Exploring uptake of a university-level educational intervention to prevent cognitive decline and reduce dementia risk: The Tasmanian Healthy Brain Project

Background: Research suggests a substantial proportion of Alzheimer’s disease (AD) cases could be delayed, or even prevented, through modifying lifestyle factors. Low educational attainment has been associated with increased vulnerability to age-related cognitive decline through reduced cognitive reserve. Strategies to enhance cognitive reserve in older adults may therefore provide cognitive resilience and reduce an individual’s AD risk. The Tasmanian Healthy Brain Project (THBP) is a longitudinal, prospective cohort study established to examine this possibility by following the cognitive health trajectory of older Australians engaging in university-level education. To characterise predictors of uptake and inform recruitment for future educational interventions, we present an exploratory examination of university-level education uptake in older Australian adults.

Method: Upon entry to the ongoing THBP, participants opted (non-random assignment) to enrol in fee reduced university-level education at the University of Tasmania. All participants undergo biennial assessments involving a comprehensive battery assessing neuropsychological, cognitive, psychological, social and clinical domains. For the current study, membership of experimental (intervention) group vs controls (non-intervention) was treated as a binary outcome utilising logistic binomial regression. Baseline age, education, gender, prior cognitive reserve (PCR), APOE, Dementia Rating Scale and Hospital Anxiety and Depression Scale were included in linear and generalized additive models. Bayes Factors (computed using bridge sampling) were estimated to provide support for main effects models. All statistical analyses were performed in R (v3.6.1).

Result: Of 562 THBP participants, 437 (22.2%) elected to undertake university-level education and 125 (77.8%) controls did not. On average, the interventional group was younger, more educated, displayed higher prior cognitive reserve and lower penetrance for APOE-ε4 allele (Table 1). Logistic binomial regression suggested that of the variables assessed, age was the primary predictor of educational uptake (Figure 1).

Conclusion: In our models, a participant’s baseline age was the only variable to display an association with interventional group adherence to a university-level education. In the current research climate where encouraging lifestyle risk factor modifications to reduce dementia risk, educational interventions may enhance cognitive resilience to age-related cognitive decline, therefore recruitment efforts should be designed to target a wider age range in more demographically diverse populations.