference prices. Result: Altogether 99% of the population used some health care services and 66% were hospitalized at least for one day during the 8 years. 128 (10%) participants died during the follow‐up. Preliminary data indicated that the intervention group spent less days in the hospital, but there were no differences in outpatient visits. Further analyses are ongoing to evaluate the costs related to these visits. Conclusion: Multidomain lifestyle intervention which is effective in prevention of cognitive decline can also help in reducing health care use at least in terms of hospital stays. [ABSTRACT FROM AUTHOR]

Background: Multimodal lifestyle interventions have proven successful with at‐risk populations; however, little is known of the interventions effect on patients with prodromal Alzheimer's disease. Even less is known of feasibility and adherence to dietary recommendations within the population. Method: A 6‐month pilot trial was conducted with 93 participants randomized into three intervention arms. Two groups received physical exercise, cognitive training, nutritional guidance, monitoring and management of vascular and metabolic risk factors, and social stimulation, with one group receiving a medical food product. The third group was a self‐guided control group. Intake of individual macro‐ and micronutrients were analyzed from 3‐day food records. Adherence to recommendations assessed from food frequency questionnaires and by using a healthy diet index. Result: For macro‐ and micronutrient intake there were no differences at the end of the intervention and intake was in line with other national food surveys. The group who received intervention and medical food product has significantly better healthy diet index score compared to the other groups. Conclusion: There were few longitudinal significant differences on macro‐ and micronutrient intake, however, dietary intake improved significantly in itself when the intervention was complemented with a medical food product. [ABSTRACT FROM AUTHOR]

Background: This exploratory study investigated associations between physical function and neuroimaging biomarkers: brain magnetic resonance imaging (MRI) and Pittsburgh compound B‐positron emission tomography (PiB‐PET) measures during the 2‐year Finnish Geriatric Intervention Study to prevent cognitive impairment and disability (FINGER). Method: FINGER targeted 60–77‐year‐old general population at‐risk and without dementia or substantial cognitive impairment. Measures of physical function (activities of daily living (ADL), hand grip strength, physical performance, Fried's frailty phenotype index and self‐rated health) from baseline and 2‐year visits were used. Baseline neuroimaging measures, MRI (hippocampus, total gray matter volumes, Alzheimer's disease (AD) signature cortical thickness) were available for 115‐132 participants and PiB‐PET (composite score) for 44‐48 participants. Linear and logistic regressions were used to test the cross‐sectional associations and the impact of baseline imaging measures on changes in physical function. Models were adjusted for site, sex and education. Result: Cross‐sectionally, higher ADL were associated with higher hippocampus volume (β = 0.18 p = 0.048), total gray matter volume (β = 0.15 p = 0.005) and AD signature cortical thickness (β = 0.25 p = 0.006) while stronger hand grip and was associated with higher total gray matter volume (β = 0.20 p = 0.041) significantly. Baseline imaging measures were associated with changes in physical function: higher baseline hippocampus volume was associated with maintenance/improvement in the ADL (OR = 0.56 p = 0.039) while lower hippocampus at baseline predicted poorer physical performance over time (OR = 1.66 p = 0.036). Conclusion: Higher brain integrity is associated with better physical function while lower baseline brain integrity predicts poorer physical function over time. [ABSTRACT FROM AUTHOR]

