The Gray Matter project: modificating lifestyles to prevent dementia

As dementia aetiology is based on different bio-psychosocial factors, prevention strategies for dementia have recently focused on multi-domain interventions of individuals at risk and/or with a normative cognitive level, encouraging the lifestyle change through combined programs of physical activity, cognitive training, nutrition education and social activities (in chapter 1, a narrative review of these studies is presented). Most of the multidomain intervention aimed on the prevention of cognitive disease are carried on with elderly patients with a mild cognitive decline or on at-risk adult categories. 5 Caregivers of patients with dementia are considered as an at-risk category. The majority of them (86%) are represented by family members (prominently women) who are also defined as “informal caregivers”. They fulfil their caringgiving role from 7 to 11 h a day on average, up to 10-15 h when clinical conditions worsen 10. Informal caregivers have to cope with physical, psychological and social stressors that affect their health conditions and quality of life negatively (Eleuteri et al., 2016). The burdens of caregiving include many things that have been shown to increase the risk of cognitive decline, including chronic stress, social isolation, depression, decreased physical activity, and a shift in eating habits toward more fast food and significantly more weight compared with controls (Vitaliano et al., 1996). This could be connected with the important role that sleep plays between stress and metabolic health (Geiker et al., 2018). Being a caregiver has been found to be a factor affecting negatively sleep quality (Brummett et al., 2006). Interventions to promote positive lifestyles are, therefore, important in order to improve the caregivers’ general health and, specifically, to prevent the cognitive decline. In the second chapter, an article recently published specifies the importance of multimodal interventions in ameliorating caregivers’ health, since complex moderation and mediation effects exist between the different areas involved in the AD risk reduction. The third chapter will, finally, describe the results of the Gray Matter Project, a multidomain pilot RCT, firstly carried out done in Cache County, Utah designed to promote positive changes in lifestyle (exercise, nutrition, cognitive stimulation, social engagement, stress management, and sleep quality), specifically for the purpose of reducing AD risk in family caregivers of elderly with dementia.