The effort sits within SMRUTHI-India, short for Strategic Multimodal Intervention in at-risk Elderly Indians for Prevention of Dementia, an ongoing cohort study spanning four zones of the country: Himachal Pradesh in the north, Rajasthan in the west, Tripura in the east, and Karnataka in the south. In a paper published in Frontiers in Dementia, researchers led by teams at the All India Institute of Medical Sciences in New Delhi describe how they constructed, validated, and pilot-tested the CBM as both a printed booklet and a series of animated videos in Hindi, Kannada, and Bengali. The work is registered as a clinical trial, and its results offer an early but encouraging signal that culturally tailored, multidomain prevention can work far from the urban hospital.

The design philosophy draws on the Finnish FINGER study, the first long-term trial to show that multidomain lifestyle interventions could improve cognition in at-risk older people, and on successors such as U.S. POINTER. Those trials, however, were conducted in Western settings where the authors note the effectiveness of such programs may be underestimated because usual care is already so good. The Indian team set out to fill a different gap: pragmatic, culturally appropriate materials that address modifiable risks like diet, physical inactivity, vascular disease, and substance use within the constraints of rural primary care, where participants often have limited literacy and few dedicated resources.

The theoretical backbone is the Health Behaviour Model, which explains health actions through people’s beliefs and attitudes. The module therefore aims to raise awareness of dementia, sharpen the perceived severity of its symptoms, highlight the advantages of managing risk, and strengthen confidence in the ability to change. Building on this framework, neurologists, a neuropsychiatrist, a neuropsychologist, psychologists, a dietitian, and physiotherapists combed the literature on PubMed, JSTOR, and EMBASE to identify major content themes, drafted a booklet in English, and then subjected it to a gauntlet of stakeholder review and expert scoring.

The validation numbers are striking. The initial draft achieved an average item-level content validity index of 0.933, with individual items ranging from 0.6 to 1.0; after experts flagged five weaker sections, revisions pushed the scale-level average to 0.977, and multi-rater agreement improved from fair to excellent on nineteen of twenty-one items. The booklet’s readability on the SMOG index came out at 10.07, meaning it sits near a tenth-grade reading level, deliberately accessible for a lay audience. When 83 cohort members rated the printed material with the Patient Education Material Assessment Tool for print, between 70 and 96 percent judged the booklet understandable and actionable, with many awarding perfect scores.

For participants who cannot read, the team converted the booklet’s themes into ten animated videos of four to eight minutes each. The storylines follow a relatable older adult in an Indian village developing early signs of dementia, with voice-overs, characters, and settings drawn from the communities themselves. A behavioural science expert reviewed the videos and pushed for caricatures, clearer behavioural-change messaging, less medical jargon, and key takeaway messages at the end of each clip. Ratings from 86 viewers were similarly strong, and qualitative feedback showed that illiterate participants engaged far more readily with the videos than with the printed booklet.

To test whether the module could actually change behaviour, the researchers ran a pilot feasibility study using a cohort multiple randomised controlled trial design at the central hospital site and a pre-post design at peripheral rural sites, enrolling people aged 55 and older with elevated dementia risk on the CAIDE score but normal cognition at baseline. The primary outcome was the LIBRA index, a validated composite of lifestyle-related dementia risk factors. After six months, the intervention group at the central site improved significantly, with the median LIBRA score falling from −3.0 to −4.6, while the control group’s improvement did not reach statistical significance. At the peripheral sites, the index dropped from 0.55 to −1.0, a change the authors report as highly significant.

Feasibility metrics revealed an instructive split between settings. At the central hospital, only 42.4 percent of participants completed the six-month follow-up, largely because travelling to another state, extreme weather, and the stressful hospital environment made repeat visits difficult; many participants were caregivers accompanying patients rather than local residents. In the rural periphery, by contrast, retention reached 85 percent, and adherence was remarkably high: every participant engaged in cognitive activities, 88.2 percent in physical activity, and 70.6 percent in dietary changes. More than half monitored vascular risk, and among those with addictions, 62.5 percent reported reducing their dependence. Overall, 80 to 100 percent of rural participants said they wanted to continue the intervention beyond the trial.

Adherence translated into target achievement. At the central site, all intervention participants reached the MIND diet score goal of at least eight, 87.5 percent exceeded 600 metabolic equivalent task-minutes of weekly physical activity, and 75 percent achieved blood pressure control below 140/90 mmHg. Rural participants met the diet target as well, with 70.6 percent hitting the activity goal and 58.8 percent achieving blood pressure control. Cognitive test scores improved in both arms but not significantly, an outcome the team attributes to the small pilot sample and short follow-up rather than a failure of the approach, noting that pilots of this size are designed to generate preliminary estimates, not definitive efficacy.

The researchers are candid about limitations: heavy reliance on psychoeducation, attrition that may have introduced nonresponse bias, small numbers, and use of the original LIBRA index, which they plan to culturally adapt. Even so, the module’s low cost and its reliance on existing rural health infrastructure rather than new facilities make it a candidate for scale, and the team is planning a larger multicentric trial that will enlist ASHA community health workers to extend reach and sustainability. If those larger trials confirm what this pilot suggests, the path to delaying dementia in one of the world’s fastest-ageing populations may run through a booklet, a set of cartoons, and the trusted hands of village health workers.

Subject of Research: Development and validation of a multimodal health education intervention for dementia prevention in at-risk rural Indian elderly

Article Title: Development of a multimodal health education module for dementia prevention in at-risk rural Indian elders: a SMRUTHI INDIA initiative

Article References: Sharma, K., Dubey, A., Gupta, S., Fulara, K., Narzari, H., Nilima, N., Sneha, Kamini, Sharma, S., Sharma, V., Chaudhary, S., Vastrad, P., Priya Darshanraj, N., Bhattacharjee, S., Datta, P., Shekhawat, G. S., Verma, A., Harshath Ajay, V., Sandesh, J. R., … Padma Srivastava, M. V. (2026). Development of a multimodal health education module for dementia prevention in at-risk rural Indian elders: a SMRUTHI INDIA initiative. Frontiers in Dementia, 5, Article 1914082. https://doi.org/10.3389/frdem.2026.1914082

Image Credits: AI Generated

DOI: 10.3389/frdem.2026.1914082

Keywords: dementia prevention, rural India, SMRUTHI-India, multimodal intervention, LIBRA index, health education, animated videos, care bundle module, lifestyle intervention, cognitive health, PEMAT, elderly