A technique developed to change the behavior of people with depression helped prevent worsening of cognitive function in African Americans with mild cognitive impairment (MCI), a new study from Thomas Jefferson University Hospital found. People with MCI are at higher risk for developing dementia than other older adults.
The research is important because there are no medications that prevent cognitive decline and other studies have shown that the dementia rate for black Americans is up to twice as high as it is for white Americans, said Barry Rovner, a professor of neurology, psychiatry, and ophthalmology at Jefferson. He said the higher rate among African Americans is likely due to cardiovascular risk factors as well as exposure to social adversity rather than genetic differences.
The study, published Monday in JAMA Neurology, paired black community health workers — these are often neighborhood peers who are trained to provide medical information and support — with 221 older African Americans with mild cognitive impairment. Half of the group got a treatment called "behavioral activation," which had previously been used to help people with depression become more active. Very few of the study subjects were depressed, but researchers wanted them to spend more time in physical, social or cognitive activities because there's evidence that such activities reduce the risk of dementia. The community health workers didn't actually do activities with the study subjects. Instead, they helped them figure out what they wanted to do and how to get it done. For instance, the worker could help someone who wanted to start going to church again figure out when the service was, how to get there, write in on the calendar, etc. The workers, who saw participants five or six times over the first six months and every three months after that, also made sure that family members and friends understood what was going on.
Meanwhile, the workers met just as often with a control group just to talk without any mention of increasing activities.
Rovner thinks that a key part of the study design was that participants were allowed to choose what they wanted to do more of. Most of them picked cognitive activity.
Throughout the two-year study, participants were being tested for cognitive functioning as well as their ability to do everyday things, like pay a bill or call about changing a medical appointment. At the end, 1.2 percent of the group that received the behavioral intervention met the research team's definition for cognitive decline compared to 9.3 percent of the group that only talked with health workers. Rovner thinks that even the socializing was likely better than nothing. Previous studies have found cognitive decline in 12 to 41 percent of older African Americans over a two-year period.
Jefferson does not currently offer a similar program to patients. Rovner said that families likely could play the same sort of role as the community health workers by helping loved ones schedule activities or making a point of playing challenging games together.
"The takeaway message is that this isn't just an intervention for an individual to take up on their own," Rovner said. "It really is about a family getting behind this as well." He said people with memory problems are more likely to respond well to family members who say they want change out of love and a desire to keep a loved one healthy as opposed to explicitly saying the change will help prevent dementia.
It won't always be easy. "This is a process," he said. "Just don't expect this to happen after you talk about it one time."