| Sumario: | Purpose : As life expectancy increases worldwide, dementia has rapidly become a huge public health problem. A recent meta-analysis of population-based observational studies revealed that modifying risk factors may prevent or delay dementia by up to 40%. Under the situation there is a limit to the number of people who can receive intensive multidomain interventions at facilities, not only an effective dementia prevention programs that can be implemented at the facility, but alos an effective home-based program is essential to reach more elderly people in need. SUPERBRAIN was developed for a facility-based multidomain intervention (FMI) program and a homebased multidomain intervention (HMI) program suitable for older Koreans. The purpose of SUPERBRAIN is to assess the feasibility of the FMI and HMI programs in at-risk older Koreans to prevent cognitive impairment and protect brain health through intervention program. Method: We aimed to evaluate the feasibility of multidomain intervention tailored to the Korean context. In an outcome assessor-blinded, randomized controlled trial, participants without dementia and with one or more modifiable dementia risk factors, aged 60-79 years, were randomly assigned to the facility-based MI (FMI; n=51), the home-based MI (HMI; n=51), or the control group receiving general health advice (n=50). The 24-week intervention comprised vascular risk management, cognitive training, social activity, physical exercise, nutrition guidance, and motivational enhancement. The FMI participants performed all intervention programs at a facility three times a week. The HMI participants performed some programs at a facility once every 1-2 weeks and performed others at home. The primary outcome was feasibility measured through retention, adherence, and at least no differences from the control group in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results & Discussion: In the FMI and HMI groups, the retention rates were 88.2% and 96.1%, and adherence to the intervention was 94.5% and 96.8%, respectively. The primary outcome was feasibility measured through adherence, retention rates, and changes in the total scale index score of the RBANS with the normative data of Korean adults throughout the study. The RBANS total scale index score improved significantly in the FMI (5.46 ± 7.50, P = 0.004) and HMI (5.50 ± 8.14, P = 0.004) groups compared to the control group (-0.74 ± 11.51). The FMI and HMI are feasible and there are indicators of efficacy. Meanwhile, compared to the control group (54.18 ± 136.01 ng/mL), plasma cortisol levels were significantly decreased in both the FMI (-5.29 ± 154.01 ng/mL, P = 0.049) and HMI groups (-15.29 ± 172.09 ng/mL, P = 0.03) at the study endpoint. Serum brain-derived neurotrophic factor (BDNF) levels were significantly increased in the FMI group compared to the control group (11.83 ± 20.06 ng/mL vs. -1.62 ± 19.01 ng/mL, P = 0.02). Therefore, it is possible that the multidomain intervention may be effective in improving cognitive function through inactivation of the hypothalamic-pituitary-adrenal (HPA) axis and enhance brain plasticity.
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