African Americans (AAs) are twice as likely to develop dementia than Whites, and evidence suggests that modifiable lifestyle factors account for much of this disparity. AAs also demonstrate poorer dementia knowledge than Whites. Yet, virtually no multi-domain dementia prevention interventions have targeted AAs. Lifespan approaches implementing behavioral therapies before manifestation of impairment may be particularly advantageous, as dementia pathology may precede symptoms by over 20 years. The current study will be the first to explore the feasibility and efficacy of an individualized approach dubbed Cognitive Prescriptions (CogRx) in middle-aged AAs. This approach targets five lifestyle areas: Physical Activity, Cognitive Activity, Diet, Sleep, and Social Activity. Deficiencies in these domains have been demonstrated observationally as behavioral risk factors for dementia. These malleable domains may be especially viable intervention targets, and may have positive secondary outcomes. At 3 and 6 months we will examine primary (i.e., lifestyle changes and dementia knowledge) and secondary (i.e., cognitive function and psychological function) outcomes across three groups: no-contact control, psychoeducation only, and psychoeducation + CogRx. The psychoeducation will target general dementia knowledge, including prevalence, prognosis, and general risk factor information, while the CogRx group will receive a tailored risk/protective factor profile across the five aforementioned domains while also addressing barriers to these areas. The CogRx condition will develop a tailored plan prioritizing deficient domains and integrate activities in their daily lives over the following 3-months. The CogRx condition will receive daily text-messaging reminders and adherence queries over the 3-months and will provide qualitative feedback for future implementation of this program at the 3- month follow-up. The current study will overcome limitations of prior multi-domain cognitive interventions by: 1) enrolling middle-aged adults with a focus on prevention, 2) examining a broad range of lifestyle domains, 3) using self-initiated ?prescriptions? for behavioral changes rather than structured lab-based interventions or supplements/medications, 4) assessing adherence and self-efficacy, 5) tailoring the intervention to deficient areas, 6) examining psychological/mental health outcomes, 7) examining dementia knowledge. The theoretical underpinnings for this approach include the Social Cognitive Theory and the Health Belief Model, in that providing tailored risk factor information (i.e., susceptibility), concrete goals, and outcome expectations while also addressing self-efficacy and barriers will promote behavior change. The ultimate goal of this research is to: 1) yield new perspectives for implementation of person-centered behavioral modification interventions targeting cognitive outcomes in diverse populations, 2) impact clinical and public health recommendations for maintaining cognitive health in aging populations, and 3) reduce racial disparities in dementia.
Despite the increased risk for dementia in African Americans, the significant evidence on the role health behaviors may play in this risk, and evidence of less dementia knowledge in this group, virtually no studies have targeted this population in behavioral modification cognitive interventions. The current study will test the feasibility and initial efficacy of individualized cognitive prescriptions (CogRx) in middle-aged African Americans that combines dementia knowledge psychoeducation with a tailored risk and protective factor profile based on five lifestyle domains. The ultimate goal of this research is to: 1) yield new perspectives for implementation of person-centered behavioral modification interventions targeting cognitive outcomes in diverse populations, 2) impact clinical and public health recommendations for maintaining cognitive health in aging populations, and 3) reduce racial disparities in dementia prevalence.