Background: This exploratory study investigated associations between physical function and neuroimaging biomarkers: brain magnetic resonance imaging (MRI) and Pittsburgh compound B‐positron emission tomography (PiB‐PET) measures during the 2‐year Finnish Geriatric Intervention Study to prevent cognitive impairment and disability (FINGER). Method: FINGER targeted 60–77‐year‐old general population at‐risk and without dementia or substantial cognitive impairment. Measures of physical function (activities of daily living (ADL), hand grip strength, physical performance, Fried's frailty phenotype index and self‐rated health) from baseline and 2‐year visits were used. Baseline neuroimaging measures, MRI (hippocampus, total gray matter volumes, Alzheimer's disease (AD) signature cortical thickness) were available for 115‐132 participants and PiB‐PET (composite score) for 44‐48 participants. Linear and logistic regressions were used to test the cross‐sectional associations and the impact of baseline imaging measures on changes in physical function. Models were adjusted for site, sex and education. Result: Cross‐sectionally, higher ADL were associated with higher hippocampus volume (ß = 0.18 p = 0.048), total gray matter volume (ß = 0.15 p = 0.005) and AD signature cortical thickness (ß = 0.25 p = 0.006) while stronger hand grip and was associated with higher total gray matter volume (ß = 0.20 p = 0.041) significantly. Baseline imaging measures were associated with changes in physical function: higher baseline hippocampus volume was associated with maintenance/improvement in the ADL (OR = 0.56 p = 0.039) while lower hippocampus at baseline predicted poorer physical performance over time (OR = 1.66 p = 0.036). Conclusion: Higher brain integrity is associated with better physical function while lower baseline brain integrity predicts poorer physical function over time. [ABSTRACT FROM AUTHOR]

Background: Dementia risk scores could be instrumental in the implementation of multidomain lifestyle interventions for dementia prevention. However, as relatively new tools, their performance requires further validation. Given the extensive overlap between risk factors for dementia and cardiovascular disease (CVD), multidomain interventions usually have an important vascular component and better‐established cardiovascular risk scores could become useful in this context. More evidence is needed on their ability to predict the risk of cognitive decline and dementia. SCORE/SCORE‐Older People (OP) are the official tools of the European Society of Cardiology to estimate the 10‐year CVD‐mortality risk. In this study, we investigated the association between SCORE/SCORE‐OP and cognitive function within FINGER, the first large trial showing the efficacy of a multidomain lifestyle‐ and vascular‐based intervention in preventing cognitive decline. Method: SCORE (age<65) and SCORE‐OP (age≥65) were calculated in the population of the 2‐year FINGER trial (N = 1236, baseline and 24 months). The cognitive outcomes (baseline, 12 and 24 months) were the overall z‐score from a Neuropsychological Test Battery (NTB, 14 tests, primary outcome) and the z‐scores of the NTB cognitive domains (Memory, Executive Function, and Processing Speed, secondary outcomes). The associations between (i) SCORE/SCORE‐OP and cognition, (ii) SCORE/SCORE‐OP and changes in cognition, and (iii) changes SCORE‐OP and changes in cognition were assessed using linear mixed‐models repeated‐measures with maximum likelihood estimation. Result: Higher baseline risk of CVD‐mortality, estimated with SCORE/SCORE‐OP, was significantly and consistently associated with worse cognition, (NTB total composite: Estimate = ‐0.036; CI: ‐0.042 to ‐0.030; P‐value>0.0001; individual NTB cognitive domains: P‐values<0.0001) and yearly lower improvement in cognitive performance (NTB total composite: Estimate = ‐0.009, CI: ‐0.011 to ‐0.007, P‐value>0.0001; individual NTB cognitive domains: P‐values<0.0001). 2‐year change in SCORE‐OP was not significantly associated with changes in cognition during the FINGER study period. Conclusion: SCORE/SCORE‐OP could be useful in predicting the risk of cognitive decline in a trial aimed at improving lifestyle and vascular‐related risk factors of dementia. However, more evidence is needed on their efficacy in predicting dementia risk and the response to multidomain lifestyle‐ and vascular‐ based interventions. Future studies on other well‐established and easy‐access cardiovascular risk scores could also provide relevant findings. [ABSTRACT FROM AUTHOR]

