OBJECTIVE:The Mediterranean Diet (MedDiet) and physical activity (PA) can enhance mood and support psychological wellbeing in adults. However, the combined effect is relatively unknown. MedWalk aimed to determine the combined effect on wellbeing, psychological health and quality of life (QoL), compared to a control group. DESIGN:This is an analysis of secondary outcomes from the MedWalk 12-month cluster-randomised controlled trial. Participants completed the Total and Secure Flourishing Index (FI), the four domain General Health Questionnaire (GHQ-28) and the 8-domain Assessment of Quality of Life (AQoL-8D). Data were analysed using general linear models using change scores (FI and AQoL-8D) or generalised linear mixed models with a time × group interaction effect (GHQ-28). SETTING:Independent living facilities across South Australia and Victoria in 2021-2022. PARTICIPANTS:One hundred and sixty-one older men and women. RESULTS:Participants were 74·9 ± 5·9 years of age and predominantly female (74 %). A greater improvement was found for the MedWalk group (marginal means (MM) = 1·65, se = 1·36) than the control group (MM = -2·50, se = 1·32) for the Total Flourish score (P = 0·003) and Secure Flourish score (P = 0·009) ((MM = 1·06, se = 1·65) v. (MM = -3·34, se = 1·61)) from baseline to 6 months. The MedWalk group (MM = 0·021, se = 0·014) had more positive changes (P = 0·048) to the Mental Health AQoL-8D domain than the control group (MM = -0·007, se = 0·014). No significant group × time interactions were identified for the GHQ-28. CONCLUSIONS:Combined MedDiet and walking interventions can modify psychological health, wellbeing and QoL in relatively healthy populations.

ABSTRACT Background Digital health technology has the potential to increase access to home‐based reablement programmes for people living with dementia (PLwD) or mild cognitive impairment (MCI) to support everyday living. Digital Voice Assistants (DVAs) offer a possible solution to overcome usability issues with traditional technologies due to associated cognitive, motor and visual impairments. This paper describes the co‐design of a personalised reablement programme to be delivered via DVA. Methods PLwD or MCI ( n = 9), their care partners ( n = 9) and health professionals ( n = 8) participated in the co‐design via online workshops and semi‐structured interviews. Phases 1–7 of the IDEAS (Integrate, Design, Assess and Share) framework guided this iterative process to develop a product for future feasibility testing. Consensus on essential functions and features was facilitated using the MoSCoW prioritisation method. Transcripts were analysed using a modified thematic framework to inform the reablement programme. Results Thematic requirements of a cognitive reablement program to be delivered via DVA included (1) Daily Living (self‐care, household and cooking), (2) Activity Participation (leisure activities, home hobbies and ad hoc appointments), (3) Emotional Well‐being (social connection and coping strategies) and (4) technical requirements (activation, adaptable content, adherence, auditory processing, awareness and training). Conclusions The IDEAS framework successfully facilitated meaningful engagement from PLwD or MCI, their care partners, and health professionals to integrate user insights and feedback to co‐design a personalised reablement program via DVA for subsequent pilot feasibility testing. Patient or Public Contribution PLwD and/or MCI, and their care partners contributed by sharing lived experiences for researchers to gain insights; collaboratively identifying behaviours requiring support; creating ideas for solutions; feeding back on prototypes and prioritising program features and functions. Health professionals fed back improvements on prototypes, identifying potential barriers and solutions to implementation of the program.

Background: Behaviour-change outcomes are often incompletely reported in multidomain trials. We evaluated behaviour change during a 12-month Mediterranean diet (MedDiet) and physical activity (PA) intervention.Participants and Setting: Adults aged 60 to 90 years without cognitive impairment, independently living in two Australian cities.Methods: n=83 participants (MedWalk group) were supported over 12 months to consume a MedDiet and engage in at least 150 minutes of moderate to vigorous PA (MVPA) per week. Control group participants (n=73) maintained habitual diet and PA. Four validated measures (MedWalk MedDiet Adherence Screener (MW-MEDAS), MedDiet Score, accelerometry-derived MVPA and MET minutes by International Physical Activity Questionnaire-elderly) were analysed separately and combined into a total adherence score to determine change in behaviour from baseline. Differences within and between groups were analysed at baseline, 6-months and 12-months using linear mixed effect modelling, controlling for predictors of attrition and baseline group differences.Results: Participants were 74% female, with a mean±SD age of 74.9 ± 5.9 years. After 12 months, MW-MEDAS had increased by an average of 3.3/14 points, and total adherence score by 1.4/8 points in the MedWalk group (p<.001), with no significant change in the control group. There were no significant changes in dietary behaviours in the control group, and MVPA declined in both groups at 6 months.Conclusions: The MedWalk intervention improved overall adherence among older adults over 12 months, driven by an increase in MedDiet adherence. PA did not increase, potentially due to high baseline PA or challenges in changing PA behaviours.

