Background Alzheimer’s disease and related dementias (ADRD) are among the most feared age-related conditions. The aim of this study was to evaluate a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear of ADRD and investigate positive downstream effects on health-related secondary outcomes, including frequency of reported memory failures, psychosocial functioning, and quality of life. Methods Eighty-one older adults were recruited and randomized into REFRAME or active control intervention arms. Both groups received psycho-education and training in mindful monitoring of fears related to ADRD. The REFRAME group received an additional behavioral activation component intended to disrupt maladaptive avoidant coping (i.e., avoidance) strategies. Both groups completed 3-weeks of intervention exercises with accompanying questionnaires (baseline, mid- and post-intervention and 4-week follow-up). Results Adherence was strong (> 75%). We observed a significant reduction in ADRD-related fear and avoidance in both groups. Significant reductions were also observed for frequency of self-reported memory failures, anxiety, and depression. Depression was significantly reduced in the REFRAME group compared to the control group. Significant increases in participants’ ability to participate in social activities and well-being were also observed. Conclusions Findings suggest that a brief psychological intervention can mitigate ADRD-related fears and avoidant coping in older adults, and that benefits extend to broader health-related outcomes including anxiety, depression, social functioning, and well-being. Addressing ADRD-related fear has implications for healthy aging and risk reduction, as individuals may be more likely to engage in activities that are protective against ADRD but were previously avoided. Trial registration : https://clinicaltrials.gov/ct2/show/NCT04821960 .

IntroductionAlzheimer's disease and related dementias (ADRD) are among the most feared conditions. However, research around ADRD-specific fear and avoidance behaviors is lacking. Here, we validated a novel measure of fear and avoidance specific to memory loss, the Fear and Avoidance of Memory Loss (FAM) scale, and examined associations between fear avoidance and psychosocial functioning in older adults. MethodsWe assessed FAM Scale internal reliability and concurrent validity, and candidate subscales across two samples (total N = 813). We then examined associations between fear avoidance and memory performance, anxiety, depressive symptoms, sleep, social functioning, and quality of life. ResultsWe identified two subscales: fear and avoidance, which yielded strong psychometric validity. Higher fear was associated with memory failures and sleep disturbance. Higher avoidance was associated with memory failures, poorer verbal memory, reduced social functioning, and quality of life. DiscussionWe present the first measure of fear avoidance specific to memory loss. We propose that targeting fear avoidance can promote ADRD risk reduction and resiliency.

Dementia is one of the most feared diseases associated with aging. Although some level of fear can motivate protective strategies, too much fear can be harmful and maladaptive. We examined fear and avoidance of memory loss and their relationship to psychosocial and lifestyle factors associated with dementia risk in a community-dwelling sample of older adults. Participants were 230 adults (112 female) aged 55 years and older (61.3 ± 5.2). Questionnaires were administered to measure fear and avoidance of memory loss, perceived memory failures, depression, sleep disturbance, engagement in social activities and quality of life. We hypothesized that fear and avoidance of memory loss would positively predict perceived memory failures, depressive symptoms and sleep disturbance, and negatively predict social engagement and quality of life. Fear and avoidance of memory loss did not significantly differ by age or sex. People with a family history of dementia reported higher fear ( p s < .02, ds = .4), but not avoidance scores. Fear scores were significantly associated with increased self-reported memory failures and sleep disturbance, and lower quality of life and social functioning, after adjusting for anxiety and memory performance ( β s > .8, p s < .03). Inclusion of avoidance scores improved the predictive power of all models except sleep; avoidance was associated with reduced quality of life and social functioning, and increased memory failures and depression ( β s > .9, p s < .03). Fearful anticipation and avoidance of memory loss is associated with poorer psychosocial functioning and quality of life. Based on these results, we propose a model whereby excessive fear of memory loss motivates withdrawal from social and cognitively demanding activities that can protect against and compensate for dementia risk. Findings have practical implications for psychological and lifestyle interventions, which could allay multiple modifiable risk factor pathways.

Background Dementia is the most feared disease associated with aging. Prolonged fears about memory loss and dementia can have harmful consequences even in the absence of cognitive decline. Fear of dementia is associated with poorer health outcomes and psychological well-being and increased memory failures in older adults. Objective We will conduct a randomized controlled trial to determine the feasibility of a tailored, web-based mindfulness program to reduce fear of memory loss and increase quality of life in older adults experiencing heightened fear. Methods Eighty participants will be recruited and divided into 2 groups (40 in each group). One group will receive psychoeducation plus mindfulness training. A second group will receive psychoeducation, mindfulness training, and additional modules targeting maladaptive behavioral avoidance (ie, social and cognitive withdrawal). Results Our recent etiological model posits that maladaptive behavioral avoidance strategies critically underlie psychosocial dysfunction associated with fear of memory loss. Thus, we predict better outcomes in the second group, including reduced fear of memory loss (primary outcome), Alzheimer disease, anxiety, and subjective memory failures, and increased quality of life (secondary outcomes). Outcome measures will be applied at 5 time points (before, baseline, interim, and after the intervention, and at 3-month follow-up). Data will be analyzed using mixed models and correlations. Conclusions Results from this study will contribute to the current literature on dementia-related fear and improve our understanding of how to effectively address and reduce these fears. Trial Registration ClinicalTrials.gov NCT04821960; https://clinicaltrials.gov/ct2/show/NCT04821960. International Registered Report Identifier (IRRID) PRR1-10.2196/30514