Improvement of Working Memory is a Mechanism for Reductions in Delay Discounting Among Mid-Age Individuals in an Urban Medically Underserved Area

Abstract

Background: Delay discounting, or the tendency to devalue rewards as a function of their delayed receipt, is associated with myriad negative health behaviors. Individuals from medically underserved areas are disproportionately at risk for chronic health problems. The higher rates of delay discounting and consequent adverse outcomes evidenced among low-resource and unstable environments suggest this may be an important pathway to explain health disparities among this population.

Purpose: The current study examined the effectiveness of a computerized working memory training program to decrease rates of delay discounting among residents of a traditionally underserved region.

Methods: Participants (N = 123) were recruited from a community center serving low income and homeless individuals. Subjects completed measures of delay discounting and working memory and then took part in either an active or control working memory training.

Results: Analyses indicated that participants in the active condition demonstrated significant improvement in working memory and that this improvement mediated the relation between treatment condition and reductions in delay discounting.

Conclusions: Results suggest that a computerized intervention targeting working memory may be effective in decreasing rates of delay discounting in adults from medically underserved areas (ClinicalTrials.gov number NCT03501706).

Keywords: Cognitive training; Delay discounting; Medically underserved; Working memory; mid-age.

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Figures

Fig. 1

Consolidated Standards of Reporting Trials diagram, depicting participant enrollment and completion of the clinical trial.

Fig. 2

Significant standardized (and unstandardized) path estimates for final mediation model. TOH = Tower of Hanoi; HVLT-R = Hopkins Verbal Learning Test—Revised; LNS = Letter Number Sequencing. *p < .05; **p < .01.