Introduction: Multidomain interventions, targeting multiple risk factors simultaneously, could be effective dementia prevention strategies, but may be burdensome and not universally acceptable. Methods: We studied adherence rates and predictors in the Finnish Geriatric Intervevntion Study to Prevent Cognitive Impairment and Disability and Multidomain Alzheimer Preventive Trial prevention trials, for all intervention components (separately and simultaneously). Finnish Geriatric Intervevntion Study to Prevent Cognitive Impairment and Disability participants received a 2‐year multidomain lifestyle intervention (physical training, cognitive training, nutritional counseling, and cardiovascular monitoring). Multidomain Alzheimer Preventive Trial participants received a 3‐year multidomain lifestyle intervention (cognitive training, physical activity counseling, and nutritional counseling) with either an omega‐3 supplement or placebo. Results: Adherence decreased with increasing intervention complexity and intensity: it was highest for cardiovascular monitoring, nutritional counseling, and the omega‐3 supplement, and lowest for unsupervised computer‐based cognitive training. The most consistent baseline predictors of adherence were smoking and depressive symptoms. Discussion: Reducing participant burden, while ensuring that technological tools are suitable for older individuals, maintaining face‐to‐face contacts, and taking into account participant characteristics may increase adherence in future trials. [ABSTRACT FROM AUTHOR]

Introduction: Association between healthy diet and better cognition is well established, but evidence is limited to evaluate the effect of dietary changes adopted in older age. Methods: We investigated the role of dietary changes in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) with 1260 at‐risk participants (60–77 years) who were randomized to intensive multidomain intervention (including dietary counseling) or regular health advice for 2 years. Parallel process latent growth curves of adherence to dietary recommendations and cognitive performance were analyzed. Results: Adherence to healthy diet at baseline predicted improvement in global cognition, regardless of intervention allocation (P =.003). Dietary improvement was associated with beneficial changes in executive function, especially in the intervention group (P =.008; P =.051 for groups combined). Discussion: Dietary changes initiated during the intervention were related to changes in executive function in 2 years. Long‐term diet appeared more influential for global cognition. [ABSTRACT FROM AUTHOR]

Background: global population aging and forecasted trends of modifiable risk factors for dementia and Alzheimer's disease (AD) make prevention of these conditions an urgent priority. The World‐Wide FINGERS (WW‐FINGERS) global network of multidomain trials for dementia risk reduction and prevention is at the forefront of efforts to find effective and sustainable solutions for diverse population. The COVID‐19 pandemic has caused changes in the mental and physical health of older adults, which can influence dementia risk and prevention opportunities. Methods: The WW‐FINGERS‐SARS‐CoV‐2 survey was developed to assess direct and indirect effects of the COVID‐19 pandemic in older adults. The questionnaire measures changes in lifestyle factors (e.g., diet, physical activity), management of chronic noncommunicable diseases (e.g., diabetes, hypertension), and psychosocial factors ‐including depressive symptoms, sleep disorders, social isolation‐ that are relevant to cognition. Both a pen‐and‐paper and a digital version of the survey have been developed in several languages. The digital version is supported through REDCap (Research Electronic Data Capture), which is used also for harmonized data collection. Results: 30 countries are participating in the survey. As for January 2022, data have been collected from 20 countries, with 23000+ participants. Local adaptations and piloting were done to optimize implementation in clinical‐based and population‐based settings. Participants are in the at‐risk spectrum for dementia: from normal cognition to pre‐dementia cognitive symptoms. Timing of the survey implementation varies across populations, allowing to capture short, medium and long‐term effects of the pandemic and restrictions measures. Some countries have used the survey to recruit participants in multimodal prevention trials. An updated report of the survey status and main results will be presented. Conclusion: The WW‐FINGERS‐SARS‐CoV2 survey is a joint global action of the WW‐FINGERS network which can inform better care of older adults in the context of a pandemic. The survey is also a valuable tool for pre‐screening of participants for prevention trials, and results can inform adaptions to ensure successful recruitment and adherence in forthcoming multidomain trials for dementia prevention in older adults. [ABSTRACT FROM AUTHOR]

