Pilot study of the Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability (GINGER) in individuals with Subjective Cognitive Decline: Paving the Way towards brain health clinics in Greece

Panagiotis (Panos) Alexopoulos ^1,2,3* Panagiotis Felemegkas ^4* Xanthi Arampatzi ⁵ Evdokia Billis ⁶ Eleni Dimakopoulou ⁶ Polychronis Economou ⁷ George A Dimakopoulos ⁸ Themis Exarchos ⁸ Maria Frounta ⁹ Parthenia Giannakopoulou ¹⁰ Kalliopi Kalaitzi ¹¹ Maria -Lamprini Koula ¹² Eftyhia Nastou ⁶ Maria Skondra ⁴ Paraskevi Sakka ⁵ Faidra Kalligerou ¹³ Nikolaos Skarmeas ^13,14 Marianna Tsatali ^15,16,17 Magdalini Krommyda ¹⁸ Maria Karala ¹² Nikolaos Mastoras ¹² PANAGIOTIS VLAMOS ⁸ Mary Yannakoulia ¹⁹ Ioannis Zaganas ²⁰ Maria Karataraki ²¹ Maria Basta ^21,22,23 Constantine Lyketsos ²⁴

• ¹ Mental Health Services, Patras University General Hospital, Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece, Patras, Greece
• ² Global Brain Health Institute, Medical School, Trinity College Dublin, The University of Dublin, Dublin, Ireland
• ³ Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany
• ⁴ Mental Health Services, Patras University General Hospital, Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece
• ⁵ Alzheimer Athens, Athens, Greece
• ⁶ Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
• ⁷ Department of Civil Engineering (Statistics), School of Engineering, University of Patras, Patras, Greece
• ⁸ Department of Informatics, Ionian University, Corfu, Greece
• ⁹ Patras Dementia day care centre, Corporation for Succor and Care of Elderly and Disabled-FRODIZO, Patras, Greece
• ¹⁰ Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, United Kingdom
• ¹¹ The longevity & wellbeing clinic, Athens, Greece
• ¹² Day Care Center for people with Dementia, Society of Psychosocial Research and Intervention, Ioannina, Greece
• ¹³ First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
• ¹⁴ Department of Neurology, Columbia University, New York, New York, United States
• ¹⁵ Network Aging Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
• ¹⁶ Department of Psychology, School of Humanities and Social Sciences, University of Western Macedonia, Kozani, Greece
• ¹⁷ Laboratory of Psychology, Department of Cognition, Brain and Behavior, School of Psychology, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
• ¹⁸ Department of Neurology, Queen's Hospital, Romford, United Kingdom
• ¹⁹ Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
• ²⁰ Department of Neurology, Medical School, University of Crete, Heraklion, Crete, Greece
• ²¹ Division of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Heraklion, Greece
• ²² Day Care Center for Alzheimer’s Disease PAGNH “Nefeli”, University Hospital of Heraklion, Crete, Greece
• ²³ Department of Psychiatry, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
• ²⁴ Richman Family Precision Medicine Center of Excellence, Department of Psychiatry and Behavioral Sciences at Johns Hopkins Bayview, Johns Hopkins School of Medicine, Baltimore, MD, United States

The pilot phase of the Greek Interventional Geriatric Initiative to Prevent Cognitive Impairment and Disability (GINGER) aims to assess the feasibility of a multi-level dementia risk reduction intervention in individuals with subjective cognitive decline (SCD) over a six-month period. The study design incorporates a comprehensive set of trans-disciplinary assessments and interventions in multiple centers across Greece. Individuals 55 years or older with subjective cognitive complaints who do not fulfill criteria for either mild cognitive impairment or dementia are screened for dementia risk factors in the following domains: nutrition, physical activities, vision and hearing, vascular and metabolic parameters, anxiety and depressive symptoms, and insomnia. All GINGER participants receive a cognitive empowerment intervention. Using a precision medicine approach, they receive up to three additional domain-specific interventions based on their individual risk factor profiles. Changes in cognition, dementia risk factors, quality of life and other measures compared to baseline are assessed at three-and six months after the initiation of the intervention. The GINGER protocol was designed and is run by a multi-disciplinary team of dieticians, neurologists, psychiatrists, psychologists, and physiotherapists, while computer scientists oversee data management. The objectives of this pilot phase are (i) evaluation of the protocol's feasibility, (ii) assessment of intervention effects on the individual risk domains targeted by the interventions, (iii) estimation of the overall effects of the intervention on cognitive function, dementia risk and quality of life. The GINGER findings will provide a solid foundation for paving the way towards a network of evidence-based brain health clinics in Greece.