A Simple Method May Slow Cognitive Decline

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. Now, a new study in black participants with mild cognitive impairment – often a precursor to dementia – shows that a method for increasing activity can reduce the risk of future memory loss. The method helps participants increase their social, cognitive, and/or physical activity. 

“Stay busy and use your mind. Physicians often deliver this common sense advice, but advice is rarely sufficient to change behavior,” said the study’s senior author psychologist Barry Rovner, who sees patients and conducts research at Jefferson.

“We see higher rates of cognitive decline and dementia in black than in white communities,” says Dr. Rovner. A number of factors can account for the disparity, including higher 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.

“This study provides the first evidence that we can prevent memory decline in this high-risk population, and help people maintain independence,” said Dr. Rovner. The results of this randomized, controlled clinical study were published in JAMA Neurology.

The researchers used a method called Behavioral Activation, pioneered in patients with depression, which helps participants increase cognitive, physical or social activity by guiding them through goal setting and action planning. In this study, community health workers from the black community helped participants set their action plans. If participants didn’t meet their self-defined goals, the community health workers helped them break down goals to smaller actionable steps. It was also important that participants chose their own goals – ones they had an interest in achieving.  One study subject chose to relearn chess, another to play guitar, others to dance or re-join a church group.

(For  tips on applying this technique with your loved ones, read our how-to piece.)

The intervention worked remarkably well. The researchers showed that Behavioral Activation reduced the risk of cognitive decline by 88 percent compared to the group who received a “sugar pill” or placebo intervention. The placebo 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 to being sensitive of the needs of the black community. “It was important to work with clinical coordinators who were black, in order to help overcome the understandable hesitation about engaging in a research study,” says co-author and geriatric psychologist Robin Casten, 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.”

“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,” says Dr. Rovner.

“It’s unacceptable that African American patients are twice as likely as white patients to develop dementia,” says Stephen K. Klasko, President of Thomas Jefferson University and CEO of 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.”