Background: The positive results of the landmark Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability ‐ FINGER, 2‐year lifestyle‐based intervention and up to 11 years follow‐up ‐, followed by the Multimodal Preventive Trial for Alzheimer's Disease ‐ MIND‐ADmini, 6‐month lifestyle‐based + medical food, up to 1‐year follow‐up ‐, provided the foundation to advance multimodal trials for dementia prevention within the World‐Wide FINGERS (WW‐FINGERS) network. Innovative trials should involve tailored approaches, combining non‐pharmacological and pharmacological interventions, to optimize interventions´ adherence and efficacy. Method: Through a drug‐repurposing approach, metformin has been identified as a potential disease‐modifying drug for Alzheimer´s disease (AD) and dementia in subjects without type‐2 diabetes, with a robust pharmacological safety profile. Analysis on genetic factors (APOE, AD Polygenic‐Risk‐Score) and intervention effects from the FINGER trial indicated clear cognitive benefits in participants with genetic susceptibility to AD and dementia. Feasibility data (adherence, retention rate) from FINGER and MIND‐ADmini, including extended follow‐up data analysis, have informed the upgrade of the lifestyle‐based intervention implemented in MET‐FINGER. Result: An update on the trial status will be presented. The MET‐FINGER phase‐IIb trial population includes an APOE‐enriched population of 600 subjects aged 60‐79 years, with increased risk of dementia due to modifiable risk factors. Participants are recruited in three countries (Finland, Sweden, United Kingdom), and randomized to either an upgraded FINGER lifestyle‐based intervention, alone or in association with metformin (up to 2000mg/day), or the reference group, which follows a self‐guided lifestyle program. MET‐FINGER trial outcomes are harmonized with WW‐FINGERS guidelines, and include cognition and biological measures to detect disease‐modifying effects of metformin. Conclusion: MET‐FINGER pioneering trial leverages and expands on successful experiences from WW‐FINGERS core trials, embodying the next generation of clinical trials for dementia risk reduction and prevention within the framework of precision prevention. The MET‐FINGER trial protocol is the first in its kind, providing the basis for forthcoming trials combining non‐pharmacological and pharmacological interventions. MET‐FINGER results can inform AD drug development and reduce intervention failure rate of new trials. [ABSTRACT FROM AUTHOR]

Background: Older adults have a higher risk of Alzheimer´s disease (AD) and dementia. In terms of morbidity and mortality, they also represent the group most severely affected by the SARS‐CoV‐2 (COVID‐19) pandemic. Since February 2020, the Swedish government recommended different general measures limiting mobility and social contact, to contain the spread of infection. Pandemic‐related changes in lifestyle and access to healthcare could have a negative impact on modifiable factors for AD and dementia. Methods: A digital survey was distributed to the general population (multiple distribution channels, voluntary participation) during the last waves of the COVID‐19 pandemic in Sweden (May/2021 – December/2021). Participants were people aged 60+ years, free of dementia, and living in Sweden. The survey aimed to measure changes in lifestyle (e.g., diet, physical activity), care of vascular/metabolic risk factors (e.g., diabetes, hypertension), as well as psychosocial factors (e.g., depressive symptoms, sleep quality, social isolation) relevant for AD and dementia. The survey is part of the World‐Wide‐FINGERS‐SARS‐CoV‐2 initiative. Results: 6,918 participants completed the survey, mean age was 67.9 (5.11 SD), 58% were female, 71.6% were from urban areas. Preliminary results showed that, during the pandemic, 27% of participants decreased their physical activity, 26.3% increased intake of unhealthy snacks, 25.7% experienced increased sleep problems. Also, 58.7% had less contact with family, 40.4% experienced loneliness, 24.7% experienced worsening of memory, and 26.8% rated their health worse than before the pandemic. On the other hand, the reported increase in consumption of vegetables and fruits was 14.1% and 15.7%, respectively, and 65.2% of people had increased the use of digital services to keep in contact with family and friends. Also, 2.6% of participants decreased smoking, and 11.2% reduced their alcohol consumption. The occurrence of chronic vascular and metabolic diseases and related disruption in access to healthcare is presented in Table 1. Conclusion: The COVID‐19 pandemic has had an effect on modifiable factors for AD and dementia in Swedish older adults. These changes can affect future AD/dementia occurrence and should be addressed in forthcoming interventions for AD/dementia risk reduction and prevention. The survey can also be used for pre‐screening participants for prevention trials. [ABSTRACT FROM AUTHOR]

