Rationale and Protocol for a Pilot Randomized Controlled Trial of a Cognitive Prescription Intervention for Reducing Dementia Risk Factors Among African Americans

Figures & data

Figure 1 Conceptual framework for CogRx; HBM, Health Belief Model; SCT, Social Cognitive Theory.

Figure 2 Study design.

Table 1 Study Measures

Domain	Measure		Time
Sociodemographics and Health	Demographics^a, M: age, education, gender, income; Wide Range Achievement Test 4th Edition^Citation33 (quality of education)^a, IP; self-reported medical comorbidities and medications^a, P; Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)-Lite^Citation34 (substance use)^P; Rapid Estimate of Adult Literacy in Medicine (REALM)^a, IP and Vital Signs^IP (health literacy); Childhood Trauma Questionnaire^Citation35 (adverse childhood experiences)^a, M		20 min
Psychological, Mental Health, Successful Aging	Resilience: Connor Davidson Resilience Scale^Citation36, M Attitudes about aging: Philadelphia Geriatric Morale Scale^Citation37, M Personal mastery: personal mastery scale^Citation38, M Coping: proactive coping scale^Citation39, M	Self-rated successful aging: Montross Measure^Citation40, M Quality of life: Medical Outcomes Study Short Form 12^Citation41, M Mood: Center for Epidemiological Studies – Depression Scale^Citation42, IP Locus of control: Personality in Intellectual Aging Contexts^Citation43, M	30 min
Cognitive Function	Delayed Recall: Hopkins Verbal Learning Test (HVLT),^Citation44, P brief visuospatial memory test (BVMT)^Citation45, IP Learning: HVLT^P, BVMT^IP Verbal: controlled oral word association test,^Citation46, P category fluency^Citation47, P	Executive function: Trails B,^Citation48, IP Stroop Color Word Trial^Citation49, IP Processing speed: Trails A,^Citation48, IP Stroop Color Trial^Citation49, IP Attention/working memory: Paced Auditory Serial Addition Test,^Citation50, IP Letter Number Sequencing^Citation51, P Motor: grooved pegboard^Citation52, IP	1 hr
CogRx Domain Deficiencies^P	See Table 2		30 min
Dementia Knowledge	Dementia Knowledge Assessment Scale,^Citation53,Citation54, d, M Dementia Risk/Prevention Knowledge Questionnaire^d, IP		10 min
Barriers and Facilitators	Qualitative interview on barriers and facilitators to CogRx engagement^c, d, P		5 min
Intervention Feedback	Quantitative and qualitative items pertaining to likes and dislikes about the study and self-reported improvements and engagement in CogRx domains^b, d, P		10 min
COVID-19	Influence of COVID-19 on Lifestyle Behaviors Survey^a, d, P, Coronavirus Impact Scale,^Citation55, a, d, M		20 min
	COVID-19 Social Impact Questionnaire,^Citation56, a, d, M Knowledge and Perceptions of COVID-19^Citation57, a, d, IP

Notes: Measures given at baseline and three- and six-month follow-ups, except where noted. ^aBaseline only; ^bCogRx group only at three- and six-month follow-ups; ^cadministered at baseline to all participants and only CogRx group at three-month follow-up; ^dmeasure explained in detail in text of manuscript; as described in the text, the COVID-19 hybrid data collection protocol resulted in some measures being: ^M=mailed, ^P=phone, ^IP=in-person.

Table 2 Determination of Deficiency in CogRx

Domain	Assessment of Deficiency	Intervention
Physical Activity	International Physical Activity Questionnaire^Citation58 to determine CDC criteria CDC:^Citation59 At least 150 min of moderate aerobic activity OR 75 min of vigorous aerobic activity per week (or an equivalent mix). Deficient: not meeting either criteria	• At least 150 min of moderate aerobic activity OR 75 min of vigorous aerobic activity per week (or an equivalent mix) • Participant choses specific activities (eg, walking, jogging, bicycling)
Diet	Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diet Questionnaire.^Citation60,Citation61 Deficient: score of 5 or lower (lowest tertile)	MIND diet: Encourage: Green leafy vegetable, berries, nuts, olive oil, whole grains, fish and poultry, beans, wine. Limit: Butter and margarine, red meat, fast fried food, pastries and sweets, cheese
Social Activity	Social Network Index (SNI).^Citation62 Deficient: score lower than 6 (indicative of social network diversity)	• Encourage greater frequency of contact with satisfying friends/family (can be face-to-face, via phone) • Encourage socially active volunteer work^Citation63,Citation64
Sleep	Pittsburgh Sleep Quality Index (PSQI) to determine sleep quantity and quality. Deficient: less than 7 hours actual sleep per night reported and Overall Sleep Quality rating of “fairly bad” or “very bad”^Citation65	Aim for at least 7 hours of sleep per night and encourage healthy sleep habits: limit screen time before bed, limit alcohol and caffeine before bed, go to bed at reasonable hour, use sound machine, relaxation/breathing techniques for resting the mind^Citation66
Cognitive Activity	Leisure Activity Questionnaire.^Citation67 Deficient: score lower than 12 (indicative of “activity days”)	Encourage cognitive activity during leisure time: reading, writing, musical instruments, playing games, taking classes

Figure 3 Intervention material: introduction to the five CogRx domains with examples.

Figure 4 Intervention material: introduction to SMART goals and examples.

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