The SINGER Study: How Singapore is Engineering a Future Without Dementia

Singapore is getting older, and faster than almost any other nation on earth. By 2030, one in four residents will be over 65. While this longevity is a triumph of modern healthcare, it casts a long shadow: the rising tide of dementia. With projections showing 152,000 people in Singapore living with dementia by 2030, the nation is facing a public health crisis that demands a bold, innovative response.  

Enter the SINgapore GERiatric Intervention Study to Reduce Cognitive Decline and Physical Frailty (SINGER). More than just a clinical trial, SINGER is a strategic national effort to rewrite the future of ageing. It’s a pioneering attempt to prove, on a large scale, that cognitive decline is not inevitable and that a targeted lifestyle intervention can keep our minds sharp and our bodies strong as we age.  

This landmark study builds on a global success story but gives it a uniquely Singaporean identity, powered by a revolutionary technology platform designed to manage the immense complexity of modern medical research.

The Global Blueprint: Learning from Finland's FINGER Study

The scientific inspiration for SINGER comes from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). In 2015, the FINGER trial made global headlines by becoming the first large-scale study to prove that a "multidomain" lifestyle intervention could significantly protect cognitive function in at-risk older adults.  

For two years, 1,260 participants engaged in a program combining:

• Nutritional Guidance
• Physical Exercise
• Cognitive Training
• Intensive Vascular Risk Management

The results were groundbreaking. The intervention group showed a 25% greater improvement in cognitive scores compared to the control group. The benefits were seen even in individuals with a genetic predisposition to Alzheimer's, proving that lifestyle can powerfully influence destiny. This success launched the   

World-Wide FINGERS (WW-FINGERS) network, a global consortium dedicated to adapting the FINGER model for different cultures and populations, with SINGER as its flagship Asian initiative.  

The Engine Room: Powering SINGER with the Mahalo Research Platform

Adapting a study as complex as FINGER for 1,212 participants in Singapore is a monumental task. It requires flawless coordination, massive data handling, and personalized engagement at a scale never before seen in local dementia research. To meet this challenge, the SINGER initiative partnered with the   

Mahalo Research Platform, a technology suite with a proven track record in large-scale neurological studies.

This partnership was built on a foundation of success. In a prior five-year initiative, Mahalo collaborated with a leading national dementia advocacy group to launch a similar D2P registry. The results from that project demonstrated the platform's unique ability to manage the very challenges SINGER would face:

• Exceptional Participant Engagement: Keeping participants active in a long-term study is critical. By combining a user-friendly interface with configurable, multi-channel reminders, the Mahalo platform maintained an 87% average completion rate for scheduled quarterly patient-reported outcomes (PROs) and an incredible 94% completion rate for initial baseline surveys.
• Seamless Data Integration: A complete picture of health requires pulling data from multiple sources. Mahalo's multi-modal strategy—which includes patient-mediated access and connections to Health Information Exchanges (HIE)—successfully retrieved and integrated electronic health records for over 92% of consented participants.
• Commitment to Diversity: Singapore's strength is its multiculturalism, and research must reflect that. Through targeted outreach support and by offering the platform in multiple languages, the previous registry enrolled a cohort where 38% of participants identified with a racial or ethnic minority, ensuring the insights gained are truly representative.

With this proven expertise, Mahalo became the indispensable engine for SINGER. Its advanced, AI-driven modules manage every facet of the trial, from initial recruitment to final analysis, ensuring a level of precision and efficiency that would be impossible with traditional methods. When the COVID-19 pandemic hit, the platform's robust telehealth and remote monitoring tools were pivotal, allowing the study to continue with minimal disruption.  

The D2P Registry: Turning Data into Prevention

At the heart of the Mahalo platform is the D2P (Data-to-Prevention) Registry. The D2P Registry is more than a database; it's a dynamic, secure biorepository that integrates the vast and varied data streams collected from every SINGER participant. This includes:

• Clinical assessments and cognitive test scores
• Neuroimaging data (MRI scans)  

• Blood biomarkers and genetic information  

• Real-time data from wearable fitness trackers
• Digital food diaries and lifestyle questionnaires

The D2P Registry uses sophisticated machine learning models to analyze this multi-layered data. Its purpose is to uncover the unique patterns of "Asian Dementia," a phenotype often characterized by a higher burden of vascular disease. By identifying novel biomarkers and risk profiles specific to Singapore's multi-ethnic population, the D2P Registry aims to move beyond a one-size-fits-all approach. Its ultimate goal is to enable a future of personalized prevention, where at-risk individuals receive tailored lifestyle prescriptions based on their unique biological and digital footprint.  

A Tale of Two Interventions: The SINGER Study in Action

The main SINGER trial is a two-year, randomized controlled trial comparing two different approaches to lifestyle change :  

1. Structured Lifestyle Intervention (SLI): This is the intensive, high-support group. Participants receive personalized coaching from nutritionists, supervised exercise sessions with trainers, a structured cognitive training program, and proactive management of vascular health by study physicians.  

1. Self-Guided Intervention (SGI): This group acts as the control. They receive general health information and resources but are empowered to manage their lifestyle changes independently, mirroring a typical public health campaign.  

This pragmatic design is brilliant. It doesn't just ask "Does this work?" but also "What is the most cost-effective way to make it work for an entire nation?" The results will provide policymakers with a clear, evidence-based roadmap for designing a national dementia prevention program.  

Before the main trial, a crucial pilot study tested culturally adapted interventions. For instance, it compared computer-based cognitive training with a pen-and-paper version and a Nordic diet with a locally-adapted Asian diet. The pilot found that the pen-and-paper training led to much higher adherence, a vital insight that shaped the design of the full-scale study.  

The Bigger Picture: Why SINGER Matters for Singapore and Beyond

The SINGER study, supercharged by the analytical power of the Mahalo platform and its D2P Registry, is a landmark investment in Singapore's future. Its findings are expected to:

• Inform National Policy: Provide the evidence needed to launch a national, cost-effective dementia prevention program, potentially integrated into community centers and primary care clinics.  

• Lead Asian Research: As the first FINGER-based trial in a multi-ethnic Asian population, SINGER will provide invaluable data on the "Asian Dementia" phenotype, serving as a model for other nations in the region.  

• Empower Individuals: Shift the public narrative from one of fearing dementia to one of proactively building brain health, giving Singaporeans the tools and knowledge to take control of their cognitive future.  

The journey is still underway, with final results expected after 2025. But the SINGER study already represents a powerful statement of intent. By combining a proven scientific model with cultural adaptation and cutting-edge technology, Singapore is not just studying the future of ageing—it is actively building a healthier, sharper, and more resilient one.  

‍

‍