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Efforts to address the major health, environmental, and social threats that can be found across the globe rely on changes in human behavior. Yet identifying effective and efficient ways to change behavior remains a vexing challenge. To meet this need, investigators need to design and evaluate behavioral intervention strategies in a manner that affords the creation of evidence-based guidelines that specify not only whether interventions work but also how and under what conditions. In this chapter, the design and testing of interventions are situated within the experimental medicine approach. This approach leverages the strength of the experimental method to test how behavior change intervention strategies work and to identify the conditions under which they operate effectively. Moreover, it organizes how investigators specify the questions that underlie the study of behavior change interventions and requires them to articulate precisely what intervention strategy they are using, how they think the strategy operates, and the outcomes it generates. Through the systematic use of this approach, evidence will emerge that addresses practitioners’ prevailing concerns directly – what intervention strategy is the most effective and efficient way to address the problem at hand. This chapter provides an overview of how to implement the experimental medicine approach, describes its key features, and addresses the importance of precision and, finally, considers this approach within a broader set of initiatives that have emerged to support a programmatic approach to the design, evaluation, and implementation of behavior change interventions.
To examine the impact of determinants of incident dementia in three different old age groups (75–79, 80–84, 85+years) in Germany.
Design:
Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals.
Setting:
Primary care medical record registry sample.
Participants:
General practitioners’ (GPs) patients aged 75+years at baseline.
Measurements:
Conduction of standardized interviews including neuropsychological assessment and collection of GP information at each assessment wave. We used age-stratified competing risk regression models (accounting for the competing event of mortality) to assess determinants of incident dementia and age-stratified ordinary least square regressions to quantify the impact of identified determinants on the age at dementia onset.
Results:
Among 3027 dementia-free GP patients, n = 704 (23.3%) developed dementia during the 13-year study period. Worse cognitive performance and subjective memory decline with related worries at baseline, and the APOE ε4 allele were associated independently with increased dementia risk in all three old age groups. Worse cognitive performance at baseline was also associated with younger age at dementia onset in all three age groups. Other well-known determinants were associated with dementia risk and age at dementia onset only in some or in none of the three old age groups.
Conclusions:
This study provides further evidence for the age-specific importance of determinants of incident dementia in old age. Such specifics have to be considered more strongly particularly with regard to potential approaches of early detection and prevention of dementia.
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