Rovner BW, et al. - Authors ascertained whether or not behavioral activation prevents cognitive and functional decline over 2 years in black individuals with mild cognitive impairment (MCI). Cognitive and functional decline was prevented by behavioral activation. Almost twice the rate of dementia as white individuals is seen in black individuals; this health disparity may be reduced by behavioral activation.

• Researchers conducted a single-center, single-masked, attention-controlled randomized clinical trial.
• They enrolled the participants from June 21, 2011, to October 3, 2014, and follow-up ended December 13, 2016.
• They conducted community-based recruitment and treatment of black individuals older than 65 years with amnestic MCI.
• They screened the volunteer sample of 1,390 persons with memory complaints.
• Overall, baseline assessment was conducted in 536 individuals, and 315 (58.8%) were ineligible, most often owing to normal cognition (205 of 315 [65%]) or dementia (59 of 315 [18.7%]); 221 fully eligible participants were randomized.
• Analyses were intention to treat.
• They randomized the participants to behavioral activation, which aimed to increase cognitive, physical, and social activity (111 [50.2%]), or supportive therapy, an attention control treatment (110 [49.8%]).
• A decline of 6 or more recalled words on the total recall score of the Hopkins Verbal Learning Test–Revised assessed at 6, 12, 18, and 24 months was prespecified primary outcome.
• Functional decline was the secondary outcome.

• As per data, out of 221 randomized participants (mean [SD] 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.
• Findings suggested that after baseline, behavioral activation participants engaged in significantly more cognitive activities than supportive therapy participants.
• For behavioral activation, the 2-year incidence of memory decline was 1.2% (95% CI, 0.2-6.4) vs 9.3% (95% CI, 5.30-16.4) for supportive therapy (relative risk, 0.12; 95% CI, 0.02-0.74; P = .02).
• They noted an association of behavioral activation with stable everyday function, whereas supportive therapy was associated with decline (difference in slopes, 2.71; 95% CI, 0.12-5.30; P = .04).
• 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%]).