A study from Thomas Jefferson University Hospital has found success in a new approach to prevent further memory loss in older African-Americans. It’s not a pharmaceutical treatment — in fact, no medications are involved at all. Instead, it’s behavioral.
The study paired older, black patients who were in the early stages of memory loss with community health workers, who helped them develop a plan to increase their social, cognitive and physical activity.
Older black Americans are twice as likely to develop dementia than white Americans.
To explain why, past research has suggested that genetics might be a contributing factor. Lately, evidence is mounting that it is the lived experience of African-Americans, often marked by more adversity starting at a young age, that’s the culprit.
When African-Americans experience stress during early childhood, studies have found those experiences take a greater toll on the brain. They also increase the likelihood of chronic medical conditions such as diabetes and heart disease that, in turn, accelerate cognitive decline.
“Diabetes can damage small vessels in the eye and cause blindness,” said Dr. Barry Rovner, geriatric psychiatrist at Jefferson Hospital and lead on the study. “In the same way, it can damage small vessels in the brain and cause cognitive problems.
But Rovner didn’t set out to prove that older black patients were experiencing dementia twice as often — that’s been established. Instead, he wanted to test a treatment he hoped would stop the cognitive decline before it advanced in to full-on memory loss.
He worked with a group of 221 African-American patients who were in the early stages of memory loss, placing half in a control group.
The others were paired with community health workers who came to their homes and worked with them on a plan for what Rovner and his team call “behavioral activity.” It’s a method used by some therapists to treat depression that involves intentional goal setting to increase cognitive, social and physical activity.
That activity can range from going for a weekly swim, to having lunch with a friend, to doing word searches or sudoku puzzles.
While many studies have demonstrated observationally that brain health is linked to increased physical, cognitive and social activity, Rovner said this study proves it by isolating those activities as the dependent variable in a randomized controlled trial.
Goal-setting group much less likely to lose memory
The group was measured against a control group who also received regular therapy (to control for simple personal interaction), but did not receive the behavioral activation method. Those in the control group were not encouraged to set goals, and they had no conversations about the link between memory and an increase in activity.
After three years, researchers found that the group setting goals to increase activity was almost 90 percent less likely to experience memory loss.
Studies like these can sound optimal in theory, but there is often a chasm between planning to change behavior and actually doing it. Because of this, said Joann Akpan, the clinical research coordinator for the study who headed the community health workers team, her health workers made sure that the goals patients were setting were attainable, realistic, and most importantly, fun.
Akpan remembered one participant who told her that on the first Saturday of every month, a group of guys he knew from high school all ate breakfast together. He was always invited, but he never made it.
“It wasn’t really a priority, even if it was something that he wanted to do — he just never actually made a plan,” she said.
So, together they made one. They figured out how he would get to the restaurant, and they put a reminder in his calendar. (Since many of the study participants are already experiencing memory loss, Akpan said, forgetting to go to activities or what the goals were in the first place can be a big challenges.)
The breakfast became his monthly ritual. And, at the end of the study, he filled out a survey asking him to rank from 1-10 how satisfied he was with accomplishing his goal.
“He said a 12 — that’s how excited he was,” Akpan said.
While community health workers are gaining popularity as a model for delivering care, Rovner acknowledged that this might not appear to be possible — at least at first.
“This is not going to be something that health insurers are going to pay for right away, despite its benefits,” he said. “So that gets back to encouraging family members to do this.”
Rovner stressed that dementia is a public health issue. While the study focused on African-Americans, he said nothing suggests it wouldn’t work for people of all races. If family members know there is something this simple to prevent — or slow — memory loss, they’re in the best position to do it.
“The approach for family members isn’t to say, ‘Here’s a study, here are the facts, here’s the logic about why you need to do more.’ That doesn’t work,” he said.
“What makes it work is the power of the relationship — the relationship provides the motivation to change the behavior.”