1a. To investigate novel interventions for vascular cognitive impairment.
The WHO Guidelines on risk reduction of cognitive decline and dementia (Risk reduction of cognitive decline and dementia: WHO guidelines) provide evidence-based recommendations on lifestyle behaviours and interventions to delay or prevent cognitive decline and dementia. However, how best to implement such interventions and importantly whether a multi domain lifestyle intervention is effective, safe and globally feasible remain important research topics. Hence we propose to conduct a large community-based innovative trial as part of the World Wide FINGERS interdisciplinary network toshare experiences, harmonize data and plan joint international initiatives for the prevention of cognitive impairment or dementia (https://www.alz.org/wwfingers/overview.asp). The trial will target subjects with high risk to develop cognitive impairment and dementia. The main goal is to determine the efficacy and safety of multimodal lifestyle interventions together with intensive BP lowering. We hypothesize that these interventions have the potential to reduce cognitive decline and severity of CeVD and other VCI biomarkers which is closely integrated with Themes 2.
Progress: We have finished recruitment for the SINGER study, and currently doing follow up visits for all the recruited participants.
https://medicine.nus.edu.sg/macc/projects/singer/
1b. Health Services Research in VCI. (Linked to Theme 3)
We shall examine the results from the interventional trial in Theme 1 and the biomarker studies in Theme 2 to understand what factors impact clinical progression and their respective trajectories of decline so that we can better appreciate where to invest and what is worth investing in individuals affected by VCI to reduce the economic burden and improve delivery of care to demented individuals. This work aims to a) generate estimates of the long-term health and economic impact of VCI by applying simulation modelling and external data sources; and b) investigate the economic impact including cost-effectiveness of VCI management in the context of the clinical trial of multidomain lifestyle interventions and use of diagnostic biomarkers .
