A Multidomain Approach to Preventing Dementia in African Americans: Cognitive Prescriptions - PROJECT SUMMARY/ABSTRACT
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.
