| Objective:The effectiveness of multidomain lifestyle interventions in preventing cognitive decline and dementia has been verified.However,current multidomain intervention studie s focus more on confirming the effectiveness of interventions for cognitive improvement.However,Studies that apply this evidence to community health services to promote adherence to brain-healthy behaviors in at-risk populations are lacking.When developing multidomain lifestyle intervention programs,exploring ways to promote behavior change and adherence to healthy lifestyle is needed.This study intends to conduct a cross-sectional survey of dementia risk and brain health-related lifestyle of the community residents to understand the current situation of dementia risk and brain health-related lifestyle of the community residents in Chongqing,and analyze their characteristics to clarify the key population and content of dementia prevention.Based on the results of literature review and cross-sectional survey,we will develop effective and feasible multidomain lifestyle intervention strategies,apply the original brain health education program,and explore its application effect in the community dementia risk population,so as to provide practical basis for dementia prevention and brain health promotion in the community.Methods:1.A questionnaire survey was conducted to understand the status of risk of dementia and brain health related lifestyle of the community residents in ChongqingThe convenient sampling method was used to select the residents who participated in the free physical examination of community health service center in 5 communities in Shapingba district of Chongqing as the research objects.Self-made general information questionnaire,Cardiovascular risk factors,aging,and incidence of dementia(CAIDE),Dementia risk reduction lifestyle scale(DRRLS),the Montreal cognitive assessment Beijing version(MoCA),Dementia knowledge assessment scale(DKAS),Motivation to change lifestyle and health behaviors for dementia risk reduction(MCLHB-DRR)were investigated.Data were entered into EXCEL software and statistical analysis was performed using SPSS 25.0 software.2.A randomized controlled trial was conducted to evaluate the intervention effect of multidomain lifestyle intervention on community residents at risk of dementiaReview nearly five years of domestic and foreign literature,understand the analysis of multidomain brain health promotion research status,behavior intervention technology application status and implementation points.Based on the results of the cross-sectional survey,develop effective and feasible multidomain lifestyle intervention strategies,revise the existing brain health education program,and the multidomain lifestyle intervention program was determined after discussion by the research group.The subjects included in the volume exclusion criteria were divided into control and experimental groups by EXCEL random number table.The study subjects in the control group received routine community health services provided by community health services centers,and the experimental group received a multidomain lifestyle intervention on the basis of routine community health services.Before the intervention(T0),after intervention(T1),intervention ended 3 months later(T2)collection subjects’data information.Data were entered into EXCEL software and statistical analysis was performed using SPSS 25.0software.Results:1.Questionnaire survey was conducted to understand the status of dementia risk and brain health related lifestyle of the residents the community residents in ChongqingA total of 211 residents were included in the survey,including 71 males and 140females,aged 45～86(67.10±7.49)years.A family history of dementia accounted for 11.4%(24/211),with a mean CAIDE score of(7.39±0.97)points,with low risk of dementia 19.0%(40/211),intermediate risk 65.9%(139/211)and high risk 15.1%(32/211).The mean MoCA score was(23.94±4.42)points(full marks 30 points).The mean DKAS score was(7.27±2.69)points(full marks 12 points.The mean score of MCLHB-DRR was(102.74±12.31)points(full marks 135 points),and the mean score of DRRLS was(89.41±11.60)points(full marks 128 points).The results of K-means cluster analysis show that the knowledge,belief and behavior performance of reducing dementia risk of the community residents i n Chongqing can be classified into three categories:knowledge,belief and practice Excellent type(referred to as Excellent type),low knowledge-high belief-bad behavior type(referred to as low knowledge type),and high knowledge-low belief-bad behavior type(referred to as low belief type).Among them,those with good behavior(i.e.,excellent type)accounted for39.8%,those with bad behavior(i.e.,low knowledge type and low belief type accounted for61.2%),and among those with bad behavior,low knowledge type accounted for 62.0%,low belief type accounted for 38.0%.There were significant differences in the three types of the length of schooling(χ~2=11.234,P<0.001).The average years of schooling of the excellent type were significantly higher than those of the other two types.There are differences in MoCA scores(χ~2=7.410,P<0.001),in CAIDE scores(χ~2=12.748,P<0.001).The MoCA score of low-knowledge type is significantly lower than the other two types,and the CAIDE score of excellent type is significantly lower than the other two types.2.A randomized controlled trial was conducted to evaluate the intervention effect of multidomain lifestyle intervention on community residents at risk of dementiaAccording to the results of the above cross-sectional survey,it is determined that mental activities,brain exercise and brain diet should be focused on by this population,and the knowledge and belief of reducing the risk of dementia are important targets to promote brain health.Therefore,diet,exercise and cognitive training were combined to form a multidomain lifestyle intervention strategy,and then motivational interview was integrated into the multidomain lifestyle intervention framework as a new intervention