Minoritized communities are disproportionately impacted by modifiable dementia risk factors but are underrepresented in dementia research globally. In Australia, the number of dementia prevention cohort and intervention studies has rapidly increased in the past two decades, yet the representation of minoritized groups has not been synthesized. The aims of this mixed-methods review were to summarize the demographic characteristics of participants involved in Australian dementia prevention-focused cohort and intervention studies. A systematic search of published literature, funded grant outcomes, and clinical trial registrations was conducted in October 2023 and updated in February 2025 to identify any Australia-based cohort or intervention studies which focused on dementia prevention. Data custodians of eligible studies were contacted and invited to submit de-identified participant-level data for these studies. The demographic characteristics of participants involved in published manuscripts and submitted participant-level data were synthesized. These data were then presented to 23 Australian dementia prevention researchers during a 2-h workshop in March 2025. Using co-creation methodologies, the workshop aimed to generate consensus-based recommendations for governments, institutions, and individual researchers to improve inclusivity and representativeness in future dementia prevention research. Twenty-eight published dementia prevention studies were summarized alongside fourteen studies for which de-identified participant-level data were submitted. Compared to the modern Australian population, participants enrolled in dementia prevention studies have been predominantly female, highly educated, and less diverse in terms of culture, language, ethnicity and gender. Thirty-seven recommendations were generated by Australian researchers and ranked by importance, providing actionable changes for government and institutional policy and researcher practice. This review identified that participants enrolled in Australian dementia prevention research studies do not accurately represent those most at risk for dementia in the general population. Changes to recruitment and engagement practices and policies are recommended to improve the representativeness and inclusivity of Australian dementia prevention research.

High healthcare costs and the poor outcomes associated with dementia have led to the application of new technologies to support management of people with dementia (PwD) in the community. To date, technology-based support for post diagnostic care for PwD has primarily focused on safety monitoring and memory aids, and has largely ignored the need to support PwD to better self-manage their condition. We recently developed and co-designed an innovative digital voice assistant program (Dementia Australia Research Foundation - Project Grant) that delivers personalised two way conversational post-diagnostic care at home. It utilises natural language processing to interpret speech across all languages circumventing barriers using web-based, touch screens or other digital input applications for PwD. We conducted a 12-week co-designed feasibility and pilot randomised controlled trial of a digital voice assistant-delivered personalised rehabilitative program in men and women with early dementia. We recruited 30 community-based adults aged 60-85 years and their carers residing anywhere in Australia with a recent (≤6 months) clinical diagnosis of early dementia (any type). Using a person-centred approach to care, participants and carers consulted with a clinical psychologist to develop personally meaningful goals, in relation to improving cognition, function and/or activities of daily living delivered by our digital voice assistant program. ( N  = 30/30) have shown mean±SD adherence to personalised, digital voice assistant program was 85±23% with no intervention-related adverse events. System usability was rated above average (80.4±16.9 out of 100). Compared with controls, the intervention group significantly improved the Illness Cognition Questionnaire and the Bayar Activities of Daily Living Scale. A home-based rehabilitative intervention delivered and monitored by health professionals using digital voice assistants was feasible for improving memory, cognition and activities of daily living in older adults with dementia. Future large-scale, longer-term studies are warranted to explore the clinical- and cost effectiveness of this digital health approach to supporting self-management of dementia in older adults.

