Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

Mark A. Espeland; José A Luchsinger; Laura D Baker; Rebecca H. Neiberg; Steven E. Kahn; Steven E. Arnold; Rena R. Wing; George L Blackburn; George A. Bray; Mary Evans; Helen P Hazuda; Robert W. Jeffery; Valerie M Wilson; Jeanne M. Clark; Mace Coday; Kathryn Demos-McDermott; John P. Foreyt; Frank L. Greenway; James O. Hill; Edward S. Horton; John M. Jakicic; Karen C. Johnson; William C. Knowler; Cora E. Lewis; David M. Nathan; Anne L. Peters; Xavier Pi-Sunyer; Henry Pownall; Thomas A. Wadden; Stephen R Rapp; Look AHEAD Study Group

doi:10.1212/WNL.0000000000003955

Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

Mark A. Espeland, José A Luchsinger, Laura D Baker, Rebecca H. Neiberg, Steven E. Kahn, Steven E. Arnold, Rena R. Wing, George L Blackburn, George A. Bray, Mary Evans, Helen P Hazuda, Robert W. Jeffery, Valerie M Wilson, Jeanne M. Clark, Mace Coday, Kathryn Demos-McDermott, John P. Foreyt, Frank L. Greenway, James O. Hill, Edward S. HortonJohn M. Jakicic, Karen C. Johnson, William C. Knowler, Cora E. Lewis, David M. Nathan, Anne L. Peters, Xavier Pi-Sunyer, Henry Pownall, Thomas A. Wadden, Stephen R Rapp, Look AHEAD Study Group

Research output: Contribution to journal › Article › peer-review

62 Scopus citations

Abstract

OBJECTIVE: To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight.

METHODS: Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview.

RESULTS: Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5-13.5) years after enrollment, when participants' mean age was 69.6 (54.9-87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p = 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE ε4 allele status (all p ≥ 0.50). However, there was evidence (p = 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI.

CONCLUSIONS: Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes.

CLINICALTRIALSGOV IDENTIFIER: NCT00017953 (Action for Health in Diabetes).

LEVEL OF EVIDENCE: This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment.

Original language	English (US)
Journal	Neurology
DOIs	https://doi.org/10.1212/WNL.0000000000003955
State	E-pub ahead of print - Apr 26 2017

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Journal Article

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Espeland, M. A., Luchsinger, J. A., Baker, L. D., Neiberg, R. H., Kahn, S. E., Arnold, S. E., Wing, R. R., Blackburn, G. L., Bray, G. A., Evans, M., Hazuda, H. P., Jeffery, R. W., Wilson, V. M., Clark, J. M., Coday, M., Demos-McDermott, K., Foreyt, J. P., Greenway, F. L., Hill, J. O., ... Look AHEAD Study Group (2017). Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment. Neurology. Advance online publication. https://doi.org/10.1212/WNL.0000000000003955

Espeland, MA, Luchsinger, JA, Baker, LD, Neiberg, RH, Kahn, SE, Arnold, SE, Wing, RR, Blackburn, GL, Bray, GA, Evans, M, Hazuda, HP, Jeffery, RW, Wilson, VM, Clark, JM, Coday, M, Demos-McDermott, K, Foreyt, JP, Greenway, FL, Hill, JO, Horton, ES, Jakicic, JM, Johnson, KC, Knowler, WC, Lewis, CE, Nathan, DM, Peters, AL, Pi-Sunyer, X, Pownall, H, Wadden, TA, Rapp, SR & Look AHEAD Study Group 2017, 'Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment', Neurology. https://doi.org/10.1212/WNL.0000000000003955

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title = "Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment",

abstract = "OBJECTIVE: To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight.METHODS: Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview.RESULTS: Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5-13.5) years after enrollment, when participants' mean age was 69.6 (54.9-87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p = 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE ε4 allele status (all p ≥ 0.50). However, there was evidence (p = 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI.CONCLUSIONS: Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes.CLINICALTRIALSGOV IDENTIFIER: NCT00017953 (Action for Health in Diabetes).LEVEL OF EVIDENCE: This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment.",

