4.2. Adherence
ADRD, ketosis
KETOSIS
Across the 6-week program, participants in the MKNA arm reported significantly higher self-reported adherence and tended to demonstrate higher levels of urine ketones compared to the MKNE arm. Both arms of the trial demonstrated a substantial drop in self-reported adherence and objective measures of ketones by the 3-month post-assessment. These findings demonstrate that the MI-BCT strategies appear effective for enhancing adherence during the active program but may not confer lasting benefits for remaining in ketosis. These findings are consistent with reviews showing that MI and BCT strategies are effective for increasing adherence to lifestyle programs [In addition to long-term adherence strategies, characteristics of the sample related to adherence may be important to consider for future tailoring. Most characteristics examined were not associated with adherence measures, although a significant limitation for interpreting these results relates to poor racial and ethnic diversity in the sample. Despite this limitation, we found that younger participants with higher cognitive scores at screening tended to report better adherence and evidenced higher levels of ketones during the program. These findings may suggest that earlier intervention targeting younger and cognitively normal individuals with other risks for ADRD may lead to greater benefits from the MKNA program. The strategy of identifying participants in mid- and late-life based on demographic and cardiovascular risks associated with ADRD has been successful in other lifestyle intervention trials [