The University of Alabama at Birmingham (UAB) recently launched a pilot project to assess ways to help patients prevent cognitive decline. We caught up with Dr. Ronald Lazar, Director of the Evelyn F. McKnight Brain Institute at UAB, to tell us more about this innovative project, which integrates brain health assessments and coaching into the primary care setting.
Q: What is the Brain Health Advocacy Mission Project at the University of Alabama at Birmingham?
A: The Brain Health Advocacy Mission (BHAM) is a program started at two primary care clinics at the University of Alabama at Birmingham to help patients prevent cognitive decline by encouraging them to make smart choices to improve their brain health. We’ve implemented the program to help address the rising number of Americans with mild cognitive impairment and dementia. Our goal with this project is not to detect when cognitive impairment happens, but to prevent it from happening in the first place.
Q: What makes the Brain Health Advocacy Mission distinct from other preventative medicine approaches?
A: With this project, we’ve brought Healthcare Champions into the primary care clinic to offer brain health assessments and coaching to supplement the work primary care providers do. We believe this is the first brain health clinic in the country to be integrated within a primary care clinic, allowing us to incorporate the brain health visit with the patient’s routine medical care. We contact patients in advance of their primary care visit and ask if they would like to have a conversation about brain health and the proactive steps they can take to protect their cognition over time.
In 2020, the U.S. Preventative Services Taskforce recommended cognitive screenings, but they have not been proven to have a long-term impact on protecting cognition, so we decided to test working with patients before any problems begin. We consider brain health a lifetime practice of prevention. We completed the enrollment of 100 patients in our pilot project and are now enrolling in a long-term registry. With an average patient age of 46, we enroll patients without any signs of cognitive impairment to establish a profile and see if we can positively change their behavior with time. Our goal is not early detection but rather, primary prevention.
Q: What behavior changes are you trying to implement with the enrolled patients?
A: Our program operates as a “clinic within a clinic” at UAB Hospital-Highlands and UAB Hoover Primary & Specialty Care. In the clinic, a brain health nurse or other healthcare investigator meets with interested patients and provides them with a roadmap to maintaining brain health that is built around the American Heart Association’s Life’s Essential 8,. This is a set of eight lifestyle targets known to be beneficial for heart health in addition to brain health, including managing blood pressure and blood sugar, controlling cholesterol, physical activity, healthy diet, managing weight, healthy sleep and not smoking. The investigator works with patients to establish a baseline brain health score based on their lifestyle targets and offers a choice of strategies and resources they can use to improve their scores.
We use the McCance Center Brain Care Score to measure their baseline brain health and to track changes over time. We let the patients decide for themselves which initial targets they would like to address and we tailor the program to them. If someone wants to exercise more, we help them find the various local places they can go to exercise and we give them examples of activities they can do at home for exercise.
Q: What do you think is the most important factor to making the Brain Health Advocacy Mission successful?
A: Sharing knowledge is not enough. We strongly believe that listening to patients and learning about their priorities is a critical step in fostering engagement. Working with patients in the clinic, we’re surprised by how much they already know. Many people know they are overweight and they know it’s because of their diet. The lifestyle modifications we’re working with the patients to implement will gradually improve their health over time – the results aren’t immediate, and we need patients to trust and stay with the process to be successful. Our brain health specialists, led by a nurse practitioner-investigator, spend more time with patients than would be feasible for primary care providers, allowing them to engage in longer and deeper conversations. These conversations help build trust, which we’ve found to be the critical first step to changing behavior in patients.
Q: What is the key takeaway you’d like others to learn from this project?
A: We have found that many BHAM participants already have some knowledge about healthy lifestyles and the management of risk factors, but most don’t know where or how to start to make changes. We have learned to allow them to pick which targets they prefer to address first and then to work in small, achievable steps to maximize early gains and ensure success.