The Global Impact of the FINGER Trial: A New Era of Dementia Prevention
by
When Dr. Miia Kivipelto launched the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, better known as the FINGER trial, in 2009, the field of dementia prevention was much different.
“At that time, [the focus was only on] high age and genetic factors,” Kivipelto said. “Now we know that 45% of these risk factors are there throughout the whole life course and that’s why we say that it’s never too early to … prevent dementia.”
Kivipelto, a Finnish neuroscientist and professor who specializes in dementia and Alzheimer’s disease, joined John Harrison, Ph.D., CPsychol, CSci, AFBPsS, an associate professor at Alzheimercentrum, AUmc, Amsterdam, for the Pearson-sponsored podcast series, “The Progress Profile: Alzheimer’s Research in Focus,” to share insights into her research.
A Focus on the FINGER Trial
The FINGER study was the first randomized clinical trial to show that cognitive decline could be prevented by addressing five dimensions (fingers) of brain health.
- Healthy diet: The brain needs a healthy, balanced diet. Instead of focusing on single nutrients, the FINGER trial advocates for following the Nordic Nutrition Recommendations, a predominantly plant-based diet high in vegetables, fruits, and whole grains.
- Physical activity: Regular cardio, strength, and balance training are essential for brain health. “Exercise is very powerful medication,” Kivipelto said. “We know now that only 10 minutes of physical activity can affect almost 10,000 different molecules, which are important for brain health.”
- Cognitive training: Brain training that includes activities to boost memory and processing speed helps bolster brain health.
- Social activity and stress management: Prioritizing social connection to alleviate loneliness, hopelessness, stress, and sleep disturbances is important. The FINGER trial included group sessions and meetings that provided social interaction.
- Cardiovascular risk management: The FINGER trial monitored risk factors that include blood pressure, cholesterol, blood glucose, and obesity, and focused on reducing risk. Kivipelto noted, “What is good for the heart is good for the brain.”
The Power of Global Collaboration
The FINGER trial followed participants for two years. The results, published in The Lancet in 2015, found that cognitive performance improved in both groups, but that the intervention group showed a total average improvement that was 25% greater than that of the control group, demonstrating the power of lifestyle interventions for reducing dementia risk.
The FINGER trial sparked international interest and became the model for a worldwide collaboration. The Worldwide FINGERS network includes more than 70 countries across all continents.
“It has been wonderful to see the interest,” said Kivipelto. “Many of the new studies are also showing positive results.”
The Genetic Connection
One of the striking findings from the FINGER trial and subsequent studies is the positive effect of lifestyle interventions on those apolipoprotein E or APOE4, a gene that increases the risk of developing Alzheimer’s disease.
“Our analysis indicates that APOE4 carriers are getting more clear benefit of the intervention,” Kivipelto said. “That is, of course, great news, because you can’t change your genes.”
These findings suggest that genetic risk does not equal destiny; it’s a message that offers hope for families with a history of Alzheimer’s disease.
Toward Precision Prevention
The FINGER trial paved the way for a future of more individualized prevention strategies. Going forward, Kivipelto envisions a model similar to cancer care, where treatment is tailored to genetic and biological profiles.
“If we want to move to precision medicine or precision prevention, knowing more about your risk profiles — if it’s genetics, if it’s Alzheimer biomarkers, if it’s ’omics — that is probably the future,” she said.
Kivipelto is optimistic that within the next five years, prevention strategies will become more personalized, combining lifestyle, pharmacological interventions, and early detection to create a “cocktail of different interventions available at different stages of the disease.”
Beyond Memory
Dementia is not only about memory. Participants in the FINGER trial showed improvements in executive function, planning skills, and processing speed, which are domains important for daily living.
The knowledge had led to shifts in how we talk about dementia. In Sweden, for example, the term “cognitive clinic” has replaced “memory clinic” to indicate a more holistic concept of dementia care. Kivipelto hopes that focus will shift to “brain health clinics” that take a holistic approach addressing hearing, vision, depression, stress, and other conditions that affect cognition.
“It’s never too early; it’s never too late,” she emphasized. “The concept of brain health applies for the whole continuum of Alzheimer’s disease.”
The Global Reach of the FINGER Trial
2009
Launch year of the original FINGER study in Finland.
45%
Proportion of dementia cases linked to modifiable risk factors
2 years
Duration of the initial trial’s intervention period
5
Lifestyle domains
Diet, exercise, cognitive training, social activity/stress management, and cardiovascular care
70+ countries
Joined the Worldwide FINGERS network across all continents
83%
Improvement in executive function over the control group
150%
Improvement in psychomotor speed over the control group in the FINGER trial
40%
Improvement of complex memory tasks over the control group
Watch Episode 3 of “The Progress Profile” to learn more about the groundbreaking FINGER study.