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Gray Matters Study

THE GRAY MATTERS STUDY, FROM UTAH STATE UNIVERSITY TO ROME UNIVERSITY LA SAPIENZA:
THE IMPORTANCE OF PREVENTION PROGRAMS TO LOWER THE RISK OF ALZHEIMER’S DISEASE
by Laura Valzolgher, MD; Stefano Eleuteri

Gray Matters study:

  • Multi-domain behavioural intervention with an innovative smartphone app
  • Aims at improving lifestyle changes in 7 behavioural domains
  • Gray Matters Study USA (Utah State University): RCT, 146 participants ( age 39-56 y)
  • Gray Matters Rome (University La Sapienza) ongoing, RCT, 117 participants (age 39-65 y)

Intro:
Gray Matters is a multi-domain behavioural intervention, conducted by Prof. Maria Norton at Utah State University (USA) and subsequently initiated in Rome in partnership with Sapienza University of Rome. The program uses a novel smartphone application for promoting healthy lifestyles in middle-aged people, in order to improve cognitive, physical, and psychological health, and ideally to lower the risk of Alzheimer’s disease.

Intervention:
The smartphone application was developed at Ulster University, Northern Ireland, under the direction of Dr. Chris Nugent. Specifically, the app was designed to act on six different behavioural domains linked to cognitive health: physical activity, healthy food choices, sleep quality, cognitive/mental activities, social engagement, and stress management. In the Rome protocol, smoking was added to the domains investigated. For each domain, they were given the same set of information, accountability practices, reporting system and feedback.

Aim:
The objective of the study was to determine whether a six month intervention period could show significantly more positive behavioural change (healthier lifestyle) in one or more domains, and more positive cognitive health and wellbeing outcomes, compared to no intervention.

Study design:
Participants in the USA (n=146), aged 40- 64 years, were recruited in Cache County (Utah), primarily through the university and community health department. 69% had a relative with dementia (43% parent/sibling, 27% with g-parent/aunt/uncle). The research design was a randomized controlled trial: the treatment group (104) received the intervention, and the control group (42) received no intervention. Data were collected at time zero, three, and six months, and clinical/laboratory procedures at time zero and 6 months. The Gray Matters Rome study is currently underway at La Sapienza University. The smartphone app is in Italian, and the Italian Gray Matters website is also in Italian. The study also provides live topical seminars at San’Andrea Hospital on health behaviour domains (e.g. stress, physical activity). Data collection is underway.

Results:
Consistency of engagement with the Gray Matter app was important. Results from Gray Matters USA on the pattern of app usage showed that participants who improved their HDL Cholesterol levels answered statistically more questions per day than those with no improvement. Moreover, participants who achieved over 60% of their recommended daily goals were more likely to decrease their BMI during the study.

As measured with an intrinsic motivation survey, “Action” orientation was predictive of behavior change, where a lower level of “Action” significantly predicted greater improvement in physical activity (if younger than age 57). Being at a “High” level of readiness to change predicted significantly greater improvements in physical activity, but for females only.

Effect of “fear of developing Alzheimer’s disease and metacognitive concerns” on health-related behavior change were also investigated. Results showed that a moderate level of fear of AD and a moderate level of metacognitive concerns predicted significant increases in physical activity. Additionally, a moderate level of metacognitive concerns predicted significant improvement in diet quality (adherence to a DASH diet). Factors that influence fear of developing Alzheimer’s differed by gender. Women were more affected by greater metacognitive concerns while men were more affected by prior caregiving experience. Both genders were greatly affected by having more family members with dementia.

Considering psychological and behavioural predictors of Body Mass Index, the latter was significantly influenced by physiological behaviours (diet quality and physical activity), rather than psychological factors. Investigating psychological and behavioural predictors of depressive symptoms, they were influenced by a combination of psychological factors (perceived stress) and physiological factors (physical activity and sleep quality).

Conclusion:
Studies on prevention programs should be encouraged, given the role of environment in the development of AD and the lack of pharmacological treatment of dementia. A longer follow-up would be needed to see if such interventions could effectively lower AD risk. We hope that results of the Gray Matters Rome study will give us further data on this interesting but still not well understood topic.

For further reading:

  • Norton MC, et al. Lifestyle behavior pattern is associated with different levels of risk for incident dementia and Alzheimer’s disease: the Cache County study. Journal of the American Geriatrics Society. 2012 Mar; 60(3):405-12.
  • Norton MC, et al. The design and progress of a multidomain lifestyle intervention to improve brain health in middle-aged persons to reduce later Alzheimer’s disease risk: the Gray Matters randomized trial. Alzheimers & Dementia: Translational. 2015 ( 1); 53-62.
  • Hartin PJ et al. The Empowering Role of Smartphones in Behaviour Change Interventions: The Gray Matters Study. The Journal of Medical Internet Research Mhealth Uhealth. 2016 Jul-Sep; 4(3): e93.
  • Direct link to the Gray Matters Intervention Study in Rome: http://dip38.psi.uniroma1.it/ricerca/convenzioni-e-progetti/progetto-gray-matters

Laura Valzolgher, MD, works in the Memory Clinic of the Geriatric Department at Bolzano Regional Hospital, Italy. She is currently doing a Master of Science Degree on Psychogeriatrics at Sapienza University of Rome.
Stefano Eleuteri, Health Psychologist, Research Fellow, he teaches “Psychology of the elderly“, “Psychology of caregiving“ and “Sexuality in the elderly“ in the Master of Science Degrees on “Psychogeriatrics“ for MDs and PsyDs and on “Elderly Case Management“ for Nurses at Sapienza University of Rome.

Excerpted article as reprint from IPA's newsletter, the IPA Bulletin, Volume 34, Number 3: IPA Members can read full issues here.

Acknowledgements

VCambridge University Press