Introduction: The 2‐year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) multidomain lifestyle intervention trial (NCT01041989) demonstrated beneficial effects on cognition. We investigated whether sociodemographics, socioeconomic status, baseline cognition, or cardiovascular factors influenced intervention effects on cognition. Methods: The FINGER recruited 1260 people from the general Finnish population (60–77 years, at risk for dementia). Participants were randomized 1:1 to multidomain intervention (diet, exercise, cognition, and vascular risk management) and regular health advice. Primary outcome was change in cognition (Neuropsychological Test Battery z‐score). Prespecified analyses to investigate whether participants' characteristics modified response to intervention were carried out using mixed‐model repeated‐measures analyses. Results: Sociodemographics (sex, age, and education), socioeconomic status (income), cognition (Mini–Mental State Examination), cardiovascular factors (body mass index, blood pressure, cholesterol, fasting glucose, and overall cardiovascular risk), and cardiovascular comorbidity did not modify response to intervention (P‐values for interaction >.05). Conclusions: The FINGER intervention was beneficial regardless of participants' characteristics and can thus be implemented in a large elderly population at increased risk for dementia. Highlights: The FINGER intervention benefits cognition regardless of participants' characteristics.Sociodemographics, vascular risk, or MMSE do not modify response to intervention.Intervention can be implemented in a large elderly population at risk for dementia. [ABSTRACT FROM AUTHOR]

Background: Given the complex and multi‐factorial aetiology of dementia, preventive interventions targeting several risk‐factors simultaneously and tailored on specific risk‐profiles are likely to be most beneficial. To date, trials testing lifestyle‐ and vascular‐based multidomain interventions for dementia and cognitive decline prevention have shown inconsistent results. In particular, achieving sufficient level of intervention intensity, accurately assessing adherence, and identifying the optimal target population have been highlighted among the key challenges. Within FINGER, the first large trial showing the efficacy of a multidomain intervention in preventing cognitive decline, we aimed to develop a Healthy Lifestyle Index (HLI) as a potential easy‐access indicator of adherence, and to assess its association with cognition. Method: The HLI (score 0‐24) was developed based on a brief set of self‐reported questions collected at baseline, 12, and 24 months within the FINGER trial (N=1260) and across four lifestyle components: physical activity, diet, smoking and alcohol, and social and cognitive activity. The FINGER cognitive outcomes were the overall z‐score from a Neuropsychological Test Battery (NTB, 14 tests, primary outcome) and the z‐scores of the NTB cognitive domains (secondary outcomes). Linear mixed‐models repeated‐measures with maximum likelihood estimation were used to assess the effect of the intervention on change in the HLI and associations between HLI and cognition over the 2‐year study period. Result: The intervention led to an increase in HLI (P<0.001). At baseline, the HLI was directly associated with the overall NTB z‐score (b=0.024; 95% CI: 0.014‐0.033; P<0.001) and individual cognitive domains. Baseline HLI was significantly associated with 2‐year changes in the NTB z‐score (0.006; 95% CI: 0.003‐0.010; P<0.001), as well as the memory domain. Changes in HLI were not significantly associated with 2‐year changes in cognitive outcomes. Conclusion: The FINGER HLI may potentially help measure and monitor adherence to multidomain interventions aimed at prevention of cognitive decline. Being developed as an easy‐access tool, its application could be especially relevant for those settings where more complex assessments are not feasible, such as implementation trials in clinical practice, and primary care in particular. More evidence is needed to determine its efficacy in predicting response to such interventions. [ABSTRACT FROM AUTHOR]

