Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)

• ClinicalTrials.gov Identifier: NCT01041989
• Recruitment Status: Active, not recruiting
• First Posted: January 5, 2010
• Last Update Posted: April 19, 2023
• Sponsor: Finnish Institute for Health and Welfare
• Collaborators: Academy of Finland; University of Helsinki; University of Eastern Finland; University of Oulu; Kuopio Research Institute of Exercise Medicine; Western University, Canada; Karolinska Institutet; Umeå University
• Information provided by (Responsible Party): Miia Kivipelto, Finnish Institute for Health and Welfare

Study Description

Brief Summary:

This multi-center (6 sites: Helsinki, Kuopio, Oulu, Seinäjoki, Turku, Vantaa) intervention study aims to prevent cognitive impairment, dementia and disability in 60-77 year old persons at an increased dementia risk. The 2-year multi-domain life-style intervention includes nutritional guidance, exercise, cognitive training, increased social activity, and intensive monitoring and management of metabolic and vascular risk factors. The primary outcome is cognitive impairment measured by a sensitive Neuropsychological Test Battery (NTB), and Stroop and Trail Making tests to capture early cognitive impairment typical for both Alzheimer's disease and vascular dementia. We hypothesize that the multi-domain intervention will reduce cognitive impairment in the study group compared to the control group during the initial 2-year intervention period and reduce dementia incidence after the extended follow-up (until at least 300 participants have developed dementia).

Condition or disease	Intervention/treatment	Phase
Cognitive Impairment; Dementia	Behavioral: Nutritional guidance; Behavioral: Exercise; Behavioral: Cognitive training; Other: Reduction of vascular risk factors	Not Applicable

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 1200 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Prevention
• Official Title: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability
• Study Start Date: September 2009
• Actual Primary Completion Date: December 2013
• Estimated Study Completion Date: December 2025

Arms and Interventions

Arm	Intervention/treatment
No Intervention: Standard health counseling at baseline
Experimental: Lifestyle counseling; Multi-domain lifestyle counseling including nutritional guidance, increased physical activity, cognitive training, increased social activity and intensive monitoring of vascular and metabolic risk factors.	Behavioral: Nutritional guidance; Individual counseling sessions and group meetings will be organized.; Behavioral: Exercise; Guided muscle strength training and aerobic exercise.; Behavioral: Cognitive training; Cognitive training will be implemented through 8 group sessions lead by a psychologist and a computer-based cognitive training program available to participants via the internet.; Other: Reduction of vascular risk factors; Monitoring and maintenance of metabolic and vascular risk factors

Outcome Measures

Primary Outcome Measures :

1. Cognitive impairment assessed with a Neuropsychological Test Battery, and Stroop and Trail Making tests. [ Time Frame: 2 years ]

Secondary Outcome Measures :

1. Depressive symptoms will be assessed using the Zung depression scale. [ Time Frame: 2 years ]
2. Disability will be assessed using the ADCS-ADL scale [ Time Frame: 2 years ]
3. Quality of Life will be assessed using the RAND-36 and 15D questionnaires. [ Time Frame: 2 years ]
4. Utilization of health resources will be assessed using questionnaire and register data. [ Time Frame: 2 years ]
5. Vascular and metabolic risk factors will be assessed with blood pressure and anthropometric measurements, and laboratory analyses of metabolic biomarkers. [ Time Frame: 2 years ]
6. Vascular and metabolic morbidity and mortality will be assessed through questionnaire and register data. [ Time Frame: 2 years ]
7. Changes in dietary biomarker levels will be assessed through laboratory testing. [ Time Frame: 2 years ]

Eligibility Criteria

• Ages Eligible for Study: 60 Years to 77 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• aged 60-77 years
• dementia Risk Score 6 points or more
• fulfillment of at least one of the following CERAD criteria: i) MMSE: 20-26 points ii) word list memory task (3x10 words): 19 words or less iii) delayed recall: 75% or less

Exclusion Criteria:

• malignant diseases
• dementia
• substantial cognitive decline
• major depression
• symptomatic cardiovascular disease
• revascularisation within 1 year
• severe loss of vision, hearing or communicative ability
• other conditions inhibiting from safe engagement in the prescribed intervention as judged by the study physician
• other conditions preventing from cooperation as judged by the study physician

