What the Finns are teaching the world about dementia and lifestyle

Their research is the first major trial to show that lifestyle changes can improve brain health and prevent cognitive decline.

It’s known as FINGER — the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability — and is a collaboration between Finnish and Swedish scientists, led by the Finns.

They recruited 1,260 men and women aged 60 to 77 who had risk factors for dementia, but no current memory problems.

The recruits were split into two groups. One undertook a two-year lifestyle intervention comprising five areas — diet, physical activity, cognitive training, social activity, and monitoring of cardiovascular risk factors. (The five lifestyle areas tie into the idea of five FINGERS.)

The other was the control group.

The five areas involved:

• Three individual sessions and six to eight group sessions with a nutritionist who supported them in eating a healthy range of foods including, for example, fruit and vegetables, wholegrain cereals, and fish.
• Individual exercise programs including strength and balance training one to three times a week, and aerobic exercise two to five times a week.
• Cognitive training using a computer program to develop skills such as memory, mental speed, and problem solving.
• Sessions with a doctor or nurse at 3, 6, 9, 12 and 18 months to manage blood pressure, cholesterol, blood sugar, and weight.

(So far, I can’t find a reference to how social activity was addressed.)

The control group received regular health advice only.

After the two years, both groups showed improved cognitive health. Although the control group didn’t participate in the lifestyle program, people typically pay more attention to what they’re doing when they’re part of a study and are being monitored.

But overall, the lifestyle group came out 25% ahead of the controls. This included an 83% greater improvement in executive function, and a 40% greater improvement on complex memory tasks.

(Executive function includes memory and how we integrate new information with what we already know, adapting to change, and controlling our thoughts and emotions, all of which can tail off from our 60s.)

By the end of the trial the control group had a 30% greater risk of developing cognitive impairment than the lifestyle group. That’s substantial.

Not surprisingly, cognitive function wasn’t the only area to benefit from the lifestyle intervention, which no doubt increased circulation, reduced inflammation, and so on. Cardiovascular health, mobility, and general capacity to handle everyday life improved too.

This suggests that while individual areas matter — for example, physically active older people have been shown to be up to 40% less likely to develop dementia than sedentary people — addressing the group of five is even more beneficial.

Since 2017 the success of FINGER has generated interest in off-shoot trials in over 60 other countries. Australia is one of them, led by a team in Perth, with participants from Perth and Sydney.

And there’s enough information about the Australian trial (known as AU-ARROW — yes, it’s a complicated acronym) that we can piggy-back on it, without participating in the research.

For instance, we know that the recommended diet for the study is what’s called the MIND diet (or Mediterranean-DASH Intervention for Neurodegenerative Delay), which reflects what we typically think of as a Mediterranean-style diet. Maggie Beer’s book Recipes for Life will be provided to participants during the trial.

In addition, cognitive training will be done at home using the computer-based program BrainHQ in four 30-minute sessions each week.

And everyone will get a Fitbit to encourage them to keep physically active.

Any of us with the means can make an effort to eat real food, tap into Maggie Beer’s book, sign up to BrainHQ, exercise, and work with our GP to monitor cardiovascular risk factors. Or at least start somewhere on that list.

Meanwhile, the first local government Train your Brain programs based on the FINGER results are being trialed in Stockholm with people over 65 at risk of cognitive decline and dementia. Hopefully we’ll see that kind of initiative here too.

Despite FINGER’s impressive results, there are still questions around the way we apply the findings.

For example, that regime is quite a commitment, and no one knows how closely we need to stick to it to get worthwhile benefits.

Another question is how sustainable it will be when the program structure is taken away.

Fortunately, the original FINGER participants are being followed up for years to come, so we’ll find that out.