Introduction Diagnosis in the early stages of dementia can lead to successful delay in associated cognitive decline. However, up to 76% of Australians diagnosed with dementia have already advanced beyond the early stage of disease. BrainTrack is an evidence-based mobile application (app) designed in Australia to promote brain health self-awareness, self-determination to promote help-seeking and, ultimately, a timelier dementia diagnosis. We will evaluate user experience, implementation and social return-on-investment outcomes of BrainTrack and will report dementia-related concerns, dementia literacy, knowledge, stigma and motivation for behaviour change and explore their associations with demographic characteristics.Methods and analysis A multimethods, concurrent, two-study observational design will be used. Study 1 will evaluate BrainTrack user experience and implementation outcomes, changes in users’ dementia literacy, dementia knowledge, perceptions of dementia-related stigma and help-seeking at five time points (baseline, 1, 3, 6 and 12 months). People residing in all states and territories of Australia will be recruited to the study via the BrainTrack app. Data collection will occur online and through teleconferencing. Approximately 1000 participants will complete all five surveys. Google Analytics data will measure adoption. App usage data will identify app use patterns. A sample of continuing app users (~n=80) and those who cease app use within 6 months (~n=20) will be interviewed to obtain in-depth information about their app use and help-seeking experience. Dementia Australia Helpline data will quantify help-seeking calls triggered by BrainTrack use. In Study 1, longitudinal outcomes will be analysed using mixed models. The economic and social value of BrainTrack will be assessed using social return on investment analysis. In Study 2, general practitioners (~n=20) currently practising in Australia will participate in semi-structured interviews conducted via online teleconferencing. Interviews will elicit perceptions of the usefulness of BrainTrack for initiating and facilitating discussions with patients about cognition and dementia. Qualitative data will be analysed thematically, followed by deductive analysis guided by the Theoretical Domains Framework.Ethics and dissemination This study has received Human Research Ethics Committee approval from Deakin University Human Research Ethics Committee (Study 1: HREC Reference Number 2022–220) and Deakin University Human Ethics Advisory Group, Faculty of Health (Study 2: Reference Number 202_2022). Informed consent will be obtained prior to participation, either verbally for interviews or online for surveys. Study findings will be published in peer-reviewed journals and communicated to key stakeholders.

Abstract The rising incidence of neurodegenerative diseases in an ageing global population has shifted research focus toward modifiable risk factors, such as diet. Despite potential links between dietary patterns and brain health, inconsistencies in neuroimaging outcomes underscore a gap in understanding how diet impacts brain ageing. This study explores the relationship between three dietary patterns—Mediterranean (MeDi), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)—and cognitive outcomes as well as brain connectivity. The study aimed to assess the association of these diets with brain structure and cognitive function, involving a middle-aged healthy group and an older cohort with subjective cognitive decline (SCD). The study included cognitive assessments and diffusion-weighted MRI data to analyse white matter microstructural integrity. Participants comprised 55 older individuals with SCD (54.5% female, mean age = 64) and 52 healthy middle-aged individuals (48.1% female, mean age = 53). Age inversely correlated with certain cognitive functions and global brain metrics, across both cohorts. Adherence to the MeDi, DASH, and MIND diets showed no significant cognitive or global brain metric improvements after adjusting for covariates (age, education, BMI). Network-based statistics (NBS) analysis revealed differences in brain subnetworks based on DASH diet adherence levels in the SCD cohort. In the healthy cohort, lower white matter connectivity was associated with reduced adherence to MIND and DASH diets. Ultimately, the study found no strong evidence connecting dietary patterns to cognitive or brain connectivity outcomes. Future research should focus on longitudinal studies and refine dietary assessments.

There is growing evidence that optimising dietary quality and engaging in physical activity (PA) can reduce dementia and cognitive decline risk and improve psychosocial health and quality of life (QoL). Multimodal interventions focusing on diet and PA are recognised as significant strategies to tackle these behavioural risk factors; however, the cost-effectiveness of such interventions is seldom reported. A limited cost consequence based on a 12-month cluster-randomised Mediterranean diet (MedDiet) and walking controlled trial (MedWalk) was undertaken. In addition, QoL data were analysed. Programme costs ($AUD2024) covered staff to deliver the MedWalk programme and foods to support dietary behaviour change. The primary outcome measure of this study was change in QoL utility score, measured using the Assessment of Quality of Life (AQoL-8D). Change scores were compared for the groups using general linear models while controlling for demographic factors associated with baseline group differences and attrition. Change in QoL (decreased, maintained or improved) was determined using a cross-tabulation test. MedWalk programme costs were estimated at $2695 AUD per participant and control group cost at $165 per person - a differential cost of $2530. Mean change in utility scores from baseline to 12 months was not statistically significant between groups. Nevertheless, the MedWalk group was significantly less likely to experience a reduction in their QoL (20·3 % MedWalk v. 42·6 % control group) (P = 0·020). A MedDiet and walking intervention may have a role in preventing decline in QoL of older Australians; however, longer-term follow-up would be beneficial to see if this is maintained.

