A Multidomain Approach to Preventing Dementia in African Americans: Cognitive Prescriptions

The goal of this R21 study is to explore the feasibility and preliminary efficacy of individualized cognitive prescriptions (CogRxs) in improving engagement in healthy behaviors and other outcomes in middle-aged AAs and to gain feedback on future implementation of the program.

A pre-post experimental design will be used, in which 150 AA participants aged 50-65 will complete a baseline assessment of cognitive testing and data-driven assessment of deficiencies across five CogRx domains (physical activity, cognitive activity, diet, sleep, social activity). Participants will be randomized to either: psychoeducation + CogRx, psychoeducation only, or no contact control. The psychoeducation and CogRx groups will receive general psychoeducation on dementia prevalence, prognosis, and risk factors, while the CogRx group will also receive personalized information on their risk factor profile and develop a tailored 3-month intervention plan, which will consist of simple evidence-based strategies to implement at home. Motivational reminders as well as adherence and self-efficacy questions will be administered via text-messaging over the 3-months. Participants will return for 3-month and 6-month follow-ups. Specific Aim 1 (proximal outcomes) is to determine whether the CogRx condition is superior to psychoeducation alone in improving engagement in healthy lifestyle behaviors. Specific Aim 2 (distal outcomes) is to compare the three conditions on a brief battery of cognitive and psychological measures. The Exploratory Aim is to gather feedback for future implementation of this program, including cultural considerations, barriers and facilitators to engagement, and likelihood of continuing the program.

A pre-post experimental design will be used, in which 150 AA participants aged 50-65 will complete a baseline assessment of cognitive testing and data-driven assessment of deficiencies across five CogRx domains (physical activity, cognitive activity, diet, sleep, social activity). Participants will be randomized to either: psychoeducation + CogRx, psychoeducation only, or no-contact control.

Receives same general psychoeducation on dementia and will also receive personalized information on their risk factor profile and develop a tailored 3-month intervention plan, which will consist of simple evidence-based strategies to implement at home.

Personalized information on their risk factor profile across five CogRx domains (physical activity, cognitive activity, diet, sleep, social activity) and develop a tailored 3-month intervention plan, which will consist of simple evidence-based strategies to implement at home.

Physical activity, cognitive activity, diet, sleep, and social activity are the primary outcome, as the goal of the intervention is to improve behaviors the participant is determined to have deficiencies in at baseline. Since the intervention is tailored, outcomes are unique (e.g., one persons intervention might consist of improving physical activity and diet, whereas another might focus on cognitive activity and sleep). The following self-reported questionnaires will be used: Physical activity (the International Physical Activity Questionnaire), Diet (the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) questionnaire), Social Activity (the Duke Social Support Inventory), Sleep (the Pittsburg Sleep Quality Index (PSQI)), Cognitive Activity (a modified Florida Cognitive Activities Scale). Cutoffs will be used to create dichotomies for each domain such that 1=optimal and 0=suboptimal, which will be summed to create a Health Behavior composite (scores ranging from 0-5).

Scores on the Dementia Knowledge Assessment Scale (DKAS-27) which assesses knowledge about risk factors and prognosis of dementia. Scores include percentage correct for the 27 items, with scores ranging from 0-100%.

Inclusions: Must be African American Must be age 50 to 65 Must have a working cell phone with unlimited texting Must be ambulatory Exclusions: No neurological (including dementia diagnosis) or severe psychiatric (e.g., schizophrenia or bipolar disorder) disorders No insomnia Telephone Interview for Cognitive Status (TICS) score ≤20