Rovner BW, et al. – This 2-year, single-center, single-masked, attention-controlled, randomized trial assessed whether behavioral activation prevents cognitive and functional decline in black individuals with mild cognitive impairment. Participants (n=221) were randomized to behavioral activation and supportive therapy groups. Rates of serious adverse events for participants in the behavioral activation and supportive therapy groups of this study were falls, emergency department visits, hospitalizations, and deaths. Findings indicated that black individuals had nearly twice the rate of dementia as white individuals. Behavioral activation prevented cognitive and functional decline in this population and may help to reduce this health disparity.

Methods

• Participants in the study were enlisted from June 21, 2011, to October 3, 2014, and follow-up ended December 13, 2016.
• Researchers performed community-based recruitment and treatment of black individuals aged >65 years with amnestic MCI.
• Volunteer sample of 1,390 individuals with memory complaints were screened.
• A total of 536 individuals had baseline assessment; 315 (58.8%) were ineligible, most often due to normal cognition (205 [65%]) or dementia (59 [18.7%]).
• Of those assessed, 221 eligible participants were randomized to behavioral activation, which intended to increase cognitive, physical, and social activity (111 [50.2%]), or supportive therapy, an attention control treatment (110 [49.8%]).
• Analyses were intention to treat.
• A decline of ≥6 recalled words on the total recall score of the Hopkins Verbal Learning Test–Revised assessed at 6, 12, 18, and 24 months was the prespecified primary outcome.
• Functional decline was the secondary outcome.

Results

• Of 221 randomized participants (mean [standard deviation] age, 75.8 [7.0] years; 175 women [79%]) 77 behavioral activation participants (69.4%) and 87 supportive therapy participants (79.1%) had 2-year outcome assessments.
• Behavioral activation participants engaged in significantly more cognitive activities than supportive therapy participants after baseline.
• The 2-year incidence of memory decline was 1.2% (95% confidence interval [CI]: 0.2-6.4) for behavioral activation vs 9.3% (95% CI: 5.30-16.4) for supportive therapy (relative risk, 0.12; 95% CI: 0.02-0.74; P=0.02).
• Behavioral activation was related to stable everyday function.
• Supportive therapy was correlated with decline (difference in slopes, 2.71; 95% CI: 0.12-5.30; P=0.04).
• Findings revealed that rates of serious adverse events for behavioral activation and supportive therapy, respectively, were: falls (14 [13%] vs 28 [25%]), emergency department visits (24 [22%] vs 24 [22%]), hospitalizations (36 [32%] vs 31 [28%]), and deaths (7 [5%] vs 3 [4%]).