The APPLE-Tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce) remote, lower-intensity multidomain lifestyle intervention for subjective cognitive decline or MCI: Randomised controlled trial

Demnitz-King, Harriet, Adeleke, Mariam, Minihane, Anne-Marie, Gillings, Rachel and Cooper, Claudia (2025) The APPLE-Tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce) remote, lower-intensity multidomain lifestyle intervention for subjective cognitive decline or MCI: Randomised controlled trial. Lancet Healthy Longevity. ISSN 2666-7568 (In Press)

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Abstract

Background: Trials of high-intensity, multidomain interventions show modifying lifestyle and psychological risk factors can slow cognitive decline. We aimed to evaluate if a lower-intensity, personally-tailored dementia prevention programme could improve cognition in adults with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). Methods: We conducted a two-arm, single-masked, multi-site, randomised, clinical trial recruiting older adults with SCD or MCI in England. Participants were randomly assigned (1:1) to the 12-month APPLE-Tree intervention or control (usual care plus brief written dementia prevention information). Randomisation was blocked and stratified by site, with allocations assigned via a remote web-based system. The intervention promoted healthy lifestyles, social connections, enjoyable activities, and self-management of long-term conditions. It comprised ten, 1-hour group video-call sessions over six months, supplemented with alternating video-call ‘tea breaks’ and individual goal-setting calls between sessions. From months 6-12, participants continued with monthly online ‘tea breaks’. The primary outcome was cognition (Neuropsychological Test Battery [NTB] score) at 24-months, analysed using an intention-to-treat approach. This trial was pre-registered with ISRCTN Registry (ISRCTN17325135). Findings: Between October 5, 2020, and December 31, 2022, we assessed the eligibility of 1287 participants and randomised 746 who were eligible and consented: 374 to the intervention (177 [47%] women) and 372 to the control (173 [47%] women). The primary outcome analysis included 635/746 (85%) participants. Mean NTB scores increased in both groups over time, with greater improvement in the intervention group (mean [standard deviation] 24-month NTB: 0·33 [0·67] versus 0·21 [0·75]; adjusted mean difference: 0·06 [95%CI -0·00-0·13], p=0·055). Serious adverse events occurred in 35 (9·4%) intervention and 30 (8·1%) control participants; none were intervention related. Interpretation: APPLE-Tree is an accessible intervention, associated with small improvements in cognition of marginal statistical significance, indicative of potentially meaningful benefits. With remote delivery by non-clinical facilitators, it is optimised for broad implementation.

Item Type:	Article
Additional Information:	Funding information: This trial is funded by an Economic and Social Research Council/National Institute for Health Research programme grant (ES/S010408/1).
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine
Depositing User:	LivePure Connector
Date Deposited:	18 Sep 2025 15:30
Last Modified:	18 Sep 2025 15:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100440
DOI:	issn:2666-7568

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