The rising incidence of neurodegenerative diseases in an ageing global population has shifted research focus towards modifiable risk factors, such as diet. Despite potential links between dietary patterns and brain health, inconsistencies in neuroimaging outcomes underscore a gap in understanding how diet impacts brain ageing. This study explores the relationship between three dietary patterns - Mediterranean, Dietary Approaches to Stop Hypertension (DASH) and Mediterranean-DASH Intervention for Neurodegenerative Delay - and cognitive outcomes as well as brain connectivity. The study aimed to assess the association of these diets with brain structure and cognitive function, involving a middle-aged healthy group and an older cohort with subjective cognitive decline. The study included cognitive assessments and diffusion-weighted MRI data to analyse white matter microstructural integrity. Participants comprised fifty-five older individuals with subjective cognitive decline (54·5 % female, mean age = 64) and fifty-two healthy middle-aged individuals (48·1 % female, mean age = 53). Age inversely correlated with certain cognitive functions and global brain metrics, across both cohorts. Adherence to the Mediterranean, DASH and Mediterranean-DASH Intervention for Neurodegenerative Delay diets showed no significant cognitive or global brain metric improvements after adjusting for covariates (age, education, BMI). Network-based statistics analysis revealed differences in brain subnetworks based on DASH diet adherence levels in the subjective cognitive decline cohort. In the healthy cohort, lower white matter connectivity was associated with reduced adherence to Mediterranean-DASH Intervention for Neurodegenerative Delay and DASH diets. Ultimately, the study found no strong evidence connecting dietary patterns to cognitive or brain connectivity outcomes. Future research should focus on longitudinal studies and refine dietary assessments.

This study examined the relationship between total vegetable intake, including specific vegetable types with long-term late-life dementia (LLD) risk in older Australian women. 1206 community-dwelling older women aged >= 70 years were included. Consumption of total vegetable intake and vegetable types (yellow/orange/red [YOR], cruciferous, allium, green leafy vegetables [GLV], and legumes) were estimated using a validated food frequency questionnaire at baseline (1998). LLD was considered any form of dementia occurring after 80 years of age. LLD events (comprising hospitalisation and/or death) were obtained from linked health records. Associations were examined using restricted cubic splines within multivariable-adjusted (including APOE4 genotype) Cox proportional hazard models. Over 14.5 years of follow-up (similar to 15 134 person-years) there were 207 (17.2%) LLD events, 183 (15.25%) with LLD hospitalisations and 83 (6.9%) with LLD deaths. Compared to women in the lowest Quartile (Q1) of total vegetable intake, those with higher intakes (Q3, but not Q4) had 39% lower hazard for a LLD death. Compared to Q1, women in the highest quartile of YOR intake (Q4) consistently recorded lower hazards for a LLD event (47%), hospitalisation (46%), and death (50%). Similarly, women with the highest allium intake (Q4), had lower hazards for LLD events (36%) and deaths (49%), compared to Q1. Women with the highest GLV intake (Q4) also recorded 45% lower hazards for a LLD death. Whilst total vegetable intake may be important, allium, GLV and especially YOR vegetables may be most beneficial when considering LLD risk. These results require further validation in other cohorts, including men. The clinical trial registry numbers are https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368778&isReview=true, CAIFOS: ACTRN12615000750583, and https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372818&showOriginal=true&isReview=true, PLSAW: ACTRN12617000640303. This study found an association between total vegetable intake as well as specific types of vegetables including yellow/orange/red, green leafy, and allium vegetables with lower long-term risk for late-life dementia in older women.

Dementia is a global public health priority. Physical activity has myriad health benefits, including for reducing dementia risk. To increase physical activity, detailed understanding of influencing factors is needed. Socioeconomic deprivation affects many aspects of health and wellbeing. Qualitative research with older people experiencing socioeconomic deprivation is needed to explore barriers and enablers to engaging in physical activity, with the view to co-designing interventions for implementation trials. A whole of society approach is pivotal to improving effectiveness of physical activity interventions for older adults with cognitive impairment, and target support for people experiencing socioeconomic deprivation, to improve their health outcomes.

Healthy dietary patterns such as the Mediterranean diet (MeDi), Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) have been evaluated for their potential association with health outcomes. However, the lack of standardisation in scoring methodologies can hinder reproducibility and meaningful cross-study comparisons. Here we provide a reproducible workflow for generating the MeDi, DASH and MIND dietary pattern scores from frequently used dietary assessment tools including the 24-h recall tool and two variations of FFQ. Subjective aspects of the scoring process are highlighted and have led to a recommended reporting checklist. This checklist enables standardised reporting with sufficient detail to enhance the reproducibility and comparability of their outcomes. In addition to these aims, valuable insights in the strengths and limitations of each assessment tool for scoring the MeDi, DASH and MIND diet can be utilised by researchers and clinicians to determine which dietary assessment tool best meets their needs.

