Nurse-Led Coaching Trial Trimmed Dementia Risk Scores, but Not Cognition

This article is based on that report. The paper itself, published in The Lancet Regional Health – Western Pacific, was not reviewed.

According to News-Medical, the HAPPI MIND trial assigned 31 general practices in Victoria and New South Wales, by chance, to a coaching arm or a control arm. Participants were adults aged 45 to 65 with two or more modifiable dementia risk factors and access to a smartphone or tablet. The report says 201 people were in the intervention group and 202 in the control group.

The coaching group had six nurse-led sessions: five in the first year and one at 24 months. Nurses gave personalized risk reports, set goals with participants and used motivational interviewing. Participants also used an app to track goals and read education material. Controls received a risk screening, a risk report and an educational booklet, then continued usual care.

The main measure was the ANU-ADRI, a questionnaire that estimates future dementia risk from known risk and protective factors. Lower scores mean a more favorable profile. According to News-Medical, 56% of the coaching group improved their score, versus 44% of controls. The adjusted difference between groups was 1.6 points. The report says the estimated effect was smaller after further adjustment for baseline differences.

The report is clear about what did not change. The groups did not differ significantly on cognition, quality of life, cardiovascular risk, psychosocial measures, or clinical and biomarker measures. The ANU-ADRI is an estimate built from habits and health factors. It is not a dementia diagnosis, and the coverage describes no dementia outcomes.

Some component scores moved. According to the report, protective-factor scores improved more with coaching, particularly physical activity, fish intake and body mass index status. Risk-factor scores did not differ between groups. These extra comparisons were not adjusted for multiple testing, which raises the chance that some findings are noise. Both groups improved on LDL cholesterol. Diet and medication adherence scores worsened in both groups.

Several limits apply, per the coverage. Participants and nurses knew who was coaching. Groups differed at the start: physical inactivity and uncontrolled diabetes were more common in the intervention arm, and its risk scores were numerically higher. Follow-up at 12 months was 78% for coaching and 88% for controls. Exploratory analyses hinted at larger benefits for people with low socioeconomic status and high baseline risk, but the report says these need confirmation in larger studies.

So far, the evidence suggests structured primary-care coaching can shift an estimated risk score. It does not yet show effects on memory, thinking or health measures. Follow-up is planned to 36 months, and those results will show whether the score changes lead to anything measurable.