Lifestyle interventions for dementia prevention in low- and middle-income countries: a systematic review.

INTRODUCTION

By 2050, two-thirds of people with dementia will live in low-and-middle-income countries (LMICs). However, multimodal prevention lifestyle interventions for people at risk are being developed predominantly in higher-income countries.

METHODS

We systematically reviewed randomised controlled trials (RCTs) evaluating non-pharmacological interventions in individuals with mild cognitive impairment and subjective cognitive decline in LMICs. We assessed quality using the Mixed Methods Assessment Tool, meta-analysed and synthesised evidence.

RESULTS

We included 25 RCTs from six countries (most in China, n=17), involving 1304 participants. In the 15 studies with sufficient data to meta-analyse, we found significant positive effects on cognition favouring interventions (1.49 (standardised mean difference, 95% CI 1.06 to 1.93)). There was significant publication bias. We classified interventions into exercise, multidomain and arts/creative expression. Exercise (1.67, 95% CI 1.24 to 2.11, n=8) and multidomain (1.22, 95% CI 0.22 to 2.21, n=5) had replicated evidence of effectiveness. There was insufficient data to meta-analyse the arts/creative category.

CONCLUSION

We propose greater consideration and investment in the development of interventions accounting for specific LMIC contexts from the outset, so they are acceptable and used by local services.

PROSPERO REGISTRATION NUMBER: CRD42023403908.