In April 2015, the Institute of Medicine called for clinical trials and multi-component interventions to prevent cognitive decline among at-risk adults. We here propose a pilot randomized trial of high polyphenol foods combined with speed of processing cognitive training in older adults with low education. Low education is the top modifiable risk factor for Alzheimer disease (AD). Low cognitive reserve is a leading hypothesis for low education's effects on early cognitive decline. Specific dietary components, here referred to as MIND foods,? have emerged as key interventions for enhancing cognitive reserve. Randomized trials support that just 12 weeks of consumption of MIND foods improves short-term cognition, including speed of processing. Similarly, 12 weeks of speed of processing training has broad effects and has been hypothesized to improve cognitive reserve. Our secondary analysis of existing trial data showed that cognitive training effects were largest in those with low education. At this time, there are no published trials of speed of processing training among older adults with low education nor are there any trials of speed of processing training combined with MIND foods. Using a 2 x 2 factorial design, we propose a randomized controlled trial of the efficacy of speed training and MIND foods in maintaining or improving brain and cognitive health in older adults with low education and no dementia. Older adults seeking primary care who have low education will be recruited and randomized to one of four arms: MIND food + Speed training, MIND food + Speed training control, MIND food control + Speed training, or MIND food control + Speed training control. We refer to the MIND and Speed combination as MINDSpeed, while the combination of MIND food control and speed training control we refer to as Double Control. Twelve weeks of access, support, and incentives for trainings and food will be facilitated by tablet applications created with users by our user-interface design team. The primary specific aim of this pilot clinical trial is to determine MINDSpeed effects on an executive cognitive composite (ECC) score relative to Double Control. Secondary aims are to determine: 1) MIND and Speed treatment effects on ECC vs Double Control and MINDSpeed, 2) feasibility (i.e., adherence, satisfaction, adverse events, costs), 3) treatment effect modifiers (e.g., education, age, baseline cognitive status, APOE ?4 carrier status), and 4) mechanisms of inflammation, oxidative stress, and hippocampal volume. The ultimate goal of this line of research is to enhance cognitive reserve through MIND foods and brain training and thereby delay AD.
Low education is a top risk factor for Alzheimer's Disease. This project will test in a pilot randomized controlled trial the effects of ?MIND? foods and speed of processing training on cognitive reserve in older adults with low education.
