Primary care doctors can help preserve brain health

Primary care doctors can play an important role in helping to preserve brain health by encouraging healthy behaviors and addressing risk factors associated with cognitive decline, according to a new scientific report.

The American Heart Association statement published Monday in the journal Stroke outlines seven lifestyle targets and six risk factors for brain health that primary care doctors should address in adults of all ages. The statement also has been endorsed by the American Academy of Neurology as an educational tool for neurologists.

As the nation ages, preserving brain health has become a growing concern. Mild cognitive impairment affects an estimated 1 in 5 Americans age 65 and older; 1 in 7 has dementia – a number expected to triple by 2050.

"Primary care is the right home for practice-based efforts to prevent or postpone cognitive decline," Ronald Lazar, chair of the scientific statement writing group, said in a news release. Lazar directs the Evelyn F. McKnight Brain Institute at the University of Alabama at Birmingham.

"Prevention doesn't start in older age; it exists along the health care continuum from pediatrics to adulthood," he said. "The evidence in this statement demonstrates that early attention to these factors improves later life outcomes."

The statement asks primary care doctors to integrate brain health into their treatment of adults guided by the AHA's Life's Simple 7, a collection of lifestyle targets shown to help achieve ideal heart and brain health. These include managing blood pressure, cholesterol and blood sugar levels; increasing physical activity; eating a healthy diet; losing weight; and not smoking.

The statement also asks them to assess their patients' risk factors for cognitive health, including depression, social isolation, excessive alcohol use, sleep disorders, lower education levels and hearing loss.

"Scientists are learning more about how to prevent cognitive decline before changes to the brain have begun," Lazar, a professor of neurology and neurobiology, said. "We have compiled the latest research and found Life's Simple 7 plus other factors like sleep, mental health and education are a more comprehensive lifestyle strategy that optimizes brain health in addition to cardiovascular health."

Dr. Deborah Levine, one of the statement's co-authors, said it is never too soon to target risk factors for ideal heart and brain health. It's also never too late.

"For example, lower blood pressure levels reduce the risk of cognitive impairment and dementia in older adults," she said. "In adults of all ages, the metrics in Life's Simple 7 prevent stroke, and stroke increases the risk of dementia by more than twofold."

Additional risk factors can help physicians identify which patients may need special attention, said Levine, an associate professor of medicine at the University of Michigan Medical School in Ann Arbor.

For example, "Primary care doctors can help their patients reduce dementia risk by identifying and aggressively treating vascular risk factors like high blood pressure. Black and Hispanic individuals, women and individuals with lower educational levels appear at higher risk for dementia, so these high-risk groups are a top priority," Levine said.

According to the statement, recent research shows high blood pressure, diabetes and smoking in adulthood and midlife increase the odds of cognitive decline in middle age. And they accelerate cognitive decline in older age.

"Many people think of high blood pressure, Type 2 diabetes and other risk factors as affecting only heart health, yet these very same risk factors affect our brain health," Lazar said. "Patients might be more likely to pay attention to the importance of addressing modifiable risk factors if they understood the links."

The statement defines brain health using the term cognition, which includes memory, thinking, reasoning, communication and problem-solving.

Together, these functions enable people to navigate the everyday world, according to the report. The ability to think, solve problems, remember, perceive and communicate are crucial to successful living; their loss can lead to helplessness and dependency.

"Studies have shown that these domains are impacted by factors that are within our control to change," Lazar said. "Prevention and mitigation are important, because once people have impaired cognition, the current treatment options are very limited."

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