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Adherence and intensity in multimodal lifestyle-based interventions for cognitive decline prevention: state-of-the-art and future directions
Natalia Soldevila‐Domenech, Amaia Ayala‐García, Mariagnese Barbera, Jenni Lehtisalo, Laura Forcano, Ana M. Diaz-Ponce, Marissa Deborah Zwan, Wiesje M. van der Flier et al.. Alzheimer s Research & Therapy, 2025-03-17
Topic: Risk, prevention and care in population studies
Preventing dementia and Alzheimer's disease (AD) is a global priority. Multimodal interventions targeting several risk factors and disease mechanisms simultaneously are currently being tested worldwide under the World-Wide FINGERS (WW-FINGERS) network of clinical trials. Adherence to these interventions is crucial for their success, yet there is significant heterogeneity in adherence reporting across studies, hindering the understanding of adherence barriers and facilitators. This article is a narrative review of available evidence from multimodal dementia prevention trials. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: nonpharmacological multimodal interventions (i.e., combining three or more intervention domains), targeting individuals without dementia, and using changes in cognitive performance and/or incident mild cognitive impairment or dementia as primary outcomes. Based on the findings, we propose future adherence reporting to encompass both participation (average attendance to each intervention component) and lifestyle change using dementia risk scores (e.g., the LIBRA index). Moreover, we provide an estimation of the expected intensity of multimodal interventions, defined as the ratio of the expected dose (i.e., the overall amount of the intervention offered specified in the trial protocol) to duration (in months). Adjusting the expected dose by average adherence enables estimation of the observed dose and intensity, which could be informative for identifying optimal dosage thresholds that maximize cognitive benefits across different populations. Finally, this article provides an overview of the determinants of adherence to multimodal interventions, emphasizing the need for improved adherence reporting to inform the design and implementation of precision prevention interventions.
Key findings
- Adherence to these interventions is crucial for their success, yet there is significant heterogeneity in adherence reporting across studies, hindering the understanding of adherence barriers and facilitators.
- Moreover, we provide an estimation of the expected intensity of multimodal interventions, defined as the ratio of the expected dose (i.e., the overall amount of the intervention offered specified in the trial protocol) to duration (in months).
Why it matters
This narrative review examines how adherence and intensity are reported in multimodal lifestyle trials aimed at preventing cognitive decline, and proposes ways to standardize adherence reporting. It does not test whether these interventions prevent Alzheimer's disease, so it cannot show that they work.
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Study details
- Study designnarrative review
- Evidence strengthLow
How this study scored 49/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s Research & Therapy) |
| Journal's citation record | 1 / 4 | Alzheimer s Research & Therapy: journal h-index 146 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | Design recorded as “narrative review”, which our rubric does not rank (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 25 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 8.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 4 / 6 | Cited 15.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 6 other studies in this library |
| Still being cited | 2 / 4 | Cited 25 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Rafael de la Torre: h-index 90 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Imperial College London: institution h-index 1,744 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 14 institution(s) in 6 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40098201) |
| Free to read | 2 / 2 | Free to read |
| Total | 49 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1186/s13195-025-01691-0
- PubMed: 40098201
- Original source →
- Free full text: Alzheimer s Research & Therapy →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Soldevila‐Domenech, N., Ayala‐García, A., Barbera, M., Lehtisalo, J., Forcano, L., Diaz-Ponce, A. M., et al. (2025). Adherence and intensity in multimodal lifestyle-based interventions for cognitive decline prevention: state-of-the-art and future directions. Alzheimer s Research & Therapy. https://doi.org/10.1186/s13195-025-01691-0
Vancouver
Soldevila‐Domenech N, Ayala‐García A, Barbera M, Lehtisalo J, Forcano L, Diaz-Ponce AM, et al. Adherence and intensity in multimodal lifestyle-based interventions for cognitive decline prevention: state-of-the-art and future directions. Alzheimer s Research & Therapy. 2025. doi:10.1186/s13195-025-01691-0. PMID: 40098201.
BibTeX
@article{soldeviladomenech2025-40098201,
author = {Soldevila‐Domenech, Natalia and Ayala‐García, Amaia and Barbera, Mariagnese and Lehtisalo, Jenni and Forcano, Laura and Diaz-Ponce, Ana M. and Zwan, Marissa Deborah and van der Flier, Wiesje M. and others},
title = {{Adherence and intensity in multimodal lifestyle-based interventions for cognitive decline prevention: state-of-the-art and future directions}},
journal = {Alzheimer s Research \& Therapy},
year = {2025},
doi = {10.1186/s13195-025-01691-0},
pmid = {40098201},
url = {https://doi.org/10.1186/s13195-025-01691-0}
}
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