A Pilot of Memory Support System for Older Chinese Americans with Mild Cognitive Impairment

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Project Summary The older Chinese American population has been rising for the last few decades, with the risk of Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD) also increasing. Despite the pressing need to increase racial/ethnic diversity in clinical trial participation in the US, older Chinese Americans remain historically underrepresented and understudied in AD/ADRD research due to a lack of culturally and linguistically appropriate study materials and assessment tools. Using Chinese language translations of clinical measures and cognitive tests, the study PI (Li) successfully enrolled over 200 older Chinese Americans in clinical research at the Alzheimer’s Disease Research Center (ADRC) at Mount Sinai. The sample, with over 80% non-demented older adults, provides a window of opportunity for early intervention and treatment of AD/ADRD. Since a majority of older Chinese Americans are foreign born with limited to no English proficiency, they are frequently excluded from clinical trial participation as English language proficiency is one of the inclusionary criteria. The Memory Support System (MSS) from the Healthy Action to Benefit Independence & Thinking® (HABIT) Program is a promising non-pharmacological intervention for Mild Cognitive Impairment (MCI). Prior data suggest the effectiveness of MSS on self-efficacy for memory, adapted functioning, quality of life, depression, and anxiety in the participants and their study partners, with an excellent retention rate. However, the MSS was primarily developed and used on non-Hispanic White, English-speaking adults. Additionally, little is known regarding the effectiveness of MSS on cognitive and neuropsychiatric symptoms associated with early AD/ADRD. Here, the study team proposes a 2-year study to translate and adapt the MSS materials and assessment tools from English into Mandarin and Cantonese - the most common spoken languages in the US after English and Spanish. This study will leverage Dr. Li’s expertise in research recruitment and enrollment of Chinese American older adults to answer the following questions: 1) Does Chinese language translation and cultural adaptation of MSS effectively engage and recruit Chinese Americans in clinical trials for AD/ADRD? (2) Can Chinese Americans with MCI and their study partners learn and use the MSS? (3) Is the MSS effective in mitigating early symptoms of AD/ADRD in older Chinese Americans? The team will collaborate with key community stakeholders to ensure that the materials and tests are culturally and linguistically appropriate for this population. Capitalizing on the older Chinese American cohort at the ADRC at Mount Sinai, the overarching goal is to extend the MSS to older Chinese Americans with MCI by developing a linguistically and culturally appropriate adaption. Using 30 Mandarin- and 30 Cantonese-speaking older adults with MCI and their study partners, the primary outcomes are recruitment, retention, and completion rates to assess feasibility. The team will also examine the efficacy and utility of MSS in this sample. Findings from this study will provide pilot data to support a large-scale clinical trial with longer follow-up periods.