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.