Contacts and Locations

Locations

Finland

Finnish Institute for Health and Welfare

Helsinki, Finland, 00300

University of Eastern Finland

Kuopio, Finland, 70211

University of Oulu

Oulu, Finland, 90014

Research Center Mediwest

Seinajoki, Finland, 60220

Finnish Institute for Health and Welfare

Turku, Finland, 20720

Sponsors and Collaborators

Finnish Institute for Health and Welfare

Academy of Finland

University of Helsinki

University of Eastern Finland

University of Oulu

Kuopio Research Institute of Exercise Medicine

Western University, Canada

Karolinska Institutet

Umeå University

Investigators

• Principal Investigator: Miia Kivipelto, professor; Finnish Institute for Health and Welfare
• Study Director: Tiina K Laatikainen, professor; Finnish Institute for Health and Welfare
• Study Director: Hilkka S Soininen, professor; University of Eastern Finland
• Study Director: Jaakko Tuomilehto, professor; University of Helsinki
• Study Director: Timo E Strandberg, professor; University of Oulu
• Study Director: Raimo Sulkava, professor; University of Eastern Finland
• Study Director: Rainer Rauramaa, professor; Kuopio Research Institute of Exercise Medicine
• Study Director: Antti Jula, research prof; Finnish Institute for Health and Welfare
• Study Director: Markku Peltonen, research professor; Finnish Institute for Health and Welfare
• Study Director: Satu Havulinna, PhD; Finnish Institute for Health and Welfare
• Study Director: Jaana Lindström, Adjunct prof.; Finnish Institute for Health and Welfare
• Study Director: Riitta Antikainen, professor; Oulu City Health Services
• Study Director: Tiia Ngandu, MD, PhD, Adjunct professor; Finnish Institute for Health and Welfare
• Study Director: Tuomo Hänninen, Adjunct prof; University of Eastern Finland
• Study Director: Jenni Lehtisalo, PhD; Finnish Institute for Health and Welfare
• Study Director: Alina Solomon, MD, PhD, Adjunct professor; University of Eastern Finland

More Information

Publications of Results:

Kivipelto M, Solomon A, Ahtiluoto S, Ngandu T, Lehtisalo J, Antikainen R, Backman L, Hanninen T, Jula A, Laatikainen T, Lindstrom J, Mangialasche F, Nissinen A, Paajanen T, Pajala S, Peltonen M, Rauramaa R, Stigsdotter-Neely A, Strandberg T, Tuomilehto J, Soininen H. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): study design and progress. Alzheimers Dement. 2013 Nov;9(6):657-65. doi: 10.1016/j.jalz.2012.09.012. Epub 2013 Jan 17.

Ngandu T, Lehtisalo J, Levalahti E, Laatikainen T, Lindstrom J, Peltonen M, Solomon A, Ahtiluoto S, Antikainen R, Hanninen T, Jula A, Mangialasche F, Paajanen T, Pajala S, Rauramaa R, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M. Recruitment and baseline characteristics of participants in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER)-a randomized controlled lifestyle trial. Int J Environ Res Public Health. 2014 Sep 10;11(9):9345-60. doi: 10.3390/ijerph110909345.

Ngandu T, Lehtisalo J, Solomon A, Levalahti E, Ahtiluoto S, Antikainen R, Backman L, Hanninen T, Jula A, Laatikainen T, Lindstrom J, Mangialasche F, Paajanen T, Pajala S, Peltonen M, Rauramaa R, Stigsdotter-Neely A, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015 Jun 6;385(9984):2255-63. doi: 10.1016/S0140-6736(15)60461-5. Epub 2015 Mar 12.

Kulmala J, Ngandu T, Pajala S, Lehtisalo J, Levalahti E, Antikainen R, Laatikainen T, Oksa H, Peltonen M, Rauramaa R, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M. Leisure-Time and Occupational Physical Activity in Early and Late Adulthood in Relation to Later Life Physical Functioning. J Phys Act Health. 2016 Oct;13(10):1079-1087. doi: 10.1123/jpah.2015-0664. Epub 2016 Aug 16.

Strandberg TE, Levälahti E, Ngandu T, Solomon A, M Kivipelto for FINGER Study Group. Health-Related Quality of Life in a Multidomain Intervention Trial to Prevent Cognitive Decline (FINGER). Eur Ger Med. 2017; 8: 164-167.

Lehtisalo J, Ngandu T, Valve P, Antikainen R, Laatikainen T, Strandberg T, Soininen H, Tuomilehto J, Kivipelto M, Lindstrom J. Nutrient intake and dietary changes during a 2-year multi-domain lifestyle intervention among older adults: secondary analysis of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) randomised controlled trial. Br J Nutr. 2017 Aug;118(4):291-302. doi: 10.1017/S0007114517001982.

Marengoni A, Rizzuto D, Fratiglioni L, Antikainen R, Laatikainen T, Lehtisalo J, Peltonen M, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M, Ngandu T. The Effect of a 2-Year Intervention Consisting of Diet, Physical Exercise, Cognitive Training, and Monitoring of Vascular Risk on Chronic Morbidity-the FINGER Randomized Controlled Trial. J Am Med Dir Assoc. 2018 Apr;19(4):355-360.e1. doi: 10.1016/j.jamda.2017.09.020. Epub 2017 Nov 3.

