Alzheimer's Behavioral Intervention Overview

Presentation on Alzheimers Behavioral Intervention Smart E. Presenter, Ph.D., ABPP

Presentation Goals Review the rationale for, and published literature on, behavioral interventions. Review the procedure and introduce pilot data on a novel behavioral intervention. Discuss demographic influences, limits to interpretive power, and future directions.

Epidemiology 1 in 10 Americans over the age of 65 have Alzheimer dementia. Although incidence is declining in high-income countries, number of cases are expected to double as overall population ages. Incidence is currently greater in high-income countries, but expected to shift to low-income countries as longevity increases while health systems ability to proactively address risk factors remains low. The prevalence and lifetime risk is almost twice as high among women This is believed due to women s greater longevity, as same-age incidence is roughly equivalent. The prevalence and risk is higher among Black American & Latinx individuals Although there are different rates of APOE pairs among groups, but does not fully explain size of prevalence differences Differences in risk-increasing medical conditions (e.g., hypertension) and socioeconomic factors (e.g., education level & quality, poverty) appear to account for greater proportion of prevalence difference Alzheimer s Association, 2019; World Health Organization, 2015

Intervention: Broader Relevance It is unclear, however, whether these effects are consistent across a range of groups. Samples in the reviewed studies were fairly homogeneous, and subgroup/moderation analyses for outcome variables were not performed. In general, cultural adaptations of behavioral interventions for mood increase outcome effect sizes (g = .52). A cultural adaptation of cognitive stimulation was found to be more acceptable and enjoyable for Indian elders. A cultural adaptation of an education program found better information retention for Latinx caregivers. Gallagher-Thompson et al., 2015; Nagayama-Hall et al., 2016; Raghuraman et al., 2017

Future Directions: Continued Pathological confirmation of Alzheimer disease is limited due to disparities in brain bank enrollment (e.g., 4% of brain donations were Latinx). There needs to be inclusion of participants that are more representative of the US s demographics. This may require limiting common barriers (e.g., time/availability of intervention, transportation assistance). Relevant numbers for subgroups should be reported and, if possible, analyses should be conducted. This will facilitate robust and informative meta-analyses. Bilbrey et al., 2018