Background: As the global population ages, there has been a growing incidence of neurodegenerative diseases such as Alzheimer's. More recently, studies exploring the relationship between dietary patterns and neuro-imaging outcomes have received particular attention. This systematic literature review provides a structured overview of the association between dietary and nutrient patterns on neuroimaging outcomes and cognitive markers in middle-aged to older adults. A comprehensive literature search was conducted to find relevant articles published from 1999 to date using the following databases Ovid MEDLINE, Embase, PubMed, Scopus and Web of Science. The inclusion criteria for the articles comprised studies reporting on the association between dietary patterns and neuroimaging outcomes, which includes both specific pathological hallmarks of neurodegenerative diseases such as A beta and tau and nonspecific markers such as structural MRI and glucose metabolism. The risk of bias was evaluated using the Quality Assessment tool from the National Heart, Lung, and Blood Institute of the National Institutes of Health. The results were then organized into a summary of results table, collated based on synthesis without meta-analysis. After conducting the search, 6050 records were extracted and screened for eligibility, with 107 eligible for full-text screening and 42 articles ultimately being included in this review. The results of the systematic review indicate that there is some evidence suggesting that healthy dietary and nutrient patterns were associated with neuroimaging measures, indicative of a protective influence on neurodegeneration and brain ageing. Conversely, unhealthy dietary and nutrient patterns showed evidence pointing to decreased brain volumes, poorer cognition and increased A beta deposition. Future research should focus on sensitive neuro-imaging acquisition and analysis methods, to study early neurodegenerative changes and identify critical periods for interventions and prevention. Systematic Review Registration: PROSPERO registration no, CRD42020194444).

Impaired muscle function has been identified as a risk factor for declining cognitive function and cardiovascular health, both of which are risk factors for late‐life dementia (after 80 years of age). We examined whether hand grip strength and timed‐up‐and‐go (TUG) performance, including their change over 5 years, were associated with late‐life dementia events in older women and whether any associations provided independent information to Apolipoprotein E ℇ4 (APOE ℇ4) genotype.

COPYRIGHT © 2023 Falck, Liu-Ambrose, Van U elen, Macpherson, Marquez, Gardiner and Savelberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Editorial: The 24-hour activity cycle and cognitive health: how are physical activity, sedentary behavior, and sleep interactively associated with cognitive health across the lifespan?

Social concepts such as loneliness and social isolation are fairly new factors that have been recently gaining attention as to their involvement in changes in cognitive function and association with dementia. The primary aim of this narrative review was to describe the current understanding of how loneliness and social isolation influence cognitive aging and how they are linked to dementia. Studies have shown that there is an association between loneliness, social isolation, and reduced cognitive function, in older adults, across multiple cognitive domains, as well as a heightened risk of dementia. Numerous changes to underlying neural biomechanisms including cortisol secretion and brain volume alterations (e.g., white/grey matter, hippocampus) may contribute to these relationships. However, due to poor quality research, mixed and inconclusive findings, and issues accurately defining and measuring loneliness and social isolation, more consistent high-quality interventions are needed to determine whether studies addressing loneliness and social isolation can impact longer term risk of dementia. This is especially important given the long-term impact of the COVID-19 pandemic on social isolation in older people is yet to be fully understood.

Advancing age is recognized as the primary risk factor for Alzheimer's disease (AD); however approximately one third of dementia cases are attributable to modifiable risk factors such as hypertension, diabetes, smoking, and obesity. Recent research also implicates oral health and the oral microbiome in AD risk and pathophysiology. The oral microbiome contributes to the cerebrovascular and neurodegenerative pathology of AD via the inflammatory, vascular, neurotoxic, and oxidative stress pathways of known modifiable risk factors. This review proposes a conceptual framework that integrates the emerging evidence regarding the oral microbiome with established modifiable risk factors. There are numerous mechanisms by which the oral microbiome may interact with AD pathophysiology. Microbiota have immunomodulatory functions, including the activation of systemic pro-inflammatory cytokines. This inflammation can affect the integrity of the blood-brain barrier, which in turn modulates translocation of bacteria and their metabolites to brain parenchyma. Amyloid-β is an antimicrobial peptide, a feature which may in part explain its accumulation. There are microbial interactions with cardiovascular health, glucose tolerance, physical activity, and sleep, suggesting that these modifiable lifestyle risk factors of dementia may have microbial contributors. There is mounting evidence to suggest the relevance of oral health practices and the microbiome to AD. The conceptual framework presented here additionally demonstrates the potential for the oral microbiome to comprise a mechanistic intermediary between some lifestyle risk factors and AD pathophysiology. Future clinical studies may identify specific oral microbial targets and the optimum oral health practices to reduce dementia risk.

Background: Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer’s disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive. Objective: The MedWalk trial’s primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment. Methods: MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60–90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation. Progress and Discussion: Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community. Trial registration: Registered on the Australia New Zealand Clinical Trials Registry ANZCTR 12620000978965 (https://www.anzctr.org.au).