Solomon A, Handels R, Wimo A, Antikainen R, Laatikainen T, Levalahti E, Peltonen M, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M, Ngandu T. Effect of a Multidomain Lifestyle Intervention on Estimated Dementia Risk. J Alzheimers Dis. 2021;82(4):1461-1466. doi: 10.3233/JAD-210331.

Lehtisalo J, Rusanen M, Solomon A, Antikainen R, Laatikainen T, Peltonen M, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M, Ngandu T. Effect of a multi-domain lifestyle intervention on cardiovascular risk in older people: the FINGER trial. Eur Heart J. 2022 Jun 1;43(21):2054-2061. doi: 10.1093/eurheartj/ehab922.

Wimo A, Handels R, Antikainen R, Eriksdotter M, Jonsson L, Knapp M, Kulmala J, Laatikainen T, Lehtisalo J, Peltonen M, Skoldunger A, Soininen H, Solomon A, Strandberg T, Tuomilehto J, Ngandu T, Kivipelto M. Dementia prevention: The potential long-term cost-effectiveness of the FINGER prevention program. Alzheimers Dement. 2022 Jul 16. doi: 10.1002/alz.12698. Online ahead of print.

Other Publications:

Kivipelto M, Ngandu T, Laatikainen T, Winblad B, Soininen H, Tuomilehto J. Risk score for the prediction of dementia risk in 20 years among middle aged people: a longitudinal, population-based study. Lancet Neurol. 2006 Sep;5(9):735-41. doi: 10.1016/S1474-4422(06)70537-3.

Kivipelto M, Helkala EL, Laakso MP, Hanninen T, Hallikainen M, Alhainen K, Soininen H, Tuomilehto J, Nissinen A. Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study. BMJ. 2001 Jun 16;322(7300):1447-51. doi: 10.1136/bmj.322.7300.1447.

Kivipelto M, Helkala EL, Hanninen T, Laakso MP, Hallikainen M, Alhainen K, Soininen H, Tuomilehto J, Nissinen A. Midlife vascular risk factors and late-life mild cognitive impairment: A population-based study. Neurology. 2001 Jun 26;56(12):1683-9. doi: 10.1212/wnl.56.12.1683.

Kivipelto M, Helkala EL, Laakso MP, Hanninen T, Hallikainen M, Alhainen K, Iivonen S, Mannermaa A, Tuomilehto J, Nissinen A, Soininen H. Apolipoprotein E epsilon4 allele, elevated midlife total cholesterol level, and high midlife systolic blood pressure are independent risk factors for late-life Alzheimer disease. Ann Intern Med. 2002 Aug 6;137(3):149-55. doi: 10.7326/0003-4819-137-3-200208060-00006.

Rovio S, Kareholt I, Helkala EL, Viitanen M, Winblad B, Tuomilehto J, Soininen H, Nissinen A, Kivipelto M. Leisure-time physical activity at midlife and the risk of dementia and Alzheimer's disease. Lancet Neurol. 2005 Nov;4(11):705-11. doi: 10.1016/S1474-4422(05)70198-8.

Kivipelto M, Ngandu T, Fratiglioni L, Viitanen M, Kareholt I, Winblad B, Helkala EL, Tuomilehto J, Soininen H, Nissinen A. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005 Oct;62(10):1556-60. doi: 10.1001/archneur.62.10.1556.

Lindstrom J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemio K, Hamalainen H, Harkonen P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J; Finnish Diabetes Prevention Study Group. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006 Nov 11;368(9548):1673-9. doi: 10.1016/S0140-6736(06)69701-8.

Kivipelto M, Rovio S, Ngandu T, Kareholt I, Eskelinen M, Winblad B, Hachinski V, Cedazo-Minguez A, Soininen H, Tuomilehto J, Nissinen A. Apolipoprotein E epsilon4 magnifies lifestyle risks for dementia: a population-based study. J Cell Mol Med. 2008 Dec;12(6B):2762-71. doi: 10.1111/j.1582-4934.2008.00296.x. Epub 2008 Feb 8.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Goikolea J, Gerenu G, Daniilidou M, Mangialasche F, Mecocci P, Ngandu T, Rinne J, Solomon A, Kivipelto M, Cedazo-Minguez A, Sandebring-Matton A, Maioli S. Serum Thioredoxin-80 is associated with age, ApoE4, and neuropathological biomarkers in Alzheimer's disease: a potential early sign of AD. Alzheimers Res Ther. 2022 Feb 24;14(1):37. doi: 10.1186/s13195-022-00979-9.

Alenius M, Ngandu T, Koskinen S, Hallikainen I, Hanninen T, Karrasch M, Kivipelto M, Raivio MM, Laakkonen ML, Kruger J, Suhonen NM, Hokkanen L. Education-Based Cutoffs for Cognitive Screening of Alzheimer's Disease. Dement Geriatr Cogn Disord. 2022;51(1):42-55. doi: 10.1159/000521982. Epub 2022 Feb 23.

