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‘Culturally Sensitive’ Treatment Slows Cognitive Decline, Says Study

By Odharnait Ansbro | September 14th, 2018

Alzheimer’s is a complex disease, baffling researchers for decades as they’ve tried to unravel its cause and potential treatments, but this week saw fresh evidence that simple lifestyle changes can make a big difference when it comes to preventing its onset, regardless of ethnicity or race. The study, one of the first of its kind conducted with an African-American population, found that helping at-risk people to increase their social and physical activity significantly reduced their risk of dementia.

Black Americans have nearly twice the rate of dementia as whites, and are at a higher risk for developing diseases like Alzheimer’s. However, black communities have, historically, been underrepresented in Alzheimer’s research.

“We see higher rates of cognitive decline and dementia in black than in white communities,” said senior author Barry Rovner, professor of neurology, psychiatry, and ophthalmology at Thomas Jefferson University. “Differences in rates of medical conditions that are associated with cognitive decline, like diabetes and hypertension, as well as differences in health beliefs, health literacy, and access to healthy foods, safe neighborhoods, and medical care account for these disparities. There is a clear need for research in this area,” said Rovner.

Over three years, researchers measured the rates of cognitive decline among 221 African-American men and women diagnosed with mild cognitive impairment at the outset of the study. They split them into two groups: one received a treatment called behavioral activation and the other was given supportive therapy as a control. Participants received the interventions over the course of a year.

In the behavioral activation group, community health workers helped participants set goals to do more activities that would increase their cognitive, physical or social activity, and plan specific actions to achieve them. The activities could be as simple as meeting a friend for a walk or playing guitar. They also talked to them about the proven link between staying active and preserving memory. The supportive therapy group had open-ended conversations with a community health worker, increasing their social interaction, but there was no goal-setting or discussion of how to keep their memory healthy.

Researchers found that behavioral activation reduced the risk of cognitive decline by 88 percent compared to supportive therapy. After two years of cognitive testing, it emerged that 9.3 percent of the control group experienced memory decline, compared with only 1.2 percent of the test group.  

According to researchers, an important component in the study’s success was its sensitivity to the needs of the black community. “It was important to work with community health workers who were black in order to help overcome the understandable hesitation about engaging in a research study,” said co-author and geriatric psychologist Robin Casten, Ph.D. “Our colleagues helped participants feel at ease and unjudged. They provided racially sensitive education and had respect for the participant’s values and self-selected treatment goals.”

Studies like this one could be an important step in closing the gap in dementia research in non-white communities in the U.S. Up until now, researchers trying to unravel the pathology of the disease and come up with effective treatments have looked at mostly white populations. Developing ‘culturally sensitive’ treatments could help to combat the mistrust African Americans still feel when it comes to the medical system and increase their willingness to participate in research.

“It’s not only important to address bias in care delivery but we also need to research—with dignity and without judgement—the interventions that can start to close this gap. Dr. Rovner’s research is a model for a step in the right direction,” said Stephen Klasko, president of Thomas Jefferson University.

And while this research focused on the black community, study authors said this approach would likely work for all racial groups.

The study was published in JAMA Neurology on September 10, 2018.

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