April 21, 2021
Inspiring self-care to prevent hypertension-related dementias in African American older adults

by Kathy D. Wright

As the United States population ages, a new case of Alzheimer’s disease will develop every 33 seconds by the year 2050 (Alzheimer’s Association, 2019).1 African Americans are twice as likely to develop Alzheimer’s disease as Whites (Special Report: Race Ethnicity and Alzheimer’s in America). This disparity may be attributed to uncontrolled hypertension, a significant risk factor of Alzheimer’s disease and related dementias (ADRD).

According to the American Heart Association, the prevalence of hypertension among U.S. Blacks is 40%, among the highest levels in the world.2 New guidelines for hypertension management designate a systolic blood pressure under 130 mm Hg, but control of the condition is attained in only 44.4% of African Americans with hypertension.3 The good news is that controlling blood pressure, even by a 10 mmHg reduction in systolic blood pressure, may reduce the risk of developing ADRD.4

Chronic stress may also play a role as a risk factor for the development of ADRD for African Americans.5-7 Results from the Lifetime Stressful Experiences, Racial Disparities and Cognitive Performance study indicated that African Americans experienced over 60% more stressful events than Whites during their lifetimes. Each stressful event such as interpersonal conflicts, serious health events, physical trauma or psychological trauma resulted in four years of cognitive aging.

Controlling hypertension and preventing ADRD share common non-pharmacological self-care interventions that include stress management, healthy eating and physical activity. However, the adoption of healthy behaviors is a challenge for African Americans living with hypertension and mild cognitive impairment due to a lack of cultural tailoring. One of the greatest inequalities is the lack of access to comprehensive and culturally tailored self-care education. The interdisciplinary lab known as the B^BHIVE, Brain and Blood Pressure Health in Valuable Elders was developed to address health inequity in self-care interventions for African Americans across the lifespan.

Our team conducted a pilot randomized-controlled trial, Mindfulness in Motion (MIM) and the Dietary Approaches to Stop Hypertension9 (DASH)8. Thirty-eight African Americans age 65 and older with mild cognitive impairment and hypertension were randomized to the MIM DASH group, attention only (non-hypertensive education) group or true control group.* A combination of didactic and experiential activities were utilized with the participants and included sampling foods, such as quinoa and tofu, that were not traditionally part of the “Soul” food diet. Participants were encouraged to complete a weekly homework assignment to practice the DASH diet in daily life. They also received an individual My Plate displaying serving sizes and food groups comprising a balanced meal. Repetition of key concepts were embedded throughout the sessions to increase critical thinking and problem solving.

The results of the MIM DASH pilot indicated that the intervention was feasible.9 The median session attendance was six for the MIM DASH group and seven for the attention-only group. Unfortunately, because this was a small sample size, we did not see improvements in diet, mindfulness or stress. Also, at baseline, the participants had low stress levels. There was, however, a clinically significant reduction in systolic blood pressure in the MIM DASH group (-7.2mm Hg) relative to the attention-only group (-.7) and no change between the MIM DASH and true control groups. This pilot study will set the stage for a future larger trial to establish the efficacy of the MIM DASH approach.

Outreach and engagement with the community, by nurses and other health providers to foster culturally-informed healthy self-care, will disrupt health disparities in brain and blood pressure health for African Americans across the lifespan. We can collaborate with community allies to provide health risk screening and disseminate evidence-based strategies to promote self-care. For example, there is a new project through The Ohio State University College of Nursing, Center for Cancer Health Equity and several other partners led by Dr. Timiya Nolan: Friendship Missionary Baptist Church-Global Church Health and Wellness Event. The event on May 1 includes COVID-19 vaccinations, biometric screenings and cancer screenings for the African American community. A list of opportunities and time slots to volunteer for this event are available. Other outreach opportunities for College of Nursing faculty, staff and students to provide care and guidance to the community will be reactivated post-pandemic, including Barbers and Beauticians Who Care and Million Hearts®. The Ohio State University and Wexner Medical Center was recently designated a Million Hearts® Health System in recognition of its work to systematically improve cardiovascular health in the population and communities it serves.

What’s good for the heart is good for the brain. To dream, discover and deliver a healthier world, we can educate and provide access to culturally-informed self-care for African American older adults.

Kathy D. Wright, PhD, RN, APRN-CNS, PMHCNS-BC, is an assistant professor at The Ohio State College of Nursing. She also holds a faculty position in The Ohio State University Discovery Themes-Prevention and Treatment of Chronic Brain Injury Institute. Dr. Wright’s research on blood pressure self-management was featured by Ohio State in a special “Minute Professor” video in July 2020.


