Alzheimer disease and Alzheimer disease related dementias (AD/ADRD) are common, costly, and feared illnesses. Prevention or even a several-year delay of AD/ADRD is a critical but unrealized goal. One important prevention strategy is grounded on our and others’ findings that 40% of AD/ADRD risk could be reduced by targeting lifestyle, medical, and behavioral factors.

While it is challenging to change one’s risk and behaviors, research suggests that working with people to choose their goals and align their preferences with making changes is critical. We recently conducted the Systematic Multi-domain Alzheimer’s Risk Reduction Trial (SMARRT), a randomized controlled trial (RCT) testing a personalized, multi-domain AD/ADRD risk reduction intervention in an integrated US healthcare system. Over this novel two-year trial, participants who received the risk reduction intervention had significantly better cognition, improved risk factors, and increased quality of life compared to the education control. These findings have been met with tremendous excitement as they suggest a personalized approach to lowering the risk for AD/ADRD may be cost-effective, successful, and important for prevention, possibly along with medications. However, after only two years, there were too few participants who developed AD/ADRD to be able to conclude if this approach reduced dementia and mild cognitive impairment (MCI). We also hypothesize that SMARRT might lower other age-related outcomes, such as cardiovascular disease and mortality.

This proposal’s objective is to reevaluate the SMARRT participants around 4 years after trial completion to reassess maintenance of risk reduction and to measure new diagnoses of MCI/dementia as well as cardiovascular outcomes such as myocardial infarction and stroke, which we hypothesize may be decreased by the intervention. We also will examine rates of hospitalizations, falls, and death. The results stemming from this proposal could be pivotal for the brain and body health of older adults nationally and even globally.