Background: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial that showed beneficial effect on cognition with a 2‐year multidomain lifestyle intervention. During the post‐intervention follow‐up, COVID19 pandemic emerged resulting in lockdown and reduced services. Our aim is to investigate how lifestyle and behavior changes during the pandemic are related to lifestyle earlier in the study. Method: The FINGER cohort included 1260 individuals aged 60‐77 years at baseline and at risk of dementia, randomized into multidomain intervention or control groups. A postal survey was sent to all eligible participants from the FINGER study in June 2020 (end of the first wave of the pandemic in Finland), on average 10 year after the baseline. 859 (68%) were still alive and eligible for the survey. Result: Total of 735 responders (85% of the eligible participants) were on average 78 years old. They were younger, had higher baseline cognition, and were more often from the former control group than non‐responders (p<0.05 for all). The intervention allocation showed no association with self‐reported lifestyle changes during the pandemic in diet, exercise, or cognitive activity. Among older participants (>78 y), the intervention group reported more increase in remote contact with friends and relatives (p=0.013) and health care (p=0.042) than the control, and also less pandemic‐related reduction in overall contact with friends (p=0.045). Among all, reductions in physical exercise were reported among those who were less physically active earlier in the study. Both increase and decrease in contact with friends and family were reported by those more cognitively active earlier in the study. They also had more increase in remote contacts. Changes in diet were positive (increase in fruit and vegetable intake), but they were not related to earlier diet. Conclusion: The FINGER participants reported only minor change in their lifestyle and behavior during the first wave of the COVID pandemic related lockdown. For physical activity, the pandemic appeared to have negative effect particularly among those with lower levels earlier, possibly adding inequalities. Intervention was related to more remote contacts, probably due to better computer literacy after the cognitive training. [ABSTRACT FROM AUTHOR]

Background: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a multi‐center, randomized trial that showed beneficial effect on cognition with a multi‐domain lifestyle intervention including nutritional guidance. The aim here is to investigate how dietary changes are maintained after the active intervention period, and if baseline cognitive performance modifies the intervention effect. Method: Individuals aged 60‐77 years and at risk of dementia were randomly allocated into intervention (n=631) or control (n=629) group for 2 years, with post‐intervention follow‐up visit at 5 and 7 years. Neuropsychological Test Battery was executed and a z‐score for global cognition calculated (14 tests). Three food records during the intervention and one at 7 years were used to calculate FINGER dietary adherence score based on national recommendations (9 goals, higher indicating better adherence). A linear mixed model was used to evaluate association between dietary change, group allocation and baseline cognition dichotomized at the median, adjusting for age, education, sex, study area, BMI, and total energy intake. Result: Altogether 783 participated at the 7‐year visits. Better baseline cognition predicted 7‐year participation (p<0.01) and food record completion (p<0.01), which was lower than at earlier visits (73%; n=572). Dietary quality improved more in the intervention group compared with the control over the 7‐year period (p<0.01). Baseline cognitive function did not modify the intervention effect on diet during the first years of the study (p<0.05 for the intervention effect in both cognition groups at the 1st and the 2nd year, respectively). On longer term the interaction between baseline cognition and intervention group became significant (p=0.03 at the 7‐year follow‐up), and the intervention effect was especially seen with lower baseline cognition. Dietary quality declined only in the control group participants with lower baseline cognition. Conclusion: The FINGER dietary intervention showed that beneficial dietary changes are achieved by older individuals and also maintained after the active intervention period. These results indicate that while dietary changes during the intervention are achieved regardless of baseline cognition, people with lower baseline cognition may benefit more in long term, because their dietary quality is more likely to worsen without an intervention. [ABSTRACT FROM AUTHOR]

Background: Dietary components such as berries and fruits are part of the recommended Nordic diet, and are considered having health‐enhancing characteristics. A randomized multi‐center and multi‐domain lifestyle intervention trial FINGER has shown benefits on cognition with dietary guidance, exercise, cognitive training and vascular risk management. Here, we investigate the association between berry and fruit intake at baseline and cognitive function over 2 years. Methods: Individuals aged 60‐77 years were randomly assigned in a 1:1 ratio to intervention (n=631, nutritional guidance, exercise, cognitive training, and management of metabolic and vascular risk factors) or control group (n=629, general health advice). A modified neuropsychological test battery and 3‐day food records were administered annually. Mixed‐model repeated‐measures analyses with maximum likelihood estimation were used to analyse change in cognitive scores as a function of randomization group, time, berry consumption, total energy intake, berry consumption x time interaction, group x time interaction, energy intake x time interaction, age x time interaction, age, sex, education, study site, C‐reactive protein, systolic blood pressure, and low‐density lipoprotein cholesterol. A similar model was used to investigate effects of fruit consumption. Results: High berry consumption at baseline compared with no berry consumption was associated with more improvement in all investigated cognitive domains. Berry consumption x time interaction coefficient (95% CI) was for global cognition 0.058 (0.034‐0.082), p<0.001; for executive functioning 0.050 (0.018‐0.081), p=0.002; for memory 0.069 (0.028‐0.109), p=0.001; and for processing speed 0.051 (0.018‐0.085), p=0.003 over two years. When berry consumption was combined with fruit consumption, the results remained similar. However, fruit consumption alone did not show any association with the cognitive domains. Conclusions: Berries are an important component of the Nordic diet, and higher consumption of berries seems to have a beneficial impact on cognitive functioning. Several healthy components such as flavonoids in berries might be behind this association, e.g. by influencing cerebrovascular blood flow and synaptic plasticity of the brain. Acknowledgements: The presenting author wish to acknowledge The Juho Vainio Foundation; Yrjö Jahnsson Foundation; Päivikki and Sakari Sohlberg Foundation. [ABSTRACT FROM AUTHOR]

