Study prevents cognitive decline in older blacks with memory loss

September 10, 2018, Thomas Jefferson University
Credit: CC0 Public Domain

With nearly twice the rate of dementia as whites, blacks are at a higher risk for developing diseases like Alzheimer's, but there has been little research on how to reduce this racial health disparity. A new study in black participants with mild cognitive impairment—often a precursor to dementia—shows that a behavioral intervention can reduce the risk of future memory loss by increasing social, cognitive, and/or physical activity. The results of this randomized, controlled clinical study were published in JAMA Neurology September 10th 2018.

"We see higher rates of and dementia in black than in white communities. Differences in rates of medical conditions that are associated with cognitive decline, like diabetes and hypertension, as well as differences in health beliefs, health literacy, and access to healthy foods, safe neighborhoods, and medical care account for these disparities, said senior author, Barry Rovner, MD, Professor of Neurology, Psychiatry, and Ophthalmology at Jefferson (Philadelphia University + Thomas Jefferson University). "There is a clear need for research in this area. This study provides the first evidence that we can prevent memory decline in this high-risk population, and help people maintain independence."

Dementia is a condition that is often associated with changes in the brain's structure and function. Some research suggests that people who remain active and engaged in community or stimulating work are resistant to the cognitive decline that otherwise can accompany these neurological changes.

"Stay busy, and use your mind. Physicians often deliver this common sense advice, but advice is often not sufficient to change behavior," said Dr. Rovner.

To test whether it was possible to help people set goals and engage in a more active lifestyle, Dr. Rovner and colleagues used a treatment called Behavioral Activation. Researchers have shown that Behavioral Activation effectively reduces depression. Rovner and colleagues used this approach to prevent memory loss, and thereby potentially delay the onset of dementia.

Behavioral Activation helps participants increase cognitive, physical or social activity by guiding someone through goal setting and action planning. In this study, Race-concordant community health workers helped participants set the action plans. For example, the goal of increasing physical activity might include a breakdown of: 1) calling a friend after lunch, 2) picking a time to meet, 3) recording the date on the calendar, and 4) taking the walk. If participants don't meet the self-defined goals, the community health workers helped participants break down goals to smaller actionable steps. It was also important that participants choose their own goals—ones they had an interest in achieving. One participant chose to relearn chess, another to play guitar, others to re-join a church group.

Over a three-year period (June 2011—October 2014), the researchers screened 1,390 people from the black community with self-described memory problems. Of the 1,390 screened, 221 men and women were diagnosed with and randomized to either treatment with Behavioral Activation or to the control or comparison group. The control group received Supportive Therapy, which consisted of open-ended conversations with a community health worker, at the same dose of 11-12 one-on-one sessions over a two-year period, as the Behavioral Activation group. "Supportive Therapy controlled for the effects of social interaction and attention, but importantly, involved no goal setting or discussion of the link between activity and memory," said Dr. Rovner.

Behavioral Activation reduced the risk of cognitive decline by 88 percent compared to Supportive Therapy. The control group had a 9.3 percent incidence of memory decline over the two years, whereas participants who received Behavioral Therapy saw only a 1.2 percent occurrence of decline in memory based on a battery of standardized cognitive tests.

The researchers attribute much of the success of the study and the intervention to a sensitivity to the needs of the black community. "It was important to work with community health workers who were black, in order to help overcome the understandable hesitation about engaging in a research study," said co-author and geriatric psychologist Robin Casten, Ph.D., at Jefferson. "Our colleagues helped participants feel at ease and unjudged. They provided racially sensitive education and had respect for the participant's values and self-selected treatment goals."

"It's unacceptable that African American patients are twice as likely as white patients to develop dementia," said Stephen K. Klasko, President and CEO of Thomas Jefferson University and Jefferson Health. "It's not only important to address bias in care delivery but we also need to research—with dignity and without judgement—the interventions that can start to close this gap. Dr. Rovner's research is a model for a step in the right direction."

"Currently there is no medical treatment to prevent cognitive decline. This study highlights the need for culturally competent treatments to reduce the burden of dementia for all Americans," said Dr. Rovner.

Explore further: Glucose peaks linked to cognitive decline, dementia in diabetes

More information: Barry W. Rovner, Robin J. Casten, Mark T. Hegel, and Benjamin Leiby, "Preventing Cognitive Decline in Blacks with Mild Cognitive Impairment: A Randomized Clinical Trial," JAMA Neurology, DOI: 10.1001/jamaneurol.2018.2513 , 2018.

Related Stories

Glucose peaks linked to cognitive decline, dementia in diabetes

May 20, 2017
(HealthDay)—Glucose peaks are associated with cognitive decline and dementia among individuals with diabetes, according to a study published online May 12 in Diabetes Care.

Upswings in older-age cognitive ability may not be universal

April 23, 2018
A growing body of evidence indicates that rates of dementia may be declining, in part because older adults' cognitive abilities, such as learning and memory functions, are better than those of older adults in the past. But ...

Low-dose aspirin no aid against cognitive decline

May 9, 2017
(HealthDay)—Low-dose aspirin does not protect against cognitive decline, according to a review published April 20 in the Journal of the American Geriatrics Society.

No interventions proven to prevent late-life dementia

December 18, 2017
There is no proven intervention for preventing late-life dementia. Researchers from the Minnesota Evidence-based Practice Center (EPC) reviewed published research to determine if physical activity, prescription medications, ...

Can training improve memory, thinking abilities in older adults with cognitive impairment?

January 16, 2018
Cognition is the ability to think and make decisions. Medication-free treatments that maintain cognitive health as we age are attracting the attention of medical experts. Maintaining the ability to think clearly and make ...

Severe depression linked to dementia in seniors

April 12, 2016
(HealthDay)—Major and worsening depression may significantly increase seniors' risk of dementia, a new study suggests.

Recommended for you

For Down syndrome adults, death and dementia often come together

November 19, 2018
(HealthDay)—Seven in 10 people with Down syndrome show evidence of dementia when they die, new research from Britain reveals.

Meditation and music may alter blood markers of cellular aging and Alzheimer's disease

November 13, 2018
A research team led by Dr. Kim Innes, a professor in the West Virginia University School of Public Health, has found that a simple meditation or music listening program may alter certain biomarkers of cellular aging and Alzheimer's ...

Alzheimer's and cardiovascular disease share common genetics in some patients

November 9, 2018
Genetics may predispose some people to both Alzheimer's disease and high levels of blood lipids such as cholesterol, a common feature of cardiovascular disease, according to a new study by an international team of researchers ...

Artificial intelligence predicts Alzheimer's years before diagnosis

November 6, 2018
Artificial intelligence (AI) technology improves the ability of brain imaging to predict Alzheimer's disease, according to a study published in the journal Radiology.

Diabetes medications may reduce Alzheimer's disease severity

November 1, 2018
People with Alzheimer's disease who were treated with diabetes drugs showed considerably fewer markers of the disease—including abnormal microvasculature and disregulated gene expressions—in their brains compared to Alzheimer's ...

Massive study confirms that loneliness increases risk of dementia

October 29, 2018
A new Florida State University College of Medicine study involving data from 12,000 participants collected over 10 years confirms the heavy toll that loneliness can take on your health: It increases your risk of dementia ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.