Tuesday, September 11, 2018

Intervention Found to Slow Cognitive Decline in Older Blacks With MCI

Encouraging older black adults with mild cognitive impairment (MCI) to set goals and develop plans to increase cognitive, physical, and/or social activities may help to slow cognitive decline, according to a study published Monday in JAMA Neurology.

MCI is known to increase the risk of progressive cognitive decline. While some observational studies have suggested that engaging in cognitive, physical, and/or social activity may prevent cognitive decline, “these studies have included few black individuals who may differ from white individuals in risk profile (e.g., cognitive reserve, hypertension, diabetes), mechanisms of decline (i.e., microvascular disease, amyloid deposition), and rates of dementia (i.e., black individuals have almost twice the rate),” wrote Barry W. Rovner, M.D., of Thomas Jefferson University in Philadelphia and colleagues.

For the current study, Rovner and colleagues recruited adults who sought memory screening at senior centers, senior housing sites, churches, and primary care clinics in Philadelphia. Adults aged 65 and older who self-identified as black and had amnestic MCI (according to the National Institute on Aging and Alzheimer’s Association criteria) were included in the trial. The researchers excluded individuals who had other psychiatric disorders, were taking antidementia medication, and/or had severe sensory deficits.

The researchers randomly assigned 221 adults to behavioral activation (encouraged patients to set goals and action plans to increase cognitive, physical, and/or social activity) or supportive therapy (welcomed patients into structured discussion about the experience of aging, memory loss, and social isolation but did not include any of behavioral activation’s goal-setting strategies). Both groups received five in-home, 60-minute treatment sessions over four months and six in-home, 60-minute follow-up maintenance sessions over the next 20 months.

A total of 77 people in the behavioral activation group and 87 people in the supportive therapy group completed the two-year study. Over the course of the study, behavioral activation participants engaged in significantly more cognitive activities at 6, 12, 18, and 24 months than did supportive therapy participants; however, there were no differences in physical or social activity, the authors reported.

The two-year incidence of memory decline (as assessed by the total recall score of the Hopkins Verbal Learning Test–Revised at 6, 12, 18, and 24 months) was 1.2% for behavioral activation versus 9.3% for supportive therapy. People in the behavioral activation group also had stable function scores (as assessed by University of California Performance-Based Skills Assessment) over time, whereas function in participants in the supportive therapy group declined.

“To our knowledge, this is the first RCT [randomized, controlled trial] to demonstrate that behavioral activation specifically prevents cognitive and functional decline in older black individuals with MCI,” the authors wrote. “No effective pharmacotherapy exists to prevent cognitive decline in persons with MCI, and black individuals are twice as likely to decline cognitively, meet criteria for MCI, and develop dementia as white individuals. … These facts highlight the need for culturally competent preventive treatments such as behavioral activation to reduce the burden of dementia and achieve health equity for everyone.”

For related information, see the Psychiatric News article “Psychiatrists Write MH Resource for Black Community.”

(Image: iStock/monkeybusinessimages)