Healthy Aging

Through Internet Counselling

in the Elderly



Collaborative project co-funded by the European Unions' Seventh Framework Programme (FP7, 2007-2013) under grant agreement No 305374.

flag European Union   logo FP7 Cooperation


The HATICE trial has shown that older people can improve their lifestyle and adopt healthier behaviours with the support of an online coach. This way they can reduce their risk of cardiovascular disease and dementia. These results were published in The Lancet Digital Health on 14 November 2019.


After 18 months in the coach supported internet intervention, 90% of the treatment group set one or more goals related to their lifestyle, with the support of their coach. The researchers investigated the effect on a composite measure for cardiovascular disease risk, including blood pressure, body mass index (BMI) and cholesterol. The research shows that the treatment group had a modest, but significant improvement compared to the control group. This effect was largest in those participants who were most active on the website: for each additional goal set, the score representing the risk of cardiovascular disease improved.

These results are promising, but the researchers stress that prevention requires a long-term effort. Lead investigator Dr. Edo Richard: ‘Although the magnitude of the effect is relatively small, with this type of approach it takes time and larger effects are more likely in people with a higher risk of cardiovascular disease or those with less access to health care, such as people in low- and middle-income countries, but also people with low social advantage in Europe’.

The research also shows, according to co-lead investigator Dr. Eric Moll van Charante, that modern technology in the form of self-management with an online coach can be a valuable addition to regular health care, also in older persons. ’The results invite testing this type of intervention on a larger scale to confirm whether the beneficial effects we see are sustainable over time and eventually lead to fewer heart attacks, strokes and dementia in the long term’.



On April 12th 2018, Cathrien Beishuizen defended the second PhD thesis based on HATICE. Cathrien was involved in the development of the HATICE-platform, including the performance of a systematic review and meta-analysis on the effectiveness of internet-interventions for cardiovascular risk self-management and qualitative research with primary care nurses. Further she qualitatively investigated engagement of HATICE participants with the HATICE-platform and studied determinents of dropout and non-adherence in the PreDIVA trial. This thesis provides starting points on how to develop an eHealth application for cardiovascular self-management for older people. The results of this thesis indicate that human support forms an essential component of internet-interventions to increase their effectiveness and stimulate engagement. For more information, or a copy of the thesis, please contact Cathrien: c.r.beishuizen[at]amc.uva.nl

In March 2018, Cathrien started her training to become a general practitioner at the AMC, the Netherlands.

The results of the MAPT trial have recently been published in Lancet Neurology(1). The 3-year MAPT study was the first trial to evaluate the effectiveness of a multidomain lifestyle intervention, omega-3 fatty acid supplementation, or both interventions combined, compared to a placebo, on cognitive decline. In the main analysis, there were no significant effects on cognitive decline. However, the results of exploratory subgroup analyses suggested that the combined polyunsaturated fatty acid and multidomain intervention or the multidomain intervention alone might help to slow cognitive decline in people most likely to undergo decline—i.e., those with an increased dementia risk score, and those with evidence of brain amyloid pathology. This publication concludes the very successful range of publications of the finished trials in the HATICE consortium. Previously, the FINGER trial showed in the Lancet(2) that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population. PreDIVA showed in a secondary analysis in the Lancet(3) that 6 years of nurse-led intensive vascular care did not lead to a reduction of all-cause dementia, but seemed effective for the prevention of dementia in participants with untreated baseline hypertension at baseline and persons adherent to the intervention. The data of these trials were pooled in a specially designed pooled data platform to provide valuable input for the design of the HATICE trial on the effects of a blended internet intervention which included 2725 participants and will be finished in December 2017(4).

1. Andrieu S, Guyonnet S, Coley N, Cantet C, Bonnefoy M, Bordes S, et al. Effect of long-term omega 3 polyunsaturated fatty acid supplementation with or without multidomain intervention on cognitive function in elderly adults with memory complaints (MAPT): a randomised, placebo-controlled trial. Lancet Neurol. 2017.
2. Ngandu T, Lehtisalo J, Solomon A, Levalahti E, Ahtiluoto S, Antikainen R, et al. 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;385(9984):2255-63.
3. Moll van Charante EP, Richard E, Eurelings LS, van Dalen JW, Ligthart SA, van Bussel EF, et al. Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. Lancet. 2016.
4. Richard E, Jongstra S, Soininen H, Brayne C, Moll van Charante EP, Meiller Y, et al. Healthy Ageing Through Internet Counselling in the Elderly: the HATICE randomised controlled trial for the prevention of cardiovascular disease and cognitive impairment. BMJ Open. 2016;6(6):e010806.

On 22 September 2017 Susan Jongstra will be the first to obtain a PhD degree based on the HATICE project. As a PhD student Susan was involved in the ongoing trials evaluation, the design of the generic intervention, and the controlled trial itself.

Her thesis covers a broad spectrum of issues involving eHealth in cardiovascular risk management to prevent cognitive decline. Not only the rationale and design of the HATICE trial is presented, but also the extensive, profound and time-consuming process of developing an internet platform for the prevention of cardiovascular disease in older adults. Based on data from the preDIVA trial, the added predictive value of a neuropsychological test of visual memory (Visual Association Test, VAT) over and above a cognitive screening instrument (Mini Mental State Examination, MMSE) was assessed. It seemed that such a short, simple test as the VAT has substantial incremental value for distinguishing older individuals that are at increased risk of developing dementia. For more information, or a copy of the thesis, please contact Susan: s.jongstra[at]amc.uva.nl

In January 2017, Susan has started her training to become a neurologist at the Academic Medical Center in Amsterdam, the Netherlands.

Over 2 years ago, the HATICE trial started recruitment of older people (>=65 years) at increased risk of cardiovascular disease and dementia. Participants randomized to the intervention group have access to an interactive internet platform, stimulating self-management of vascular risk factors, with remote support by a coach. Participants in the control group have access to a static internet platform with basic health information. We will assess the impact of the intervention on the cardiovascular risk profile and the risk of cardiovascular disease and cognitive decline. In September 2016, the last of a total of 2725 participants was recruited for the HATICE trial. Baseline data collection is very complete with less than 1% missing values.

The 12 months and final (18 months) assessments are going very smoothly. According to schedule, by 15 April in total 1764 (65%) participants have finished the 12 months assessment and 673 (25%) participants also finished the final assessment. In total 194 participants (7%) have dropped out, of whom 10 (5%) were retrieved at the final visit. Of the intervention participants, 70% is a regular and persistent user of the platform (>1 time a month). The assessments will be finished in December 2017 and the results will be published in a peer reviewed international journal.