I’M BEGINNING TO REMEMBER: THE SHARP STUDY’S NEIGHBORHOOD APPROACH TO AFRICAN AMERICAN BRAIN HEALTH

Abstract

Background: Mild Cognitive Impairment (MCI) may precede dementia; African Americans have doubled risk of dementia, including Alzheimer's disease (AD), likely due to disproportionate rates of diabetes, hypertension, and obesity. Physical activity and social engagement may mitigate chronic conditions and slow cognitive decline (Winchester et al., 2013; Barnes et al., 2004). The Alzheimer's Association-funded Sharing History through Active Reminiscence and Photo-imagery Study, engages African Americans in a culturally celebratory multi-modal intervention blending social walking and history. We discuss health outcomes, including cognitive function, and share participant reflections on memory, health and aging amidst neighborhood change. Methods: Seven African American triads aged ≥55 (2 cognitively healthy/1 person with MCI/triad) walked 3x/week for 6 months in Portland, Oregon's historically Black neighborhoods. Using a tablet, triads followed 1-mile routes. GPS-triggered images prompted community reminiscence. Recorded conversations created an oral history archive and inform community learning sessions about Alzheimer's disease and healthier aging. The Montreal Cognitive Assessment (MoCA), weight, blood pressure, and a health survey were administered pre- and post-study. Focus groups gave insight into intersections of aging, memory, and place. Grounded Theory guided thematic analysis. Results: In preliminary analysis (walks and analyses to be completed March, 2018) blood pressure and MoCA scores improved for most participants, including those with MCI. About half experienced weight loss, and half weight gain, with mean loss greater than mean gain. Sharing memories prompted by neighborhood landmarks and images had a healing effect against the trauma of gentrification and boosted capacity to remember historical details. Learning partners’ community stories was cognitively stimulating, sustained participation, and contributed to increased social engagement outside the study. Recording memories within triads who shared a sense of community loss gave reason to walk and made walking more meaningful because deliverables (the archive and learning sessions) served individual and community health needs. Conclusions: Combining physical activity and social engagement in a culturally relevant context is promising for mitigating cognitive decline and possibly reducing AD risk. For African Americans and others, sustaining these behaviors may require framing them within meaningful contexts that remind people of their connection to others, place, and community as valuable voices in the collective story.