The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce

We plan to make and test a prevention programme to lower older people's chances of getting dementia. The half of older people (aged 60+) who have problems with "cognition" (memory, orientation and other thinking) have more chance of getting dementia, so we will design an approach that works for them. We will design our programme with people who will use, run and pay for it, and will think especially about how it will work for people from more deprived and minority ethnic groups, who are more likely to get dementia. Our programme will help older people make changes that can prevent dementia. These are: 1. Being more socially and mentally active 2. Eating more healthily 3. Being more physically active 4. Looking after their mental and physical health 5. Stopping smoking 6. Reducing alcohol. We will learn from therapies that have worked, but are too time consuming and expensive to run outside of research studies. What we will find out Stream 1: What do people with memory problems, including those from minority ethnic or more deprived backgrounds, do now to try to avoid dementia? Stream 2: Do people with a higher chance of getting dementia get the right help from their GPs (such as blood pressure checks) to prevent it? What makes this more and less likely? Stream 3: What should our face to face, personalised programme be like? Which "app" design will work best in helping prevent dementia? Do people with memory problems, including people from vulnerable groups, use it? Stream 4: How do people who will use, run and pay for our programme if it works, think it should be designed and used? Stream 5: Do people who take part in our programme have less cognitive problems over two years than people who only receive an information leaflet? If so, how did it work, and is it good value for money? How we will do it We will review past research and interview around 80 older people, their families and professionals, to find out how the NHS and society help older people live healthier lives to prevent dementia. We will look at how people think about memory problems and preventing dementia. We will use a database with 14 million UK primary care records, to see who is getting health care that can prevent dementia. We will work with Age-UK, the Alzheimer's society, Care organisations, local authorities and Public Health England. We will randomly allocate 704 people with memory problems without dementia, so they have an equal chance of receiving the new programme or an information leaflet. We plan that the programme will be 10 group sessions over 6 months. We will offer individual sessions for people who cannot come to groups. Two facilitators will lead the groups. They will be trained and supervised by an experienced psychologist to keep to a manual so the programme is delivered in the same way each time. Groups will take place in a range of places to be accessible to all. We will ask people taking part to complete questionnaires, including a memory test and give a voluntary blood sample, before the programme starts and 6 and 24 months later. We will interview around 50 people taking part (including those who drop out) or running the groups to hear what went well and what could be better. As more care and therapies move online, we risk leaving vulnerable people behind. We will ask engineers to design an easy to use app to support people to make the lifestyle changes that prevent dementia. We will support them to build it, then try it out with study participants, including people from vulnerable groups (we can lend them computers if they don't have their own and are willing). We can look at how this helps to get the new programme to people who need it most in future work. Our programme could make a huge difference to individuals, the NHS and society, by reducing the number of people who get dementia.