  1. Association As. Alzheimer's disease facts and figures. 2019.
  2. Carnethon MR, Pu J, Howard G, et al. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation. 2017;136(21):e393-e423.
  3. Fryar CD OY, Hales CM, Zhang G, Kruszon-Moran D. . Hypertension prevalence and control among adults: United States, 2015–2016. NCHS data brief, no 289 Hyattsville, MD: National Center for Health Statistics 2017. 2017.
  4. Peters R, Warwick J, Anstey KJ, Anderson CS. Blood pressure and dementia: What the SPRINT-MIND trial adds and what we still need to know. Neurology. 2019;92(21):1017-1018.
  5. Pacholko AG, Wotton CA, Bekar LK. Poor Diet, Stress, and Inactivity Converge to Form a "Perfect Storm" That Drives Alzheimer's Disease Pathogenesis. Neurodegener Dis. 2019;19(2):60-77.
  6. Barnes LL, Bennett DA. Alzheimer's disease in African Americans: risk factors and challenges for the future. Health Aff (Millwood). 2014;33(4):580-586.
  7. Barnes LL, Lewis TT, Begeny CT, Yu L, Bennett DA, Wilson RS. Perceived discrimination and cognition in older African Americans. J Int Neuropsychol Soc. 2012;18(5):856-865.
  8. Appel LJ, Champagne CM, Harsha DW, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003;289(16):2083-2093.
  9. Wright KD, Klatt MD, Adams IR, et al. Mindfulness in Motion and Dietary Approaches to Stop Hypertension (DASH) in Hypertensive African Americans. J Am Geriatr Soc. 2021;69(3):773-778.

*MIM, developed by Dr. Maryanna Klatt (Department of Family and Community Medicine, College of Medicine, The Ohio State University), included mindful awareness and movement from chair/standing positions, breathing exercises, healthy sleep and guided mindfulness meditation.

The DASH component, developed by Dr. Ingrid Adams (College of Medicine, College of Food, Agricultural, and Environmental Sciences Department of Extension, The Ohio State, University), used a critical thinking approach of problem solving, goal setting, reflection and self-efficacy.

February 24, 2021

Memphis, TN – Early diagnosis of Alzheimer’s disease has been shown to reduce cost and improve patient outcomes, but current diagnostic approaches can be invasive and costly. A recent study, published in the Journal of Alzheimer’s Disease, has found a novel way to identify a high potential for developing Alzheimer’s disease before symptoms occur. Ray Romano, PhD, RN, completed the research as part of his PhD in the Nursing Science Program at the University of Tennessee Health Science Center (UTHSC) College of Graduate Health Sciences. Dr. Romano conducted the research through the joint laboratory of Associate Professor Todd Monroe, PhD, RN, at The Ohio State University, who is also a graduate of the UTHSC Nursing Science PhD Program and Dr. Ronald Cowan, MD, PhD, who is the Chair of Psychiatry at UTHSC.

July 20, 2020

The five-year, $3.13 million grant will deploy social-assistive robots at Ohio Living Westminster-Thurber and Chapel Hill Community in Canal Fulton near Canton for an eight-week trial. The study is aimed at curbing loneliness and apathy in older adults, especially for those with dementia.

July 08, 2020

Kathy Wright saw the ravages of Alzheimer's disease and hypertension when she served as a caregiver for her father, who dealt with those devastating illnesses. In her role as an assistant professor in the College of Nursing, she also knows these health problems hit the African American community particularly hard.

So Wright – who holds a faculty position in Ohio State’s Prevention and Treatment of Chronic Brain Injury Institute – has dedicated her research lab, dubbed the B^HIVE (Brain and Blood Pressure Health in Valuable Elders), to work with at-risk communities on preventative methods to ward off high blood pressure and Alzheimer’s disease. Those interventions often involve healthier eating and mindfulness exercises to decrease stress.

In this Minute Professor video, Wright explains the importance of keeping your blood pressure in check, tips for how to do it, and how Ohio State is designing interventions to help the African American community. 

September 10, 2019
New five-year, $5 million grant project to advance study on sensitivity to pain

COLUMBUS, Ohio – Todd Monroe, PhD, RN-BC, FNAP, FGSA, FAAN, associate professor at The Ohio State University College of Nursing, will help lead a multi-site five-year, $5 million grant project awarded by the National Institutes of Health (NIH) and National Institute on Aging (NIA) to advance research focused on patients with Alzheimer’s disease and cancer and their sensitivity to pain.

“This grant will study the response to experimentally-evoked thermal and pressure pain to determine if people with chronic cancer pain and Alzheimer’s disease may be at greater risk of suffering from poorly-treated pain at the end of life,” Monroe said. “This is especially important for patients with Alzheimer’s disease who also have cancers, such as prostate and breast cancer, that generally lead to very painful bone metastasis.”

