Cognitive prescriptions for reducing dementia risk factors among Black/African Americans: feasibility, acceptability, and preliminary efficacy

ABSTRACT

Objectives

Black/African Americans (B/AAs) have double the risk of Alzheimer’s disease and related dementia than Whites, which is largely driven by health behaviors. This study examined the feasibility, acceptability, and preliminary efficacy of a pilot randomized clinical trial of an individualized multidomain health behavior intervention among middle-aged and older B/AAs (dubbed Cognitive Prescriptions [CogRx]).

Design

Thirty-nine community-dwelling B/AA participants aged 45–65 without significant cognitive impairment were randomized to one of three groups: CogRx, Psychoeducation, or no-contact control. The Psychoeducation and CogRx groups received material on dementia prevalence, prognosis, and risk factors, while the CogRx group additionally received information on their risk factor profile across the five CogRx domains (physical, cognitive, and social activity, diet, sleep). This information was used for developing tailored 3-month goals in their suboptimal areas.

Results

The CogRx program had high retention (all 13 CogRx participants completed the 3-month program and 97% of the full sample completed at least 1 follow-up) and was well-received as exhibited by qualitative and quantitative feedback. Themes identified in the positive feedback provided by participants on the program included: increased knowledge, goal-setting, personalization, and motivation. The COVID-19 pandemic was a consistent theme that emerged regarding barriers of adherence to the program. All three groups improved on dementia knowledge, with the largest effects observed in CogRx and Psychoeducation groups. Increases in cognitive, physical, and overall leisure activities favored the CogRx group, whereas improvements in sleep outcomes favored Psychoeducation and CogRx groups as compared to the control group.

Conclusion

The CogRx program demonstrated feasibility, acceptability, and preliminary efficacy in increasing dementia knowledge and targeted health behaviors. Further refinement and testing of the implementation and effectiveness of similar person-centered dementia prevention approaches are needed on a larger scale in diverse populations. Such findings may have implications for clinical and public health recommendations.

Trial registration

ClinicalTrials.gov identifier: NCT03864536.

KEYWORDS:

• Leisure activities
• racial disparities
• Alzheimer’s disease
• behavior change

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

De-identified data and data codes are available upon reasonable request to qualified individuals.

Additional information

Funding

This work was supported by the National Institutes of Health [R21AG059954]. Drs. Clay and Bowen are supported by the University of Alabama at Birmingham Alzheimer’s Disease Research Center [P20AG068024]. Dr. Fazeli is supported by the National Institutes of Health (R01MH131177-01, R21 AG076377-01A1 and R01AG077997-01A1) and the Alzheimer's Association and National Academy of Neuropsychology (ALZ-NAN-22-926241). Dr. Vance is supported by the National Institutes of Health (R01MH106366-01A1, R21AG077957).