Background: Life‐long mental stimulation through occupational complexity has been associated with late‐life cognition and might affect the rate of cognitive changes in randomized controlled trials (RCTs) testing preventive interventions for dementia. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER, ClinicalTrials.gov NCT01041989) is a landmark RCT that tested a lifestyle‐based multidomain intervention in 1260 community‐dwellers aged 60‐77 years at increased risk of dementia. Participants were randomized to either a group that received general health advice, or a 2‐year multidomain intervention that incorporated dietary counselling, exercise, cognitive training, and vascular/metabolic risk monitoring. The intervention improved global cognition (primary outcome) and cognitive sub‐domains including executive function, processing speed, and memory. This study aimed to test if the cognitive benefits of the 2‐year multimodal intervention were linked to baseline levels of occupational complexity. Method: Study participants: all randomized FINGER participants with at least one cognitive outcome assessment after the baseline visit (modified intention‐to treat population), available data on last held occupation, and who were retired (N: 1026). Occupational complexity was assessed through a validated rating system, identifying three domains: complexity with data; complexity with people; and substantive complexity. Cognition was assessed at baseline, 1‐year and 2‐year with the Neuropsychological Test Battery (NTB). The following cognitive outcomes were considered: global cognition, executive function, processing speed, and memory. Data analysis: Mixed‐model repeated‐measures analyses with maximum likelihood estimation were used to analyse change in cognitive scores as a function of randomization group, time, levels of occupational complexity (standardized Z‐scores), their interaction (randomization group × time × occupational complexity), age, sex, education, study site. Result: Subjects with higher levels of occupational complexity with data (i.e., occupations more mentally demanding) benefitted most in terms of improvement in executive function (interaction coefficient group × time × occupational complexity: ß[SE]:.03 (.01), p=.044) and global cognition (ß[SE]:.02 (.01), p=.060). Conclusion: The cognitive change in a multidomain preventive intervention can be affected by previous occupational complexity. This facet of mental stimulation should be further investigated within RCTs for cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Older adults have higher risk of cognitive impairment and dementia, and they also represent the group most severely affected by the SARS‐CoV‐2 (COVID‐19) pandemic in terms of higher morbidity and mortality. The World‐Wide FINGERS (WW‐FINGERS) global network of multidomain trials for dementia risk reduction and prevention (Kivipelto et al., 2020) provides a unique framework to explore how the pandemic has affected factors related to mental and physical health of populations at increased risk of dementia, while accounting also for country‐specific strategies to contain the spread of the infection. Methods: The WW‐FINGERS‐SARS‐CoV2 survey has been developed to explore direct and indirect effects of the pandemic in midlife and older age. The questions aim to measure changes in lifestyle factors (e.g., diet, physical activity), management of chronic noncommunicable diseases (e.g., diabetes, hypertension), as well as psychosocial factors ‐ including depressive symptoms, sleep disorders, social isolation ‐ that are relevant to cognition and are expected to be affected by the pandemic. The survey measures also established and possible epidemiologic risk factors for severe COVID‐19. To facilitate distribution is different settings, both a pen‐and‐paper and a digital version of the survey have been developed in several languages. The digital version is supported through REDCap (Research Electronic Data Capture), a secure web‐based software that is being also used for harmonized data collection. Results: Over 25 countries are taking part in the survey. Local adaptations and piloting are being done to optimize implementation in both clinical‐based and population‐based settings. Participants are in the at‐risk spectrum for dementia: from cognitively normal persons to individuals with pre‐dementia cognitive symptoms. An updated report of the survey status will be presented. Conclusion: the survey is a joint global action of the WW‐FINGERS network which can inform better care of older adults in the context of a pandemic. The survey is also a valuable tool for pre‐screening of participants for prevention trials, and results can inform adaptions to ensure successful recruitment and adherence in forthcoming multidomain trials for dementia prevention in older adults. [ABSTRACT FROM AUTHOR]

