Currently accepted at: JMIR Mental Health
Date Submitted: Sep 7, 2018
Open Peer Review Period: Sep 11, 2018 - Nov 6, 2018
Date Accepted: Feb 14, 2019
(closed for review but you can still tweet)
Online multi-domain lifestyle programs for brain health – a comprehensive overview and meta-analysis
Alzheimer’s disease (AD) is the most common cause of dementia. The number of AD patients is increasing worldwide, mainly due to the aging of the population. The lack of pharmaceutical interventions able to delay or treat AD underlines the potential of non-pharmacological strategies. As an estimated one third of dementia cases might be attributable to modifiable lifestyle factors, multi-domain lifestyle interventions show promise as a way to maintain or improve brain health. Offering such programs online would enable large-scale implementation. An overview of multi-domain online lifestyle programs for brain health is currently lacking though, which hampers the field to compare and improve programs in order to develop effective and sustainable innovations.
We aim to provide a comprehensive overview and meta-analysis of online multi-domain lifestyle programs aimed at optimizing brain health in healthy elderly adult populations.
Electronic databases (PubMed, EMBASE.com, PsycINFO) were searched for online lifestyle programs which were included when the program 1) aimed to optimize brain health; 2) focused on multiple lifestyle factors; 3) was completely online; 4) existed of multiple sessions; 5) focused on a healthy adult population. We extracted and compared program characteristics (target population, duration, frequency, tailoring, platform, availability) and results of program evaluations (effectiveness, user-evaluations and adherence). Studies using a controlled design were included in a random effects meta-analysis on effectiveness on brain health outcomes. The quality of these studies was assessed using the PEDro scale.
The systematic literature search resulted in 44 documents describing 14 online lifestyle programs, which together address a multitude of lifestyle factors. Physical and cognitive activities were included in all programs. The majority of the programs was not publicly available and restricted to research settings (6/14, 43%) or available after payment (2/14, 14%). Studies on user-evaluations were reported for 8 (57%) programs, of which only 3 studies described their methods. Five studies evaluated the effectiveness of 4 programs, of which 3 used a controlled design, hence eligible for the meta-analysis (N=449; studies of moderate-to-high quality on PEDro scale). Pooled results showed a significant small to medium effect of the online multi-domain lifestyle interventions on outcome measures for brain health (global cognition score, subjective cognitive score, lifestyle risk score; std. mean diff. 0.45, 95% CI [0.12-0.78]) with a high heterogeneity across studies (I2 = 75%, p=0.02).
We found 14 online multi-domain lifestyle programs aimed at optimizing brain health. The programs showed heterogeneity in both characteristics and effectiveness evaluation, which limited direct comparisons. Despite this heterogeneity, the results from this meta-analysis suggest that these programs can positively influence brain health outcomes and therefore have potential to contribute to the prevention of dementia.
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