Designing an Internet-Based Multidomain Intervention for the Prevention of Cardiovascular Disease and Cognitive Impairment in Older Adults: The HATICE Trial

Article type: Research Article

Authors: Barbera, Mariagnese^{a; *} | Mangialasche, Francesca^b | Jongstra, Susan^c | Guillemont, Juliette^d | Ngandu, Tiia^e | Beishuizen, Cathrien^c | Coley, Nicola^{d; f} | Brayne, Carol^g | Andrieu, Sandrine^{d; f} | Richard, Edo^{c; h} | Soininen, Hilkka^{a; i} | Kivipelto, Miia^{a; e; j; k} | for the HATICE study group¹

Affiliations: [a] Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland | [b] Department of Neurobiology, Aging Research Center, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden | [c] Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands | [d] INSERM, University of Toulouse UMR 1027, Toulouse, France | [e] Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland | [f] Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France | [g] Institute of Public Health, Cambridge, UK | [h] Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands | [i] Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland | [j] Department of Neurobiology, Division of Clinical Geriatrics, Care Sciences and Society, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden | [k] Stockholms Sjukhem, R&D unit, Stockholm Sweden

Correspondence: [*] Correspondence to: Mariagnese Barbera, University of Eastern Finland, Institute of Clinical Medicine/ Department of Neurology, Yliopistonranta 1C, Canthia Building, Room 5017, P.O. Box 1627, FI-70211 Kuopio, Finland. Tel.: +358 0 40 6722065; E-mail: [email protected]

Note: [1] Full list of the members of the HATICE study group can be found at the end of the manuscript.

Abstract: Background:Many dementia and cardiovascular disease (CVD) cases in older adults are attributable to modifiable vascular and lifestyle-related risk factors, providing opportunities for prevention. In the Healthy Aging Through Internet Counselling in the Elderly (HATICE) randomized controlled trial, an internet-based multidomain intervention is being tested to improve the cardiovascular risk (CVR) profile of older adults. Objective:To design a multidomain intervention to improve CVR, based on the guidelines for CVR management, and administered through a coach-supported, interactive, platform to over 2500 community-dwellers aged 65+ in three European countries. Methods:A comparative analysis of national and European guidelines for primary and secondary CVD prevention was performed. Results were used to define the content of the intervention. Results:The intervention design focused on promoting awareness and self-management of hypertension, dyslipidemia, diabetes mellitus, and overweight, and supporting smoking cessation, physical activity, and healthy diet. Overall, available guidelines lacked specific recommendations for CVR management in older adults. The comparative analysis of the guidelines showed general consistency for lifestyle-related recommendations. Key differences, identified mostly in methods used to assess the overall CVR, did not hamper the intervention design. Minor country-specific adaptations were implemented to maximize the intervention feasibility in each country. Conclusion:Despite differences in CVR management within the countries considered, it was possible to design and implement the HATICE multidomain intervention. The study can help define preventative strategies for dementia and CVD that are applicable internationally.

Keywords: Cardiovascular disease prevention, cardiovascular risk factors, dementia prevention, e-Health, multidomain intervention

DOI: 10.3233/JAD-170858

Journal: Journal of Alzheimer's Disease, vol. 62, no. 2, pp. 649-663, 2018