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| Name | Class |
|---|---|
| National Medical Research Council (NMRC), Singapore | OTHER_GOV |
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A study in Finland found that a multidomain intervention of physical activity, nutritional guidance, cognitive training, social activities and management of vascular risk factors slowed cognitive decline in healthy older adults at increased risk of cognitive decline. A 6-month pilot study was initiated in Singapore, which demonstrated the cultural feasibility and practicality of the FINGER interventions and a set of locally adapted interventions in an Asian population. The SINGER study is a 2-year randomized controlled trial that aims to test the efficacy and safety of these lifestyle changes, including diet and cardiovascular risk factor management, cognitive and physical exercises, in delaying cognitive decline in older adults at risk of dementia.
Results from a population-based 2-year clinical trial, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), demonstrated that a multidomain intervention of physical activity, nutritional guidance, cognitive training, social activities and management of vascular risk factors slowed cognitive decline in healthy older adults at increased risk of cognitive decline. Currently, no pharmacological treatment options that can rival these effects. Thus, there is an urgent need to test the generalizability, adaptability, and sustainability of these findings in Singaporean populations. A 6-month pilot study was initiated in Singapore, which demonstrated the cultural feasibility and practicality of the FINGER interventions and a set of locally adapted interventions in an Asian population. Hence, the next step was to conduct a larger scale SINGER trial to determine the efficacy of these interventions in Singapore. If the interventions are found to be effective and safe with high applicability and scalability, the study will provide important clinical and public health implications to a rapidly increasing ageing population.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Structured Lifestyle Intervention | Experimental | Structured lifestyle modification program developed for participants targeting diet, physical exercise, cognitive training, and social stimulation. |
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| Self-Guided Intervention | Experimental | General health information provided to participants. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Structured Lifestyle Intervention | Behavioral | Structured Lifestyle Intervention (SLI) involves providing participants with intensive structure and support by a team of trainers to increase physical exercise, adhere to a healthy diet, cognitive training, increase intellectual/social stimulation, and better manage vascular risk factors. |
| Measure | Description | Time Frame |
|---|---|---|
| Global Cognition | Global cognition measured using the modified Neuropsychological Test Battery (mNTB) that includes: Visual Paired Associates, Logical Memory Recall of the Wechsler Memory Scale-Revised, Rey Auditory Verbal Learning, Digit Span, Word and Category Fluency test, Trail Making Test, Letter Digit Substitution test. | Up to 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| Episodic Memory | Episodic memory measured using mNTB subtests: Visual paired associates tests, Logical Memory immediate and delayed recall of the Wechsler Memory Scale-Revised, Rey Auditory Verbal Learning test. | Up to 2 years |
| Executive Function |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Connie KL Teo | Contact | (65) 6601 5668 | kee_ling_teo@nuhs.edu.sg | |
| April KS Phua | Contact | (65) 6601 5668 | aprilphua@nuhs.edu.sg |
| Name | Affiliation | Role |
|---|---|---|
| Christopher LH Chen, MD | National University of Singapore | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| National University Hospital | Recruiting | Singapore | 117600 | Singapore |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25771249 | Background | Ngandu T, Lehtisalo J, Solomon A, Levalahti E, Ahtiluoto S, Antikainen R, Backman L, Hanninen T, Jula A, Laatikainen T, Lindstrom J, Mangialasche F, Paajanen T, Pajala S, Peltonen M, Rauramaa R, Stigsdotter-Neely A, Strandberg T, Tuomilehto J, Soininen H, Kivipelto M. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015 Jun 6;385(9984):2255-63. doi: 10.1016/S0140-6736(15)60461-5. Epub 2015 Mar 12. | |
| 33748399 |
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Interested collaborators may put in a request.
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| Self-Guided Intervention | Behavioral | In the Self-Guided Intervention (SGI), education about the importance of a healthy lifestyle as a preventive strategy and support to encourage change will be provided. |
|
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Executive function measured using mNTB subtests: Digit Span, Word and Category Fluency test, Trail Making Test Part B.
