Blueprint for a Brain Health Clinic to Detect and Manage Early-Stage Cognitive Decline: A Consensus Exercise

Abstract

Background: It is possible that about 30% of all dementia is preventable by addressing many of the modifiable health and lifestyle risks important for overall physical health. Currently, people in the pre-dementia or very early dementia stage who are referred to Memory Assessment Services (MAS) in the UK receive minimal, if any, support and/or intervention. They are typically referred back to primary care until the full syndrome of dementia emerges. This represents a lost opportunity to modify the trajectory of the condition, intervene with disease modifying therapies (DMTs) when available, and delay the onset of a full dementia syndrome. Objective:We aimed to develop a blueprint for a pragmatic 'Brain Health Clinic' (BHC) that can be implemented alongside, or in conjunction with, conventional MAS.Methods: Using modified consensus methods, an interdisciplinary task force of clinicians with experience in the diagnosis and care of people with cognitive impairment and dementia, met on several occasions to review existing evidence, share clinical experience, and propose a model for a pragmatic, 'real life' BHC, as an extension of, or embedded within, a current MAS. Results:The BHC is a systems-based, integrated care approach that uses existing resources, and can be developed by reconfiguring the way current MAS are provided. It can support people with early-stage cognitive impairment to remain well for longer, potentially changing outcomes. The practical, evidencebased and user-friendly blueprint is available as a free online tool (depicted in figures throughout this article). It sets out a vision for managing early-stage cognitive decline using a 'preempt-prevent' approach that maximizes brain health and quality of life for the person at risk and their families. It sets the stage for implementation of validated, clinically useful biomarker batteries and DMT to be introduced when available, fostering personalized cognitive healthcare. Conclusion:Adapting existing services to address neurodegenerative cognitive decline in the very earliest stages is a key intervention for secondary prevention of dementia.

Navigating the future of Alzheimer's care in Ireland - A service model for disease-modifying therapies in small and medium-sized healthcare systems

“…This paper aims to outline strategies for the detection, diagnosis, and management of AD in the prodromal or mild dementia stage, with a view to a person with AD being potentially eligible for an anti-amyloid DMT when one is approved. This blueprint extends existing and more detailed guidance on the infrastructure required for the administration of DMT for AD [10,12] 2…”

Navigating the future of Alzheimer’s care in Ireland - a service model for disease-modifying therapies in small and medium-sized healthcare systems

“…Here, we report on the findings of the group's workshop-style discussions in the form of a blueprint for the implementation of DMTs for prodromal (i.e., MCI) and early-stage dementia due to AD in Ireland. This blueprint extends existing and more detailed guidance on the infrastructure required for the administration of DMTs for AD [11,13] 1…”

“…The outcome of the assessment will enable patients to be assigned to one of three risk-based ‘streams’: [ 1 ] begin the DMT care pathway; [ 2 ] be refered to local MASS for brain health pathway or relevant care for non-AD neurodegenerative disorders; and/or [ 3 ] be referred for a research study. Details of an approach to brain health management along with the new DMTs has been outlined elsewhere [ 13 ]. Under the ‘ intervention administration ’ domain, guidelines for rationalization of prescribed medications, managing comorbidity, and pharmacological and non-pharmacological interventions are outlined, and under the ‘ ongoing monitoring and care ’ domain, guidelines for periodic MRI monitoring and possible cessation of therapy are listed.…”

The Brain Health Imperative in the 21st Century—A Call to Action

“…3 As another key element of brain health, mental health has been championed in public campaigns promoting awareness and action in support of brain health research. 4 Neuroscientists are joining forces worldwide to catalyze and share knowledge about the brain “for the benefit of humanity.” 5-7 The increasing number of recent local, national, and global brain health initiatives, notably by the Centers for Disease Control and the World Health Organization, 8-12 have fostered an understanding of brain health as an evolving concept 13,14 whose forward progress requires collaboration between the public at large, community advocates, patients, scientists, and health practitioners to bring into effect meaningful change in research, advocacy, and public engagement.…”