The multi-site, multiple PI R01, Pain Sensitivity and Unpleasantness in People with Alzheimer’s Disease and Cancer, will be performed in close partnership with Ronald Cowan, MD, PhD, Professor of Psychiatry and Behavioral Health from Vanderbilt University. The research builds on numerous studies that Monroe and his colleagues have conducted over the last decade, including research that concluded that patients living with more severe dementia and cancer were at greater risk for not receiving hospice services and for receiving little or no pain medication during the end of life. Last year, Monroe and his team earned a five-year, $3.3 million NIH/NIA grant to examine gender and Alzheimer’s-related differences in verbal pain reporting patterns and how they are displayed in regional and network brain function, with an aim to lead to a better understanding of how Alzheimer’s and gender impact central pain mechanisms.

Monroe, Cowan and their team hope to use the information from this research to further explore the neurobiology of pain in older adults with dementia and chronic pain, which can in turn help lead to the development and testing of interventions to better manage pain in this growing population.

September 17, 2018

The National Institutes of Health/National Institute on Aging (NIH/NIA) has awarded a five-year, $3.3 million R01 grant to fund the study titled, “Sex Differences in Pain Reports and Brain Activation in Older Adults with Alzheimer’s Disease.” The grant was awarded to Todd Monroe, PhD, RN-BC, FNAP, FGSA, FAAN, (PI) associate professor in The Ohio State University College of Nursing.

Monroe’s interdisciplinary team will include faculty from the College of Nursing, the Departments of Neurology and Geriatrics, and the Wright Center of Innovation in Biomedical Imaging at Ohio State, as well as collaborators from Vanderbilt University.

“Older adults with Alzheimer’s disease (AD) are at risk of having their pain undertreated. We do know that healthy males and females experience pain differently. It is not known if these sex-differences extend into the AD population. This study will provide research focused on better management of pain in people with AD,” Monroe stated in the proposal. “Poorly treated pain in older adults with Alzheimer’s disease (AD) is a critical public health problem and understanding sex and AD-related differences in pain function is an NIA priority area.”

The proposal stated that when compared to healthy adults, and in the presence of similarly known painful conditions, older adults with AD receive less pain medication. Reasons for this discrepancy are poorly understood. Meanwhile, inadequately treated pain negatively impacts quality of life and increases health care costs.

The research will examine how verbal pain reporting patterns in responses to acute experimental thermal pain differs between older males and females with and without AD and how these sex-differences map onto regional and network brain functional changes. The study aims to determine whether sensory (stimulus intensity) and affective (stimulus unpleasantness) responses differ by sex in people with and without AD during cutaneous thermal stimulation. Examining baseline differences in experimental thermal pain between males and females with and without AD will provide a foundation for understanding factors that may contribute to untreated pain risk, as well as for developing sex-specific novel assessment, prevention, and treatment strategies in the older population with AD.

July 12, 2017

Loren Wold, PhD, FAHA, FCVS, associate professor and director of biomedical research at The Ohio State University College of Nursing has been awarded a $3.89 million grant from the National Institutes of Health/National Institute on Aging (NIH/NIA) for his study entitled “Mechanisms of exposure-induced tissue functional and pathological changes in a mouse model of Alzheimer’s Disease.” This study will be performed in collaboration with Colin Combs, department chair for biomedical sciences at University of North Dakota, and Federica del Monte, PhD, MD, associate professor at the Medical University of South Carolina. 

Citing statistics from the World Health Organization, the study states that exposure to ambient pollution is responsible for more than 13 million deaths annually and has been associated with cardiovascular morbidity, mortality and poorer cognitive function in the aging population. “Alzheimer dementia and heart failure are a growing plague worldwide, [and] the recognition of their combinatory triggers and potential coexistence is an alarming prospective.” The study proposes to explore the role and mechanisms by which air pollution induces the development and progression of brain and heart diseases, both of which are worsened by exposures.

“Our overall goal is to determine the time course of plaque formation in the brains and hearts of animals with Alzheimer’s, in order to potentially define a biomarker for Alzheimer’s disease,” Wold said. “Recent discoveries by collaborator Dr. del Monte at Harvard Medical School (now at the Medical University of South Carolina) determined that beta-amyloid plaques, the plaques known to cause neurocognitive effects in [the hearts of] patients with Alzheimer’s disease, are also present in the brain of these patients. We are now poised to determine whether the plaques form in the heart prior to the brain.” If so, Wold and his associates hope to find a way to prevent the neurological issues associated with Alzheimer’s disease by quenching the protein aggregates in the heart before they spread to the brain.

Wold has also been funded by the NIH for his work focused on external triggers of cardiovascular disease, with special emphasis on the role of cancer cachexia and air pollution, investigating how the cardiovascular system is affected by these stressors.

At The Ohio State University, Wold is involved in training undergraduates, graduate students, medical students and postdoctoral Fellows in basic lab techniques as well as tools for effective manuscript and grant writing. He also serves as the editor-in-chief of the Elsevier journal Life Sciences.