| Up to 2 years |
| Processing Speed | Processing speed measured using mNTB subtests: Letter Digit Substitution test and Trail-Making Test Part A. | Up to 2 years |
| Clinical Dementia Rating-Sum of Boxes (CDR-SB) | The Clinical Dementia Rating-Sum of Boxes (CDR-SB) is scored from 0 to 18. Higher scores reflect worse performance. | Up to 2 years |
| Alzheimer's Disease Cooperative Study Activities of Daily Living-Mild Cognitive Impairment-Activities of Daily Living Inventory (ADCS-MCI-ADL) | The Alzheimer's Disease Cooperative Study Activities of Daily Living-Mild Cognitive Impairment-Activities of Daily Living Inventory (ADCS-MCI-ADL) is scored from 0 to 53. Higher scores reflect better performance. | Up to 2 years |
| The Geriatric Depression Scale (GDS) | The Geriatric Depression Scale (GDS) is scored from 0 to 15. Scores of 0-4 are considered normal, 5-8 indicate mild depression; 9-11 indicate moderate depression; and 12-15 indicate severe depression. | Up to 2 years |
| Global Physical Activity Questionnaire (GPAQ) | The Global Physical Activity Questionnaire (GPAQ) measures physical activity across 3 domains: work, travel, and recreation, as well as average time per day spent in sedentary behavior. The GPAQ is scored based on a population's mean or median physical activity spent in physical activity or by classifying a certain percentage of a population as 'inactive' or 'insufficiently active'. | Up to 2 years |
| Prospective-Retrospective Memory Questionnaire | The Prospective-Retrospective Memory Questionnaire (PRMQ) is measured on a 5-point scale. Higher scores represent greater frequency of memory failures. | Up to 2 years |
| Pittsburgh Sleep Quality Index (PSQI) | The Pittsburgh Sleep Quality Index (PSQI) is scored from 0 to 21. Higher scores indicate worse sleep quality. | Up to 2 years |
| Leisure-Time Activities Questionnaire | The Leisure-Time Activities Questionnaire measures the frequency of engagement in the following activities: Health activities, Social activities, Productive activities, Fitness activities, Recreational activities, Any cognitively-stimulating activities. Scores are measured on a 3-point scale. Higher scores represent higher frequency of engagement in leisure-time activities. | Up to 2 years |
| Physical Performance Test (PPT) | The Physical Performance Test (PPT) is scored from 0 to 36. Higher scores represent better performance. | Up to 2 years |
| Quality of Life Questionnaire (15D) | The Quality of Life Questionnaire (15D) has a single index (15D score) on a 0-1 scale, which represents overall HRQoL (0 = being dead, 0.0162 = being unconscious or comatose, 1 = no problems on any dimension = 'full' HRQOL). This is calculated from the health state descriptive system by using a set of population-based preference or utility weights. | Up to 2 years |
| 36-Item Short Form Survey (SF-36) | The 36-Item Short Form Survey (SF-36) has eight domains. Each domain is scored from 0 to 100. Higher scores represent a more favourable health state. | Up to 2 years |
| Resource Use Inventory (RUI) | The Resource Use Inventory (RUI) measures 4 domains: direct medical care, direct nonmedical care, informal care, and subjects' time use. The RUI is filled in based on the frequency and amount of resources used. If none were used, '00' is entered. | Up to 2 years |
| Height | Height is measured in metres. | Up to 2 years |
| Weight | Weight is measured in kilograms. | Up to 2 years |
| Hip and waist circumference | Hip and waist circumference measured in centimetres. | Up to 2 years |
| Changes in Blood Pressure | Vascular and metabolic risk factors measured by changes in blood pressure in mmHg. Incident events using serious adverse event reports will also be assessed. | Up to 2 years |
| Changes in Lipid Profile | Vascular and metabolic risk factors measured by changes in lipid profile in mmol/L. | Up to 2 years |
| Changes in Glucose Regulation | Vascular and metabolic risk factors measured by changes in glucose regulation in mmol/L. | Up to 2 years |
| Neuroimaging | Magnetic Resonance Imaging will be used to assess changes in brain structural integrity, grey matter volume loss, white matter microstructure degradation, and increase of cerebrovascular disease markers (CeVD). Vascular polygenic risk scores (PRS) and its association with neurodegeneration, CeVD burden and cognitive decline will be performed. | Up to 2 years |
| Blood Biomarkers | Novel and accessible blood markers to monitor AD- and CeVD-associated pathologies will be measured. Plasma concentrations of cardiac markers (High-sensitive cardiac troponin T (hs Troponin T), N-terminal pro b-type natriuretic peptide (NT-proBNP) and Growth/differentiation factor 15 (GDF 15)), and peripheral biomarkers of Aβ, tau and synaptic pathology, oxidative stress, endothelial/cardiovascular injury and degenerative protein modifications (DPMs) damaged proteins will be used. | Up to 2 years |
| Retinal Imaging Markers | Multimodal retinal imaging will be used to assess retinal structural, vascular and neuronal changes. | Baseline only |
| National University of Singapore, Yong Loo Lin School of Medicine | Recruiting | Singapore | 117600 | Singapore |
|
| National Neuroscience Institute @ Tan Tock Seng Campus (NNI @ TTSH campus) | Not yet recruiting | Singapore | 308433 | Singapore |
|
| Background |
| Chew KA, Xu X, Siongco P, Villaraza S, Phua AKS, Wong ZX, Chung CY, Tang N, Chew E, Henry CJ, Koo E, Chen C. SINgapore GERiatric intervention study to reduce physical frailty and cognitive decline (SINGER)-pilot: A feasibility study. Alzheimers Dement (N Y). 2021 Mar 15;7(1):e12141. doi: 10.1002/trc2.12141. eCollection 2021. |
| 41943481 | Derived | Yap KH, Chen C, Chong EJY, Kandiah N, Kivipelto M, Lai MKP, Maier AB, Matchar DB, Phua AKS, Teo CKL, Xu X, Zhou HJ, Chen CPL. Baseline characteristics of the SINgapore GERiatric Intervention Study to Reduce Cognitive Decline and Physical Frailty (SINGER) multidomain dementia prevention randomized controlled trial and insights from the recruitment process. Alzheimers Dement. 2026 Apr;22(4):e71313. doi: 10.1002/alz.71313. |
| 40670782 | Derived | Ooi LQR, Orban C, Zhang S, Nichols TE, Tan TWK, Kong R, Marek S, Dosenbach NUF, Laumann TO, Gordon EM, Yap KH, Ji F, Chong JSX, Chen C, An L, Franzmeier N, Roemer-Cassiano SN, Hu Q, Ren J, Liu H, Chopra S, Cocuzza CV, Baker JT, Zhou JH, Bzdok D, Eickhoff SB, Holmes AJ, Yeo BTT; Alzheimer's Disease Neuroimaging Initiative. Longer scans boost prediction and cut costs in brain-wide association studies. Nature. 2025 Aug;644(8077):731-740. doi: 10.1038/s41586-025-09250-1. Epub 2025 Jul 16. |
| ID | Term |
|---|---|
| D060825 | Cognitive Dysfunction |
| D000544 | Alzheimer Disease |
| D003704 | Dementia |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |
| D003072 | Cognition Disorders |
| ID | Term |
|---|---|
| D024801 | Tauopathies |
| D019636 | Neurodegenerative Diseases |
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