From dementia prevention research to global FINGER-based multi-domain interventions and implementation strategies

The demographic transition during the recent decades has resulted in an increase in older adults globally. Cognitive impairment and dementia are the leading causes of functional disability, which significantly decreases the quality of life and increases the use of healthcare resources and societal costs. The goal of this narrative review is to summarize the recent evidence on the epidemiology of cognitive disorders and dementia, their societal burdens, the potential of multidomain lifestyle interventions, the implementation of such interventions and the cost-effectiveness of dementia prevention. Our review demonstrates that although population-based studies have shown a stable or decreasing prevalence of dementia during the recent decades in Europe and North America, an opposite trend has been observed in other regions, including low- and middle-income countries where there is an increasing prevalence. Considering the multifactorial etiology of dementia, to date, multidomain lifestyle interventions simultaneously targeting several risk factors, such as the FINGER trial, have been most effective. Such interventions have important beneficial effects for cognition and other outcomes including physical function, reduced multimorbidity and use of healthcare resources, while proving to be cost-effective. More recent efforts have focused on tailoring and adapting multidomain lifestyle interventions to various global regions, while taking into consideration local infrastructures, cultural norms and specific needs. Such global efforts have been coordinated through the World-Wide FINGERS Network, which aims to harmonize trial methodologies to investigate the effects of FINGER-based interventions in different populations to acquire robust globally relevant evidence. Similarly, there is a need to adapt dementia risk prediction models to various geographic settings. For the wider implementation of multidomain lifestyle interventions, different societal and healthcare levels need to be included, such as the community level, primary care, and specialist (e.g. memory) clinics, and such initiatives are currently being tested in Nordic countries. Taken together, effective multidomain risk reduction programs have the potential to significantly reduce the economic and societal burdens of dementia.