Expert Interview with Dr. Lazar

Valerie PatmintraExpert Interviews

Professor of Neurology and Neurobiology and Director of the Evelyn F. McKnight Brain Institute at the University of Alabama at Birmingham School of Medicine

Dr. Ronald Lazar served as the Senior and Corresponding Author on the American Heart Association Scientific Statement published today, A Primary Care Agenda for Brain Health.

The statement focuses on the importance of taking steps to prevent cognitive decline before changes to the aging brain begin and identifies primary care as the ideal setting to address the set of specific risk factors that can prevent cognitive decline early and throughout life.

In this blog post, Dr. Lazar outlines his key take-aways from writing the scientific statement and his goals that the statement is the first step in establishing brain health as a whole-life endeavor and shifting cognitive decline from a treatment-based model to prevention-based model.

Q: What are your key take-aways from serving as senior author on the AHA statement?

A: We’ve known for several years that there are a number of lifestyle behaviors and risk factors that we should pay attention to in order to promote cardiovascular health and more recently brain health.

Since working with the American Heart Association/American Stroke Association to draft a presidential advisory on achieving optimal brain health in 2017, what’s really come to light is how early in the lifespan we need to focus on these risk factors. Even in our 30’s and 40’s, when we’re presumably in good health, the things we do then – our behaviors and even how we monitor ourselves – can have a major impact on what happens in later life. So, the notion that brain health is a whole life endeavor – not just a late life endeavor – has emerged.

Q: What is the key to identifying and modifying this set of risk factors before brain injury or decline starts to occur?

A: As scientists, we’ve been learning more about how to prevent cognitive decline before changes to the brain begin. Based on the latest research, we’ve found that Life’s Simple 7, plus other factors like sleep, mental health and education make up a comprehensive lifestyle strategy to optimize
brain health.

Life’s Simple 7 focuses on seven lifestyle and risk factor targets to achieve ideal cardiovascular health, including: managing blood pressure, maintaining healthy cholesterol levels, reducing blood sugar, increasing physical activity, eating better, losing weight and not smoking, which are not complicated entities to monitor. This combination of risk factors don’t have to be monitored daily, but the key to making this strategy successful is seeing your primary care provider regularly to check these factors and catch any problem areas before cognitive decline begins. Among these factors, increased physical activity is one of the most important, but unfortunately one that is often overlooked. We can’t overstate the benefits of regular exercise.

Q: How does this guidance differ from other advice to maintain brain health and delay cognitive decline?

A: The main shift is that with this effort, we are not looking to detect cognitive decline in its earliest phases; rather, we’re trying to prevent cognitive decline from occurring in the first place. What we found through our research and the key take-way from this effort is that prevention is a lot better than having to deal with cognitive problems after they emerge. Prevention is really the key.

Q: Why are primary care physicians best positioned to help their patients prevent or postpone cognitive decline?

A: Primary care physicians are the health professionals who observe you throughout the lifespan and therefore are in the best position to monitor and counsel you as you get older to assess and modify the risk factors that maintain brain health and prevent cognitive impairment. Primary care physicians are also well-positioned to understand the seven risk factors and explain them to their patients.

The evidence in this statement shows that early attention to these risk factors improves later life outcomes and we’re relying on primary care to provide practice-based efforts to prevent or postpone cognitive decline along the healthcare continuum from pediatrics to geriatrics.

Q: How do you take your findings from this statement to practice?

A: Expanding the focus of primary care to include brain health is an overall shift and will rely on the support of technology – from wearable watches to text messaging – to really be successful. Physicians need to find whatever ways possible to check in regularly with patients to make sure they are eating well, getting enough sleep, managing their weight, exercising daily – you can’t check every single measure virtually, but checking a few helps by having a generalizing effect of helping people realize how
they are doing against key goals.

We have some challenges ahead with how to implement this strategy, especially among disparate populations where they don’t have equal access to cell phones, Apple watches, etc., but the savings in the long term both in terms of quality of life and societal burden are enormous if we do this proactively. We also have to pay attention to culturally appropriate messaging.

Q: What would you most like people to walk away with after this statement is published?

A: The goal is really to shift cognitive decline from treatment to prevention. The purpose of the paper is to raise awareness of Life’s Simple 7 as well as the importance of other factors like sleep and depression, and to establish partnerships between patients and their primary-care providers to begin looking at these lifestyle factors over the lifespan. The paper also provides guidance around target blood pressure, level of cholesterol, and amount of exercise. For example, we recommend adults exercise a minimum of
150 minutes per week.

It’s also important to note that the committee who put the paper together included neurology, neuropsychology, nursing, pediatrics, family care medicine, and internal medicine – not just brain health professionals. We had consensus among a broad spectrum of health care specialties where this model could have impact.

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