Efficacy of multiple nonpharmacological interventions in individuals with subjective memory complaints.

Recent evidence showed that aerobic exercise, dietary habits and nutritional supplements consumption seem essential for maintaining good cognitive performances increasing hippocampal volume (HV) in healthy elderly people. Repetitive Transcranial Magnetic Stimulation (rTMS) improves general cognition through modulation of neural excitability in AD patients. Subjective memory complaint (SMC) individuals showed HV, white matter lesions (WML) and brain ventricle volumes (BVV) at limits of normative population supporting the hypothesis that they are persons at risk of AD. The above non-pharmacological treatments, when separately applied, do not impact on cognition and neuropathological processes of AD. On the contrary, combined treatments, in persons at risk to develop AD, could represent the first line of intervention to delay the onset of cognitive impairment.

Aims of the Project
To investigate the combined effect of aerobic exercise, dietary habits, nutritional supplements, and rTMS administered at three different levels of intensity on cognitive performance and MRI markers in subjective memory complaints individuals.
The three different intensity levels of nonpharmacological treatments will be organized as follows: (i) No Treatment (NT) will include rTMS brain stimulation (in sham condition) combined with cognitive training; (ii) Partial Treatment (PT) wil The three different intensity levels of nonpharmacological treatments will be organized as follows:

1. No Treatment (NT) will include rTMS brain stimulation (in sham condition) combined with cognitive training;
2. Partial Treatment (PT) will include nutritional supplements consumption and a training for a balanced diet;
3. Full treatment (FT) will include all above condition plus rTMS brain stimulation combined with cognitive training (no sham condition) and aerobic fitness training.

If confirmed, in terms of changes in cognitive performances, quality of life or brain imaging markers in SMC individuals, the positive effect of multiple non-pharmacological interventions, will allow the public health organizations to plan interventions aimed at preventing cognitive decline in at-risk elderly individuals. However, in case of a negative outcome, we will demonstrate that not even the combination of multiple non-pharmacological treatments has an effect on cognition and imaging markers.

Finally, this will be the first multiple non-pharmacological trial conducted in Italy and it will align Italy to other similar international initiatives such as the NIA-funded project Alzheimer’s Prevention Initiative (API) in the United States and the Multidomain Alzheimer Preventive Trial (MAPT) in France.