title: Reduction of Long-Term Care Dependence After an 8-Year Primary Care Prevention Program for Stroke and Dementia: The INVADE Trial.
abstract: BACKGROUND
  Stroke and dementia are the major causes for long-term care (LTC) dependence in old age. This intervention trial compared a multidomain prevention program for stroke and dementia with usual medical care in reducing the need for LTC.
  
  
  RESULTS
  The Intervention Project on Cerebrovascular Disease and Dementia in the District of Ebersberg (INVADE) was a general practice-based 8-year trial in 2 defined catchment areas in Upper Bavaria, Germany. All 11 317 insurants of a statutory health insurance plan who were ≥55 years of age and lived in the intervention district were offered the opportunity to participate in a prevention program; 3908 enrolled. The 13 301 insurants in the reference district received usual medical care. The intervention consisted of the systematic identification and evidence-based treatment of vascular risk factors. The primary clinical end point was incidence of LTC dependence according to external assessment by a special medical service in the framework of the statutory German LTC insurance. Age- and sex-specific incidence rates from the reference district were used to calculate the expected number of cases of LTC dependence under usual medical care. The expected number was compared with the observed number of cases in the intervention district. Analysis was by intention to treat. During the 5 years after completion of the recruitment period, significantly fewer incident cases of LTC dependence arose in the intervention district than expected (χ(2)=13.25; P<0.001). In women, the incidence was reduced by 10% (P<0.01). In men, the incidence was reduced by 9.6% (P<0.05).
  
  
  CONCLUSIONS
  Our results support the feasibility and effectiveness of a primary care prevention program for stroke and dementia to reduce the risk of developing LTC dependence.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01107548. (J Am Heart Assoc. 2012;1:e000786 doi: 10.1161/JAHA.112.000786.).
authors.affiliation: Department of Psychiatry, Technische Universität München,  Klinikum rechts der Isar, Munich, Germany (H.B., M.B., H.F.) ; From the  Department of Psychiatry, Technische Universität München,  Klinikum rechts der Isar, Munich, Germany (H.B., M.B., H.F.).
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ander
authors.forename: Monika
authors.initials: M
authors.lastname: Brönner
authors.forename: Thorleif
authors.initials: T
authors.lastname: Etgen
authors.forename: Hans
authors.initials: H
authors.lastname: Gnahn
authors.forename: Othmar
authors.initials: O
authors.lastname: Gotzler
authors.forename: Holger
authors.initials: H
authors.lastname: Poppert
authors.forename: Klaus
authors.initials: K
authors.lastname: Pürner
authors.forename: Dirk
authors.initials: D
authors.lastname: Sander
authors.forename: Hans
authors.initials: H
authors.lastname: Förstl
keywords: dementia; prevention; risk factors; stroke