Experiences of Participation in a Multimodal Preventive Trial MIND-AD_MINI Among Persons with Prodromal Alzheimer’s Disease: A Qualitative Study

Figures & data

Table 1 Descriptions of the Intervention Components in MIND-AD_MINI

Physical exercise training program	Training was organized in small group sessions which were supervised by a physiotherapist or a personal trainer. The exercise program was tailored to participants’ individual physical fitness level and included cardiovascular endurance training and progressive strength training twice a week.
Nutritional guidance	3 individual face-to-face counselling sessions with the study dietitian provided tailored concrete advice. 3–4 group sessions with more information and motivating activities. Food frequency questionnaires and food diaries monitored diet changes. Study partners were invited to participate in all sessions. Recommendations were adjusted to individual needs.
Cognitive training	Individual sessions consisted of computer-based training at the study site twice per week, approximately 15–20 min per session. The cognitive training program is an in-house developed computer program including several tasks. The program automatically adjusts the level of difficulty to the level of individual performance of executive processes, working memory, episodic memory, and mental speed. They also had the possibility to contact the psychologist to receive support with logging-in from home.
Social stimulation	Social activities were stimulated through the numerous group meetings for all intervention domains. The group sessions were designed to facilitate open discussions and interactions with other participants. Participants were offered a healthy snack and had the opportunity to freely discuss any aspects related to physical activity with each other and the trainer.
Management of metabolic and vascular risk factors	Management of metabolic and vascular risk factors was based on national evidence-based guidelines. It included one additional meeting with the study nurse (at 3 months), for measurements of blood pressure, weight and BMI, hip and waist circumference. If medication initiation or adjustments were needed, the study physician either wrote a prescription or referred the participant to regular healthcare, in accordance with local procedures. Smokers were also provided with support to quit smoking.
The lifestyle and medical food intervention arm	The lifestyle and medical food intervention group received all the above-mentioned lifestyle intervention components and the study product Souvenaid, a 125mL once-A-day milk-based drink. Souvenaid contains Fortasyn Connect a nutritional compound in the medical food product, which is an evidence-based nutritional compound for neuroprotection. Participants were randomized into this arm or the one with only the above lifestyle interventions.

Abbreviation: BMI, Body Mass Index.

Table 2 Demographic Characteristics of the Participants in the Study

Participants	n = 8
Gender (female/male)	5/3
Age, mean (range)	66 (62–75)
MMSE Screen (0–30)	27.3 (25–29)
Receiving medical food (arm ii)	4
Distance to study center(km) (mean, range)	19.9 (5.1–47.4)
Marital status (married %)	87.5%
Education (year) (mean, range)	14.5 (9–18.5)

Abbreviation: MMSE, Mini Mental State Examination.

Table 3 Topic Areas of Questions in the Interviews

Using open questions, the participants were asked to describe the following:

Time period before contact with the study-center from symptoms to diagnosis

Knowledge and experiences of AD and prevention

First contact with the study-center

Motives for participation in the trial

Screening and inclusion period

Expectations on participation

What they know about the aim and content of MIND-ADMINI

Experiences of participation in the prevention and intervention

Abbreviation: AD, Alzheimer’s disease.

Figure 1 Dynamic process of participation in the MIND-AD_MINI prevention trial.

Table 4 Summary of Internal and External Factors Influencing Study Participation

Internal Factors	External Factors
Cognitive functions	Access to the study-center
Difficulties in one or several cognitive	Distance
Domains	Easy to find
	Public transport
	Parking
	Traffic
	Rush hours cause stress
Health	Costs
Pain	Transport
	Loss of income
Social support
Spouses/family/study-partner
Other engagements
Work
Hobbies
Family/friends