Digital 2-year multidomain health interventions improve cognition and stabilize Alzheimer’s disease risk in at-risk adults (DC-MARVEL): A randomized controlled trial

Abstract Alzheimer's disease and related dementias (ADRD) impose a substantial burden on quality of life among older adults, with healthcare costs totaling approximately $345 billion in 2023. Research suggests lifestyle-based interventions, such as health coaching (HC), are promising intervention strategies for reducing modifiable ADRD risk factors. In-person HC has demonstrated varying degrees of efficacy through behavioral modification strategies including personalized goal setting, education, and guidance. However, the effectiveness of a virtual HC program for reducing ADRD risk and modifying cognition among at-risk adults remains unexplored. The purpose of the Digital Cognitive Multidomain Alzheimer’s Risk Velocity (DC-MARVEL) randomized controlled clinical trial was to evaluate the effectiveness of a two-year virtual HC intervention and an enhanced virtual health education (HE) intervention among adults at-risk for ADRD. There were no significant differences between the HC intervention and HE in overall ADRD risk over time; however, a sub analysis of older adults (65+) revealed significant improvement in risk scores among HC participants. Both groups improved in several cognitive domains. Results of this study support the advantages of lifestyle-based interventions in mitigating ADRD risk. It also demonstrates the efficacy of both virtual HC and structured HE protocols to stabilize ADRD risk and promote improvements in cognition among at-risk adults.