Barry W. Rovner|Robin J. Casten|Mark T. Hegel|Benjamin E. Leiby
Preventing Cognitive Decline in Black Individuals With Mild Cognitive Impairment
Thomas Jefferson University|Thomas Jefferson University|Dartmouth College|Thomas Jefferson University
mild cognitive impairment mci transition state normal cognitive aging dementia increases risk progressive cognitive decline preventing cognitive decline public health priorityto determine whether behavioral activation prevents cognitive functional decline 2 years black individuals mcisinglecenter singlemasked attentioncontrolled randomized clinical trial participants enrolled june 21 2011 october 3 2014 followup ended december 13 2016 communitybased recruitment treatment black individuals older 65 years amnestic mci volunteer sample 1390 persons memory complaints screened overall 536 individuals baseline assessment 315 588 ineligible often owing normal cognition 205 315 65 dementia 59 315 187 221 fully eligible participants randomized analyses intention treatparticipants randomized behavioral activation aimed increase cognitive physical social activity 111 502 supportive therapy attention control treatment 110 498the prespecified primary outcome decline 6 recalled words total recall score hopkins verbal learning testrevised assessed 6 12 18 24 months secondary outcome functional declineof 221 randomized participants mean sd age 758 70 years 175 women 79 77 behavioral activation participants 694 87 supportive therapy participants 791 2year outcome assessments baseline behavioral activation participants engaged significantly cognitive activities supportive therapy participants 2year incidence memory decline 12 95 ci 0264 behavioral activation vs 93 95 ci 530164 supportive therapy relative risk 012 95 ci 002074 p 02 behavioral activation associated stable everyday function whereas supportive therapy associated decline difference slopes 271 95 ci 012530 p 04 rates serious adverse events behavioral activation supportive therapy respectively falls 14 13 vs 28 25 emergency department visits 24 22 vs 24 22 hospitalizations 36 32 vs 31 28 deaths 7 5 vs 3 4behavioral activation prevented cognitive functional decline finding requires investigation black individuals almost twice rate dementia white individuals behavioral activation may reduce health disparityclinicaltrialsgov identifier nct01299766