Background: Restrictions enforced in many counties during the COVID‐19 pandemic may have both short‐ and long‐term effects on the risk factors relevant for cognitive impairment and dementia. The COVID‐19 pandemic occurred during the post‐intervention follow‐up phase of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) postponing the planned follow‐up visits of the participants. We investigated how the first phase of the COVID‐19 pandemic affected lifestyles and other risk factors among the FINGER participants using a postal survey. Method: A survey was sent in June 2020 to 859 eligible FINGER participants. The survey was developed to assess the effects of the COVID‐19 pandemic and related infection‐control measures on lifestyles, daily life, commitment to distancing measures, access to healthcare and social services, and changes in cognitive and social activities, as well as emotional health and wellbeing. Result: A total of 735 participants responded to the survey (85% of the eligible participants). They were on average 78 years old at the time of the survey. Majority of the participants adopted some distancing practices during the first months of the pandemic. Older participants were more likely to practice total isolation than younger ones. Pandemic‐related changes were reported in social engagement, including less contact with friends and family, and less frequent participation in cultural events or associations, but on the other hand the frequency of remote contacts with others was increased. About a third of the participants reported that their physical activity was reduced, and this was more common among those who had been less active earlier. Pandemic‐related changes in lifestyle and activities were more evident among those living alone. Conclusion: Finnish older persons were mainly reporting that they coped in the pandemic situation quite well. Older participants seemed to be more susceptible to negative changes. Also persons with less physical activity previously were likely to reduce their activities even more. This may have long‐term consequences on the cognitive health of older adults, and it may also impact the longer‐term effects of the FINGER intervention. [ABSTRACT FROM AUTHOR]

Background: The ANU‐ADRI is a validated risk index for Alzheimer's disease comprised of lifestyle, medical and demographic factors, with higher scores indicating more risk. We investigated the association of the ANU‐ADRI score with cognition over the 2‐year FINGER multidomain prevention trial. Method: The ANU‐ADRI score was calculated for the participants in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), at baseline (N=1174) and 24‐months (N=1023). Cholesterol and BMI were excluded due to age and pesticide exposure was not available. Age and sex were excluded from changes in ANU‐ADRI score, to focus on change in modifiable factors only. Result: At baseline, ANU‐ADRI score was strongly associated (p<0.001) with the total cognitive score as well as all the cognitive subdomains of memory, executive function and processing speed. Baseline ANU‐ADRI was also associated (p<0.001) with changes in all domains of cognition over the trial period, with lower ANU‐ADRI scores indicating better cognition. Additionally, the decline in the ANU‐ADRI score was associated with improvement in cognition (p<0.01) in all domains. Preliminary results indicated no significant modifying effect of the FINGER intervention on cognition by baseline ANU‐ADRI score. Overall, the ANU‐ADRI score was lowered 1.0 [0.8‐1.3] points during the 2‐year trial, but no significant difference was found between the intervention arms. Conclusion: Within the FINGER intervention, the ANU‐ADRI score and its change correlated negatively with cognition, with lower scores indicating better cognitive ability. However, the FINGER intervention, despite improving cognition, did not significantly modify the ANU‐ADRI score compared to the control group. [ABSTRACT FROM AUTHOR]