Neuvonen E, Lehtisalo J, Solomon A, Antikainen R, Havulinna S, Hanninen T, Laatikainen T, Lindstrom J, Rautio N, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M, Ngandu T. Psychosocial determinants for adherence to a healthy lifestyle and intervention participation in the FINGER trial: an exploratory analysis of a randomised clinical trial. Aging Clin Exp Res. 2022 Aug;34(8):1793-1805. doi: 10.1007/s40520-022-02088-x. Epub 2022 Feb 19.

Ngandu T, Lehtisalo J, Korkki S, Solomon A, Coley N, Antikainen R, Backman L, Hanninen T, Lindstrom J, Laatikainen T, Paajanen T, Havulinna S, Peltonen M, Neely AS, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M. The effect of adherence on cognition in a multidomain lifestyle intervention (FINGER). Alzheimers Dement. 2022 Jul;18(7):1325-1334. doi: 10.1002/alz.12492. Epub 2021 Oct 20.

Sandebring-Matton A, Goikolea J, Bjorkhem I, Paternain L, Kemppainen N, Laatikainen T, Ngandu T, Rinne J, Soininen H, Cedazo-Minguez A, Solomon A, Kivipelto M. 27-Hydroxycholesterol, cognition, and brain imaging markers in the FINGER randomized controlled trial. Alzheimers Res Ther. 2021 Mar 6;13(1):56. doi: 10.1186/s13195-021-00790-y.

Sindi S, Solomon A, Kareholt I, Hovatta I, Antikainen R, Hanninen T, Levalahti E, Laatikainen T, Lehtisalo J, Lindstrom J, Paajanen T, Peltonen M, Singh Khalsa D, Wolozin B, Strandberg T, Tuomilehto J, Soininen H, Ngandu T, Kivipelto M; FINGER Study Group. Telomere Length Change in a Multidomain Lifestyle Intervention to Prevent Cognitive Decline: A Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci. 2021 Feb 25;76(3):491-498. doi: 10.1093/gerona/glaa279.

Stephen R, Liu Y, Ngandu T, Antikainen R, Hulkkonen J, Koikkalainen J, Kemppainen N, Lotjonen J, Levalahti E, Parkkola R, Pippola P, Rinne J, Strandberg T, Tuomilehto J, Vanninen R, Kivipelto M, Soininen H, Solomon A; FINGER study group. Brain volumes and cortical thickness on MRI in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Alzheimers Res Ther. 2019 Jun 4;11(1):53. doi: 10.1186/s13195-019-0506-z.

Kulmala J, Ngandu T, Havulinna S, Levalahti E, Lehtisalo J, Solomon A, Antikainen R, Laatikainen T, Pippola P, Peltonen M, Rauramaa R, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M. The Effect of Multidomain Lifestyle Intervention on Daily Functioning in Older People. J Am Geriatr Soc. 2019 Jun;67(6):1138-1144. doi: 10.1111/jgs.15837. Epub 2019 Feb 26.

Lehtisalo J, Levalahti E, Lindstrom J, Hanninen T, Paajanen T, Peltonen M, Antikainen R, Laatikainen T, Strandberg T, Soininen H, Tuomilehto J, Kivipelto M, Ngandu T. Dietary changes and cognition over 2 years within a multidomain intervention trial-The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Alzheimers Dement. 2019 Mar;15(3):410-417. doi: 10.1016/j.jalz.2018.10.001. Epub 2018 Dec 4.

Solomon A, Turunen H, Ngandu T, Peltonen M, Levalahti E, Helisalmi S, Antikainen R, Backman L, Hanninen T, Jula A, Laatikainen T, Lehtisalo J, Lindstrom J, Paajanen T, Pajala S, Stigsdotter-Neely A, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M. Effect of the Apolipoprotein E Genotype on Cognitive Change During a Multidomain Lifestyle Intervention: A Subgroup Analysis of a Randomized Clinical Trial. JAMA Neurol. 2018 Apr 1;75(4):462-470. doi: 10.1001/jamaneurol.2017.4365.

• Responsible Party: Miia Kivipelto, Professor, Finnish Institute for Health and Welfare
• ClinicalTrials.gov Identifier: NCT01041989
• Other Study ID Numbers: THL/TUET 122/2009
• First Posted: January 5, 2010
• Last Update Posted: April 19, 2023
• Last Verified: April 2023

Keywords provided by Miia Kivipelto, Finnish Institute for Health and Welfare:

dementia; cognitive impairment; disability; intervention; elderly; lifestyle counseling

Additional relevant MeSH terms:

Dementia; Cognitive Dysfunction; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurocognitive Disorders; Mental Disorders; Cognition Disorders