Effects of a Digital Multidomain Cognitive Intervention in Older People at High Risk of Dementia: A Randomized Clinical Trial.

Objective: To evaluate the effects of a 6-month digital multidomain cognitive intervention on cognitive function and psychosocial outcomes in older adults at high risk of dementia. Methods: A 2-arm, randomized clinical trial was conducted at Fujian Provincial Hospital and 4 community health care centers (April 2024 to December 2024). Participants (N=166, aged ≥60 years, modified dementia risk score >79) were enrolled and randomized 1:1 to a 6-month digital multidomain cognitive intervention and control group. Primary outcomes included general cognitive function (Montreal Cognitive Assessment [MoCA]) scores; secondary outcomes covered memory (Rey-Osterrieth Complex Figure Test [ROCFT] and Auditory Verbal Learning Test), language (Verbal Fluency Test and Boston Naming Test), executive function and attention (Shape Trails Test), visuospatial skill (ROCFT), mobility (Activity of Daily Living and Berg Balance Scale), psychosocial status (15-item Geriatric Depression Scale, Zung Self-Rating Anxiety Scale, UCLA Loneliness Scale, and Quality of Life-Alzheimer's Disease), and health-promoting behaviors (Health-Promoting Lifestyle Profile II and Self-Rated Abilities for Health Practices). Intention-to-treat analysis with random forest imputation was performed. Results: A total of 154 participants (92.77%) completed the trial. Compared to the control group, the intervention group demonstrated significant improvements in general cognitive function, visuospatial memory, and loneliness, including MoCA (t=2.106, P=.037), ROCFT immediate and long-delay recall (Z=-2.789, P=.05; t=2.797, P=.05), and UCLA Loneliness Scale (Z=-2.641, P=.008). No statistically significant between-group differences emerged in other indicators. Conclusion: A 6-month digital multidomain intervention significantly enhanced general cognitive function and visuospatial memory and reduced loneliness in older adults at high risk for dementia. These results highlight the potential of WeChat-based delivery models to provide feasible, acceptable, and widely applicable solutions for dementia risk reduction in aging populations. Trial Registration: ClinicalTrials. gov identifier: NCT06442943.