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Behavioral activation prevents functional, cognitive decline

Behavioral activation that increased cognitive, physical, and social activity staved off cognitive decline in black patients with mild cognitive impairment better than social interaction, according to findings recently published in JAMA Neurology.

“Randomized clinical trials and observational studies have suggested that cognitive, physical, and/or social activity may prevent decline,” Barry W. Rovner, MD, of the department of neurology at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, and colleagues wrote.

“However, these studies have included few black individuals who may differ from white individuals in risk profile (eg, cognitive reserve, hypertension, diabetes), mechanisms of decline (ie, microvascular disease, amyloid deposition), and rates of dementia (ie, black individuals have almost twice the rate),” they added.

Researchers randomly assigned patients with mild cognitive decline (mean age, 75.8 years) to receive either behavioral activation, which utilizes goal setting and action plans to strengthen the participation in healthy activities, or supportive therapy, which is an organized, nondirective psychological treatment that promotes personal expression and expresses messages of optimism, respect and empathy. Of the 1,390 original potential trial participants, 164 had data available 2 years after baseline.

Rovner and colleagues found that the 77 behavioral activation recipients took part in significantly more cognitive activities than the 87 supportive therapy recipients. In addition, memory decline — as gauged by a decline of 6 or more recalled words on the total recall score of the Hopkins Verbal Learning Test–Revised evaluated in 6 month intervals during the course of the 2-year study — was 1.2% (95% CI, 0.2-6.4) for behavioral activation participants vs. 9.3% (95% CI, 5.3-16.4) for supportive therapy participants (RR = 0.12; 95% CI, 0.02-0.74).

Researchers also wrote whereas behavioral activation was linked to stable everyday function, supportive therapy was linked to decline (difference in slopes = 2.71; 95% CI, 0.12-5.3). The type and number of serious adverse events rates in patients who underwent behavioral activation therapy were hospitalizations (n = 36), ED visits (n = 24), falls (n = 14), and deaths (n = 7). There were 31 hospitalizations, 28 falls, 24 ED visits, and 3 deaths among patients in the supportive therapy group.

“This [randomized-controlled trial] overcomes [past trial] limitations by using current diagnostic criteria and validated psychometric outcome measures, recruiting a large sample, using an intent-to-treat analysis, and having successful randomization, adequate power, masked outcome assessments, and high adherence to two standardized and credible interventions,” Rovner and colleagues wrote.

“Black individuals ... have less accurate knowledge of dementia and are less likely to be treated for it. These facts highlight the need for culturally competent preventive treatments such as behavioral activation to reduce the burden of dementia and achieve health equity for everyone,” they concluded. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.