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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.

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Intensive treatment of cardiovascular risk factors had no significant preventive effect on dementia in the preDIVA study (‘Prevention of Dementia by Intensive Vascular Care’): the first investigation on intensive vascular care and dementia prevention

For the preDIVA study 3526 Dutch men and women aged 70-78 years were randomized to either intensive vascular care or standard care. The intervention comprised of four-monthly visits to a practice nurse in the GP practice, over a period of six years (18 visits). During these visits, cardiovascular risk factors were scrutinized: smoking habits, diet, physical activity, weight, and blood pressure. Blood glucose and lipids were assessed every two years and when indicated otherwise. Based on these assessments, individually tailored lifestyle advice was given according to a detailed protocol conform prevailing Dutch GP-guidelines on cardiovascular risk management and supported by motivational interviewing techniques. If indicated, drug treatment of hypertension, dyslipidemia, and type 2 diabetes mellitus (T2DM) was initiated or optimised.

During a follow-up of 6-8 years, dementia developed in 233 participants. The incidence of dementia was 8% lower in the intervention group than in the control group, though this difference was not significant. The protective effect of the intensive vascular care was bigger in those compliant to the treatment, and in the group with hypertension and not using antihypertensive medication at baseline.
The modest result may be due to primary care settings already providing high standards of cardiovascular risk management (CVRM) in the Netherlands, making it difficult to improve overall efficacy, especially for secondary cardiovascular prevention. Multi-domain interventions to prevent dementia might have a larger impact in low and middle income countries because of the lower standards of care and given the projected increase in hypertension, incident cardiovascular disease and dementia in these settings. Especially if vascular care is started at a younger age, in people with a high dementia risk and with extra attention to compliance.

Principal investigator Van Gool concludes: “Knowledge on dementia prevention goes with baby-steps. This study shows that there is no magical bullet. But it also gave us concrete clues which people to target to prevent dementia.”

The results of the preDIVA study were published in the LANCET. As part of the HATICE project, the preDIVA data are pooled with 2 other large dementia prevention trials.

consortium2
On 2 June 2016 the bi-annual General Assembly consortium meeting with representatives from each institution took place in Amsterdam. During this meeting the finalizing of the recruitment phase, the first experiences with the 12 months assessment and boost, and the final touch for the 18 months assessment were discussed. Also the first analyses on the baseline data were presented. It was also time to look ahead on building additional options into the shared data platform and further to utilizing the extensive data collection, beyond the plans that are already there. Also plans are made for future cooperation, beyond HATICE. It was a profitable day, underlining the next phase for HATICE.

The teams in Finland, France and the Netherlands are working very hard on including participants in the HATICE trial. In the Netherlands and Finland the first participants have been included in HATICE over 12 months ago, which means the 12 month assessments have started.

An ancillary study on determinants of participation (ACCEPT-HATICE) will start very soon. Individuals who are invited to take part in the HATICE trial and are eligible to do so will be asked to fill in a short self-administered questionnaire in order to study determinants of participation as well as barriers and facilitators to participation. This sub-study is called the ACCEPT-HATICE study. The questionnaire will include questions about socio-demographics, psychosocial characteristics (e.g. social support network), perceived health, and reasons for participation or non participation. Both persons who accept to participate in the trial and people who do not wish to participate will be asked to fill out these questionnaires. Furthermore, individual semi-structured interviews and/or focus groups will also be conducted with a subsample of HATICE participants and non participants (N=30/country) to further explore reasons for participation/non participation at baseline, and facilitators and barriers to adherence during the first year of follow-up.

In June 2016 the inclusion of participants in the HATICE trial is expected to be complete. Scientific progress will be communicated via this website.

Edo esocFrom May 9th till May 12th 2016 the second ESOC (European Stroke Organisation Conference) took place in Barcelona, Spain. Edo Richard presented encouraging data on the PreDIVA trial, which illustrated the effect of a multidomain intervention on cognitive functioning in general practice. With more than 3000 attendees this was a perfect opportunity to let the world know about PreDIVA. HATICE was also enthusiastically presented in the poster area with posters on the 'baseline characteristics HATICE' and 'blood pressure variability in PreDIVA'.