method to form a multidomain lifestyle intervention program with"active brain health"as the goal.The program mainly includes two parts:the first part is intensive group meeting(6-8 people in each group,face-to-face meeting,once a week,about 60 minutes each time,a total of 5times);the second part is individual behavior consolidation stage(one-on-one,telephone interview,once every two weeks,10-15 minutes each time,a total of 4 times).The intervention period was 12 weeks.A total of 83 subjects were included in the intervention study,and were randomly divided into the experimental group(42)and the control group(41)by EXCEL random number table method.Nine people in the experimental group and 10 in the control group failed to complete the study due to COVID-19,illness,hospitalization,or moving.A total of 64 people completed the whole study,including 33 people in the experimental group and31 people in the control group.The comparison of general information and evaluation indexes between the two groups showed no statistical difference and were comparable.2.1 The impact of a multidomain lifestyle intervention on the lifestyle of study subjectsThe results of the repeated measures ANOVA showed that there were interaction effects between time factor and group factor in the total score of DRRLS,health responsibility,brain strengthening exercise,mental activity,brain healthy diet,interpersonal relationship,stress management,and spiritual growth(all P<0.01).There was no interaction effect between the time factor and the group factor of the tobacco control behavior dimension score(P>0.05).After the intervention(T1),The total score of DRRLS in the experimental group was(93.39±11.14)points,intervention ended 3 months later(T2)scored(105.48±8.72)points,It was significantly higher than the(89.19±10.93)points on T1 and(85.48±12.16)points on T2(all P<0.01);The scores of T1 and T2 of health responsibility,interpersonal relationship,stress management and spiritual growth were also significantly higher than that of the control group(P<0.05);The scores of brain strengthening exercise and brain healthy diet were significantly higher than those of the control group(P<0.05),The rest were not statistically different.Combining the interaction profile map and within-group comparison,the total score of DRRLS and seven dimensions of health responsibility,brain exercise,mental activity,brain diet,interpersonal relationship,stress management and spiritual growth of the experimental group showed an increasing trend over time.2.2 The impact of a multidomain lifestyle intervention on dementia prevention beliefs of study subjectsThe results of repeated measures ANOVA showed that there were interaction effects between time and grouping factors in the MCLHB-DRR total score and the scores of susceptibility perception and severity perception(all P<0.01).At T1,the total score of MCLHB-DRR was(107.52±13.36)points and(113.91±7.87)points,significantly higher than(100.29±10.31)points at T1 and(103.03±14.27)points at T2(all P<0.01),also significantly higher than T1 and T2(all P<0.05);susceptibility perception,severity perception,and action motivation were significantly higher than T2(all P<0.05).Combining the interaction profile map and within-group comparison,the total score of MCLHB-DRR and the score of susceptibility perception dimension in the experimental group showed an increasing trend over time.2.3 The impact of a multidomain lifestyle intervention on dementia prevention knowledge of study subjectsThe results of repeated measures ANOVA of the DKAS score showed that there was interaction effect between time factor and group factor(P<0.01).At T1,the score of dementia prevention and control knowledge in the experimental group was(17.85±4.45),and at T2 was(19.91±4.61),significantly higher than the(15.32±4.51)points at T1 and(15.42±4.01)points at T2(all P<0.05).Combining the interaction profile map and within-group comparison,the DKAS scores of the experimental group showed an increasing trend over time.2.4 The impact of a multidomain lifestyle intervention on BMI and WHR values of study subjectsThe results of repeated measures ANOVA of BMI and WHR showed that there was no interaction effect between time factor and group factor(P>0.05),and the difference between BMI values in the two groups was statistically significant under the main effect of time(P<0.05).Combining the interaction profile map and within-group comparison showed that the experimental group BMI values decreased over time.The pairwise comparison showed that the BMI value of the experimental group at T2 was significantly lower than that of T1(P<0.05).Conclusions:1.The proportion of high risk for dementia among the community residents in Chongqing is high.Lack of mental activity and brain exercise is the main problem of poor brain health lifestyle in Chongqing community population.Although the brain diet is in the middle level,it is still a potential intervention aspect.Therefore,mental activity,b rain exercise and brain diet can be the key intervention problems of this population.There are significant category characteristics in the knowledge,belief and behavior of this population in reducing the risk of dementia,and there are differences in the overall cognitive function and dementia risk level of residents with different types of knowledge and behavior.The level of knowledge and belief in reducing the risk of dementia is related to the risk and cognitive function of dementia in the next 20 years.Therefore,knowledge and belief are important targets for dementia prevention intervention.2.In this study,a multidomain lifestyle intervention with diet,exercise and cognitive training combined with motivation/belief intervention can effectively i mprove the lifestyle of community people at risk of dementia,promote their positive belief formation to reduce the risk of dementia,and effectively improve their knowledge of dementia prevention and control and belief level of dementia prevention. |
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