Research Spotlight: Implementation of a Lifestyle Dementia Prevention Intervention

Ryan Andrew Mace, PhD, an investigator in the Center for Health Outcomes and Interdisciplinary Research (CHOIR) within the department of Psychiatry at Massachusetts General Hospital and an assistant professor of Psychology at Harvard Medical School, is the lead author of a recently published paper in the Journal of Alzheimer's Disease; Optimizing the Implementation of a Lifestyle Dementia Prevention Intervention for Older Patients in an Academic Healthcare System.

Ana-Maria Vranceanu, PhD, is the senior author of the study.

What Question Were You Investigating?

Interventions that promote healthy lifestyles are critical for the prevention of Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). However, knowledge of the best practices for implementing AD/ADRD prevention in healthcare settings remains limited.

In our recent study, we set out to investigate the barriers and facilitators to implementing a clinical trial of the “My Healthy Brain” AD/ADRD prevention intervention at Mass General Brigham (MGB).

This intervention is a virtual, group-based program for older patients (age 60+) with subjective cognitive decline who are at risk for AD/ADRD. Group members learn mindfulness and behavioral strategies to set goals to improve physical activity, sleep, nutrition, and other lifestyle factors linked to lower rates of AD/ADRD.

The goal of our study was to qualitatively identify the challenges and supportive factors impacting the acceptability, appropriateness and feasibility of this intervention within the healthcare setting​ based on focus groups with healthcare professionals.

What Were the Results?

Our team conducted five focus groups with 26 healthcare professionals (e.g., physicians, psychology, nursing) from five MGB clinics that treat older patients (e.g., memory care, psychiatry).

The study found widespread support for a randomized controlled trial (RCT) of the My Healthy Brain program aimed at AD/ADRD prevention.

Participants identified several barriers, including:

• Patient-related issues (stigma and lack of technological skills)
• Provider-related challenges (dismissiveness towards patients' concerns and doubts about behavior change capacity)
• Clinic limitations (time and resource constraints)
• Systemic issues within the larger healthcare system (underemphasis on prevention).

Despite these barriers, facilitators included strong support for the intervention and a general acknowledgment of the need for AD/ADRD prevention strategies.

Implementation strategies recommended by participants included:

• Developing tailored materials
• Training staff
• Obtaining buy-in from leadership
• Addressing stigmatized language and practices
• Identifying “champions” within the organization

Integrating the intervention with existing workflows and resources

What are the Clinical Implications and Next Steps?

The study highlights the importance of addressing multi-level barriers to effectively implement dementia prevention interventions in healthcare settings.

The findings suggest that with proper strategies it is feasible to integrate lifestyle interventions like My Healthy Brain into clinical practice. This integration could lead to improved prevention efforts for AD/ADRD, ultimately benefiting older patients at risk.

The next steps for this research involve conducting a feasibility randomized controlled trial (RCT) of the My Healthy Brain program based on the insights gained from this study.

This trial will refine recruitment, enrollment, and retention procedures, further test the implementation strategies identified, and evaluate the program's impact on cognitive health outcomes.

Additionally, ongoing collaboration with healthcare professionals and adaptation of the intervention to address identified barriers will be crucial for successful implementation and broader adoption in diverse clinical settings​.

To Participate in My Healthy Brain:

mghmyhealthybrain@mgb.org
(617) 643-9406

https://rally.massgeneralbrigham.org/study/mhb

 

Paper Cited:

Mace, R. A., Lyons, C., Cohen, J. E., Ritchie, C., Bartels, S., Okereke, O. I., Hoeppner, B. B., Brewer, J. A., & Vranceanu, A. M. (2024). Optimizing the Implementation of a Lifestyle Dementia Prevention Intervention for Older Patients in an Academic Healthcare System. Journal of Alzheimer's disease : JAD, 100(4), 1237–1259. https://doi.org/10.3233/JAD-240365