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author = "Espeland, {Mark A.} and Luchsinger, {Jos{\'e} A} and Baker, {Laura D} and Neiberg, {Rebecca H.} and Kahn, {Steven E.} and Arnold, {Steven E.} and Wing, {Rena R.} and Blackburn, {George L} and Bray, {George A.} and Mary Evans and Hazuda, {Helen P} and Jeffery, {Robert W.} and Wilson, {Valerie M} and Clark, {Jeanne M.} and Mace Coday and Kathryn Demos-McDermott and Foreyt, {John P.} and Greenway, {Frank L.} and Hill, {James O.} and Horton, {Edward S.} and Jakicic, {John M.} and Johnson, {Karen C.} and Knowler, {William C.} and Lewis, {Cora E.} and Nathan, {David M.} and Peters, {Anne L.} and Xavier Pi-Sunyer and Henry Pownall and Wadden, {Thomas A.} and Rapp, {Stephen R} and {Look AHEAD Study Group}",

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doi = "10.1212/WNL.0000000000003955",

language = "English (US)",

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T1 - Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

AU - Espeland, Mark A.

AU - Luchsinger, José A

AU - Baker, Laura D

AU - Neiberg, Rebecca H.

AU - Kahn, Steven E.

AU - Arnold, Steven E.

AU - Wing, Rena R.

AU - Blackburn, George L

AU - Bray, George A.

AU - Evans, Mary

AU - Hazuda, Helen P

AU - Jeffery, Robert W.

AU - Wilson, Valerie M

AU - Clark, Jeanne M.

AU - Coday, Mace

AU - Demos-McDermott, Kathryn

AU - Foreyt, John P.

AU - Greenway, Frank L.

AU - Hill, James O.

AU - Horton, Edward S.

AU - Jakicic, John M.

AU - Johnson, Karen C.

AU - Knowler, William C.

AU - Lewis, Cora E.

AU - Nathan, David M.

AU - Peters, Anne L.

AU - Pi-Sunyer, Xavier

AU - Pownall, Henry

AU - Wadden, Thomas A.

AU - Rapp, Stephen R

AU - Look AHEAD Study Group

PY - 2017/4/26

Y1 - 2017/4/26

N2 - OBJECTIVE: To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight.METHODS: Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview.RESULTS: Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5-13.5) years after enrollment, when participants' mean age was 69.6 (54.9-87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p = 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE ε4 allele status (all p ≥ 0.50). However, there was evidence (p = 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI.CONCLUSIONS: Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes.CLINICALTRIALSGOV IDENTIFIER: NCT00017953 (Action for Health in Diabetes).LEVEL OF EVIDENCE: This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment.

AB - OBJECTIVE: To assess whether an average of 10 years of lifestyle intervention designed to reduce weight and increase physical activity lowers the prevalence of cognitive impairment among adults at increased risk due to type 2 diabetes and obesity or overweight.METHODS: Central adjudication of mild cognitive impairment and probable dementia was based on standardized cognitive test battery scores administered to 3,802 individuals who had been randomly assigned, with equal probability, to either the lifestyle intervention or the diabetes support and education control. When scores fell below a prespecified threshold, functional information was obtained through proxy interview.RESULTS: Compared with control, the intensive lifestyle intervention induced and maintained marked differences in weight loss and self-reported physical activity throughout follow-up. At an average (range) of 11.4 (9.5-13.5) years after enrollment, when participants' mean age was 69.6 (54.9-87.2) years, the prevalence of mild cognitive impairment and probable dementia was 6.4% and 1.8%, respectively, in the intervention group, compared with 6.6% and 1.8%, respectively, in the control group (p = 0.93). The lack of an intervention effect on the prevalence of cognitive impairment was consistent among individuals grouped by cardiovascular disease history, diabetes duration, sex, and APOE ε4 allele status (all p ≥ 0.50). However, there was evidence (p = 0.03) that the intervention effect ranged from benefit to harm across participants ordered from lowest to highest baseline BMI.CONCLUSIONS: Ten years of behavioral weight loss intervention did not result in an overall difference in the prevalence of cognitive impairment among overweight or obese adults with type 2 diabetes.CLINICALTRIALSGOV IDENTIFIER: NCT00017953 (Action for Health in Diabetes).LEVEL OF EVIDENCE: This study provides Class II evidence that for overweight adults with type 2 diabetes, a lifestyle intervention designed to reduce weight and increase physical activity does not lower the risk of cognitive impairment.

KW - Journal Article

U2 - 10.1212/WNL.0000000000003955

DO - 10.1212/WNL.0000000000003955

M3 - Article

C2 - 28446656

SN - 0028-3878

JO - Neurology

JF - Neurology

ER -

Effect of a long-term intensive lifestyle intervention on prevalence of cognitive impairment

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