Researchers seek new ways to enroll men in Alzheimer's studies

What's the secret to getting men to participate in medical research?

Rodney Barnard, 77, is one of the local community members helping Rutgers University–Newark recruit men to join a study of risk and resilience to Alzheimer's disease in African Americans. He's developed some insights on best practices:

Don't overwhelm them. And be sure to offer a little enticement.

"Our attention span is limited, so you've got to have a hook to hold our interest," he said.

Rodney focuses on a double-whammy: African Americans are more than twice as likely to develop Alzheimer's, yet are underrepresented in research on aging and brain health.

This study, known as Pathways to Healthy Aging in African Americans, examines the role of health, exercise, sleep, environment and genetics in the development of Alzheimer's disease and other forms of dementia. Its goal is to uncover ways to delay or even dodge the disease.

Key to this work, however, is the participation of Newark-area African Americans who are 60 and over. They agree to give blood and saliva samples, take a battery of memory tests, and have an MRI of their brain. They answer surveys about topics including their diet, physical activity, and sleep. Some join exercise programs. Without them, there would be no research.

The program is overseen by Dr. Mark Gluck, a Professor of Neuroscience and Public Health at Rutgers University-Newark, and director of the Rutgers Aging and Brain Health Alliance. Over the last 10 years, it has succeeded in enrolling hundreds of women by working with local churches and mosques, as well as the Newark Housing Authority.

It has been more challenging to enroll men. For example, 40% of older residents in Newark Housing Authority buildings are men, yet at the Alliance's exercise classes, they account for less than 10% of attendees.

Gluck's team of researchers and community outreach workers are striving to find different methods of recruiting men. Their efforts are based on years of experience. "As men, we don't communicate what's ailing us. I think that older generation in particular was taught to just keep grinding it out," said Reverend Dana Owens, pastor of Messiah Baptist Church in East Orange, which hosts one of the Rutgers' exercise programs. "No exams, no physicals. You just keep going."

In his 21 years as pastor, Owens has made the health of his congregation a priority—hence his involvement with the Rutgers Aging and Brain Health Alliance. It has been slow going to get men to see their doctors for annual exams.

Owens now relates it to cars, because many men respond to the metaphor. "I say, 'This is like a tune-up. You've got to change your oil. Let's get the spark plugs looked at.'"

Women develop Alzheimer's at a higher rate than men. That, coupled with their greater longevity, means they account for two-thirds of cases, according to data from the Alzheimer's Association.

Despite those statistics, Gluck said it is crucial that his lab's research includes a sufficient number of men. Of the 850 people who have joined in the last decade, men account for less than 20%. However, over the past year, thanks to a growing team of dedicated older Black men working as Community Brain Health Educators, they are now, for the first time, seeing enrollment of men climb to over 35%.

However, of those men who do enroll in the bi-annual study of aging and health, only a very small fraction also volunteer to be part of the optional additional studies of how exercise can promote brain health and reduce risk for Alzheimer's disease. "Getting men to commit to six months of three-times-weekly exercise is very challenging," says Gluck.

"Men's and women's brains are different anatomically. In addition, they experience exposure to very different reproductive hormones over their lifetime. These differences, along with other social differences between men and women, can all strongly influence the trajectory and risk factors for Alzheimer's disease,"' explained Gluck. "Our goal is to better understand these sex differences so we can determine what is unique, and what is the same, about Alzheimer's disease in men versus women."

The men attending the recent brainstorming session offered suggestions about approaches that might entice more men into the program.

They've let the team know they don't think men like to sit there and be spoon-fed information about lifestyle changes they can make to reduce their dementia risk, said Bernard. Give them the short version, then go right to the question-and-answer part, Bernard recommends. According to Bernard, men like to feel they are acquiring information through their own efforts rather than passively receiving it. "They like to interact," he said.

Go easy on the lecturing, said Owens, the pastor. "They don't want to get hit over the head with statistics about health," he said.

Gluck, a neuroscientist, has offered everything from Motown-era dance parties to vintage car shows to barbecues in an attempt to encourage men to participate in his team's research. He said he learned from the session's feedback that such larger events may have their limitations. "It turns out women are more approachable in group settings. But men are much more likely to respond one on one, having conversations with other men," he told the gathering.

Bernard's theory is that men feel vulnerable when they publicly reveal a medical problem. The larger the group, the greater the threat to their sense of privacy. "The fewer the men, the less the risk the information will get out," he said.

Taking a page from churches that have televised football games shown at their men's group gatherings, Gluck said his project arranged for the men in their program to get unlimited free admission to the Rutgers-Newark campus's upcoming Division III basketball games. "All the men have to do, in return, is promise to cheer loudly for the Rutgers home team," he joked.

Owens noted he has seen the older men in his congregation gradually become more motivated to take care of themselves. Given the advances in modern medicine, many are living longer than their own fathers did—and want to stay as active as possible.

"They want to be around to see their kids and their grandkids, but also to be healthy," he said.

Provided by Rutgers University