LIGHT trial targets dementia risk before memory loss becomes irreversible
Memory clinics rarely have a preventive pathway for people who are already worried about cognition but have not developed dementia. The LIGHT trial is built to fill that gap by testing whether a multidomain lifestyle program can reduce modifiable dementia risk in adults with subjective cognitive decline and mild cognitive impairment seen in Dutch general and academic hospital memory clinics.
The study is designed around a simple clinical premise: if vascular, metabolic, behavioral, and psychosocial risk factors drive later dementia, then intervening while patients are still outside the dementia stage may offer the best chance to shift trajectories. Here, the intervention is not a single prescription. It combines coaching, access to local brain-healthy services, and structured self-management support, all aimed at helping participants turn risk awareness into daily behavior change.
A 1-year randomized design built for indicated prevention
LIGHT is a 1-year multicenter randomized controlled trial planned to enroll 300 older adults aged 50 years and older starting in early 2025. Eligibility requires SCD or MCI plus at least two modifiable dementia risk factors, a design that concentrates on people already standing at a clinically meaningful threshold of elevated risk.
Participants are randomized 1:1 to intervention or control. The control arm receives general health advice, while the intervention arm receives three linked components intended to work together rather than in isolation. First, each participant meets individually with a certified lifestyle coach for three sessions focused on personal goal setting and follow-through. Second, participants receive vouchers that can be used for brain-healthy services offered by local providers. Third, they gain access to an online self-management platform, breinzorg.nl, which delivers psychoeducation on dementia risk reduction through lifestyle.
The structure matters because behavior change in memory clinic patients is rarely limited by information alone. A patient may understand the importance of exercise, sleep, or smoking cessation and still struggle to convert that knowledge into sustainable action. Coaching addresses motivation and accountability, vouchers lower practical barriers to local services, and the digital platform keeps risk reduction visible between clinic contacts.
LIBRA2 will capture the primary shift in modifiable risk
The trial’s primary endpoint is the 1-year change in modifiable dementia risk, measured with the Lifestyle for Brain Health 2 index, or LIBRA2. This index aggregates a wide set of factors tied to dementia risk and protection: coronary heart disease, diabetes, hypercholesterolemia, hypertension, depression, obesity, smoking, high physical activity, chronic kidney disease, high alcohol intake, high cognitive activity, healthy diet, hearing impairment, sleep disturbances, and social participation.
That endpoint reflects a practical clinical question. Rather than waiting for dementia incidence, which would require a much larger and longer trial, LIGHT asks whether a memory-clinic intervention can move the risk profile itself within one year. Such a design is especially relevant in indicated prevention, where immediate changes in blood pressure control, exercise behavior, mood, sleep, diet, and social engagement may appear before any change in cognition.
One sentence captures the trial’s clinical ambition: the intervention is meant to alter the risk substrate, not merely educate about it.
Cognitive and daily-life outcomes will extend beyond risk scores
The secondary outcomes broaden the trial beyond risk-factor arithmetic. Investigators will assess cognitive functioning, health-related quality of life, activities of daily living, self-efficacy, care use, and change in individual risk factors. Those measures are important because a risk score can move without translating into a meaningful daily-life benefit, and a person can feel better even before formal cognitive test results shift.
The inclusion of self-efficacy is especially relevant. In preventive neurology, the capacity to sustain behavior change often determines whether a lifestyle intervention becomes part of routine life or fades after the trial visit. By measuring care use as well, LIGHT may help clarify whether coaching and service access alter how often patients rely on memory clinic resources or other health services over the course of a year.
The trial also makes room for heterogeneity. Patients with SCD and MCI do not occupy the same clinical position, and their response to intervention may differ depending on baseline insight, symptom burden, and the number of risk factors already present. A memory clinic cohort with multiple modifiable risks is exactly the setting where such variation is likely to emerge.
Why memory clinics may be the right place for prevention
Memory clinics see patients at a moment of heightened concern, when motivation for lifestyle change may be stronger than in general population prevention programs. That setting also offers a more targeted route than broad public health campaigns because clinicians can identify people with cognitive complaints and multiple risk factors who may be especially open to intervention.
The biological logic is straightforward. Vascular disease, metabolic dysfunction, depression, obesity, poor sleep, smoking, hearing loss, and social isolation do not act in separate compartments. They converge on brain health through pathways involving cerebrovascular injury, reduced cognitive reserve, impaired synaptic efficiency, and chronic systemic stress. A multidomain program is therefore more plausible than a single-behavior approach when the goal is to reduce dementia risk in a person whose brain is already signaling vulnerability.
LIGHT also addresses a long-standing implementation problem: even when the evidence base for lifestyle-based dementia prevention is strong, routine clinical delivery is thin. Memory clinics have historically focused on diagnosis, prognosis, and symptomatic management. This trial tests whether they can also become a setting for risk reduction before dementia becomes established.
Cost-effectiveness will matter if the program works
The study is explicitly framed around (cost-)effectiveness, a necessary focus if lifestyle intervention is to move from research to routine care. Certified coaching sessions, vouchers, and digital support all require resources. If the intervention improves LIBRA2 scores and produces favorable shifts in cognition, quality of life, or health service use, the cost question will shape whether hospitals can adopt the model at scale.
A second practical issue follows from the design itself. Participants are drawn from Dutch hospital memory clinics, so the delivery model will depend on local infrastructure, availability of certified coaches, and access to brain-healthy services in the community. Those features may make the program feasible in the study setting while still leaving open how easily it could be transported to other health systems.
Trial registration anchors the protocol in the public record
LIGHT is registered at ClinicalTrials.gov as NCT06832761 with registration dated 2025-02-18, and it is also listed under OMON: 57,198. The planned enrollment of 300 participants and the 1-year follow-up will give the trial enough structure to examine whether a memory-clinic-based lifestyle program can change modifiable dementia risk in a measurable way.
What remains unresolved is whether the combined intervention will produce enough movement in LIBRA2 and the secondary outcomes to justify broader implementation. The answer will depend not only on whether participants change behavior, but also on whether those changes persist long enough to alter the clinical course of patients who are already showing cognitive symptoms.