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A Health Communication Strategy to Promote Dementia Risk Reduction: The <scp>CULTIVAMENTE</scp> Pragmatic Cluster‐Randomized Trial
Journal
Journal of the American Geriatrics Society
ISSN
0002-8614
Date Issued
2025-12-23
Author(s)
Jose M. Aravena
Hugo Castro
Ronald Poblete
Maria Ines Aravena
Waldo Torres
Paula Vivar
Ester Lara
Marilú Budinich
Patricio Fuentes
Cecilia Albala
Becca R. Levy
Type
journal-article
Abstract
<jats:title>ABSTRACT</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Although dementia prevention is a global priority, few interventions have been successfully translated into public health and community settings. This study evaluated the effectiveness of a nudge‐based communication strategy to promote Alzheimer's disease (AD) prevention on behavioral, cognitive, and provider‐level outcomes in a real‐world setting.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>
We conducted a pragmatic cluster‐randomized trial across seven senior centers. Eligible participants were adults aged ≥ 60 with cognitive impairment but no dementia. Centers were randomized to intervention (
<jats:italic>n</jats:italic>
= 3) or control (
<jats:italic>n</jats:italic>
= 4) arms. All centers offered standard activities and provider training in dementia management. The intervention arm additionally received CULTIVAMENTE, a low‐intensity, nudge‐based communication strategy involving posters, brochures, and web‐based content promoting AD prevention. Main outcomes included changes in a composite cognitive healthy behavior score, cognitive performance (memory and executive function), prevalence of mild‐to‐moderate cognitive impairment, and provider practices (AD prevention discussions and referrals). Analyses used intention‐to‐treat linear mixed models.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>
Among 211 participants (mean age 74.8 ± 7.0 years; 80.5% women), after 6 months, those in the intervention group (
<jats:italic>n</jats:italic>
= 101) demonstrated greater improvement in cognitive healthy behaviors compared to control (SD difference = 0.15; 95% CI = 0.02–0.28;
<jats:italic>p</jats:italic>
= 0.021; 95.4% greater increase than control). Cognitive scores improved significantly in the intervention group (memory = 0.24; 95% CI = 0.07–0.41; memory–executive functioning = 0.21; 95% CI = 0.08–0.33), and mild‐to‐moderate cognitive impairment cases declined in the intervention group (from 70 to 67) compared to the control group (from 71 to 75;
<jats:italic>p</jats:italic>
< 0.001). Additionally, intervention participants were more likely to report increases in knowing how to prevent AD, having discussions about ways to prevent AD with providers, and receiving referrals to manage risk factors.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Embedding nudge‐based messaging into senior centers improved dementia prevention behaviors, cognitive outcomes, and provider practices. These results support testing low‐cost, scalable strategies in real‐world settings to reduce dementia risk.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Although dementia prevention is a global priority, few interventions have been successfully translated into public health and community settings. This study evaluated the effectiveness of a nudge‐based communication strategy to promote Alzheimer's disease (AD) prevention on behavioral, cognitive, and provider‐level outcomes in a real‐world setting.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>
We conducted a pragmatic cluster‐randomized trial across seven senior centers. Eligible participants were adults aged ≥ 60 with cognitive impairment but no dementia. Centers were randomized to intervention (
<jats:italic>n</jats:italic>
= 3) or control (
<jats:italic>n</jats:italic>
= 4) arms. All centers offered standard activities and provider training in dementia management. The intervention arm additionally received CULTIVAMENTE, a low‐intensity, nudge‐based communication strategy involving posters, brochures, and web‐based content promoting AD prevention. Main outcomes included changes in a composite cognitive healthy behavior score, cognitive performance (memory and executive function), prevalence of mild‐to‐moderate cognitive impairment, and provider practices (AD prevention discussions and referrals). Analyses used intention‐to‐treat linear mixed models.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>
Among 211 participants (mean age 74.8 ± 7.0 years; 80.5% women), after 6 months, those in the intervention group (
<jats:italic>n</jats:italic>
= 101) demonstrated greater improvement in cognitive healthy behaviors compared to control (SD difference = 0.15; 95% CI = 0.02–0.28;
<jats:italic>p</jats:italic>
= 0.021; 95.4% greater increase than control). Cognitive scores improved significantly in the intervention group (memory = 0.24; 95% CI = 0.07–0.41; memory–executive functioning = 0.21; 95% CI = 0.08–0.33), and mild‐to‐moderate cognitive impairment cases declined in the intervention group (from 70 to 67) compared to the control group (from 71 to 75;
<jats:italic>p</jats:italic>
< 0.001). Additionally, intervention participants were more likely to report increases in knowing how to prevent AD, having discussions about ways to prevent AD with providers, and receiving referrals to manage risk factors.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Embedding nudge‐based messaging into senior centers improved dementia prevention behaviors, cognitive outcomes, and provider practices. These results support testing low‐cost, scalable strategies in real‐world settings to reduce dementia risk.</jats:p>
</jats:sec>