Dementia Prevention, Personalised: How Behavioural Science is Powering Digital Health

The first systematic step in designing effective interventions is understanding the 'why'. The CAPHRI team, using systematic planning approaches like Intervention Mapping, conducted interviews and questionnaires to explore older adults’ perceptions of dementia risk.

The findings were revealing: people often perceive dementia risk as multifactorial and abstract, developing decades in the future, leaving them feeling they have little influence over it. Crucially, research indicated that simply focusing on risk perception alone is not a successful motivator for change. 

Instead, the CAPHRI approach pivoted to focus on strengthening people’s sense of control over their behaviour and building their self-confidence to initiate and sustain changes.

These insights were instrumental in the co-creation of the LETHE App, a digitally-supported lifestyle intervention. Older adults at risk for dementia were iteratively involved in the co-design process via an Advisory Board, ensuring the technology felt relevant and feasible. The resulting App integrates several key features: Self-monitoring through a weekly score and feedback messages, Tiny Habits that people can try out, and personalised push-notifications based on unobtrusive adherence measurement via Fitbit and other tech. This intervention, which also includes a clinician dashboard for tailored in-person support, has recently been pilot-tested in a two-year Randomised Control Trial across Austria, Italy, Sweden, and Finland.

Many dementia prevention programmes focus on common preventive behaviours like physical activity and nutrition. However, they frequently miss the opportunity to prioritise cognitive and social activities, which are known to significantly boost cognitive reserve.

Interventions that do promote mental stimulation are often too simplistic, relying on one-size-fits-all 'brain training'. The PhD project of Giselle Menting specifically addresses this gap by working to conceptualise what it really means to be cognitively and socially active. This involves developing clear definitions, measurement guidelines, a new questionnaire, and intervention materials to promote these activities, all of which will be implemented in existing technology-assisted platforms like LETHE.

Dementia, like many health conditions, is intrinsically linked to socioeconomic inequality. Current digital health interventions often fail to reach, or adequately serve, certain groups.

The team’s research highlights that achieving inclusivity goes beyond simply documenting differences in disease rates; it requires accounting for socioeconomic differences in the psychological determinants that influence behaviour. This ensures a more personalised and effective use of behaviour change techniques. This was the focus of Angelica d’Sa’s MSc thesis and subsequent in-depth interviews conducted by Giselle Menting with middle-aged and older adults from diverse cultural backgrounds and limited financial means, even recruiting through foodbanks. These crucial insights are being used to formulate directions for how interventions can better account for cultural and socioeconomic diversity.

This work has broad applicability, with the CAPHRI team sharing insights through collaborations in the Sectorplan Prevention community to improve equity in areas like prehabilitation for patients undergoing surgery by working together with dr. Marcel den Dulk and dr. Melissa Voorn.

Adherence is often monitored retro-spectively: tracking who attended sessions or how often they used an App. This approach is fundamentally reactive, offering support only after a challenge has occurred.

The PhD project of Kristina Ukropcová will focus on shifting the paradigm towards predictive models. By combining reactive data with predictive analytics, including exploring the use of AI-driven adherence analytics using data from the LETHE intervention, she aims to anticipate adherence difficulties before they actually happen.

This proactive approach, developed in close collaboration with technical experts such as Dr Markus Bödenler and Vassilis Loukas, allows for earlier, more personalised support for both participants and intervention providers. Ultimately, this maximises the potential for behaviour change and intervention impact: impact = reach x effect

This work demonstrates a core commitment to move beyond generic interventions and leverage science to empower every individual, regardless of background, to take control of their cognitive health. Ultimately, the team isn't just designing digital tools; they're building the evidence base for a future where personalised behavioural science makes dementia prevention not just a goal, but a reality.