Primary care has an important role to play in preserving patients’ brain health from the earliest age by using ‘Life’s Simple Seven’ as a basis, new research has concluded.
Preserving the brain health of an ageing population is a growing concern globally, with an estimated one in five people in the US aged 65 or over having a mild cognitive impairment.
While one in seven over 65s currently has dementia, that is expected to triple in the US by 2050, the new study has found.
To help support brain health well in advance of that age, ‘A Primary Care Agenda for Brain Health,’ from the American Stroke Association and American Heart Association, emphasises the role of primary care in promoting the importance of ‘Life’s Simple Seven’.
The approach focuses on seven lifestyle targets to achieve ideal cardiovascular health – managing blood pressure, healthy cholesterol levels, reducing blood sugar, increasing physical activity, eating better, losing weight and not smoking.
“Primary care is the right home for practice-based efforts to prevent or postpone cognitive decline,” says Professor Ronald M. Lazar, director of the Evelyn F. McKnight Brain Institute at the University of Alabama at Birmingham School of Medicine.
“Primary care professionals are most likely to identify and monitor risk factors early and throughout the lifespan.
“Prevention doesn’t start in older age; it exists along the health care continuum from paediatrics to adulthood.
“The evidence in this statement demonstrates that early attention to these factors improves later life outcomes.”
As well as Life’s Simple Seven, the study highlights a further six risk factors that can impact optimal brain health – depression, social isolation, excessive alcohol use, sleep disorders, less education and hearing loss.
The study lists risk factors for cognitive impairment, prevention strategies and best practices to integrate brain health prevention into primary care.
“Scientists are learning more about how to prevent cognitive decline before changes to the brain have begun,” says Professor Lazar, also a professor of neurology and neurobiology at the University of Alabama at Birmingham.
“We have compiled the latest research and found Life’s Simple Seven, plus other factors like sleep, mental health and education are a more comprehensive lifestyle strategy that optimises brain health in addition to cardiovascular health.”
The statement uses cognition to define brain health, referring to the spectrum of intellectual-related activities, such as memory, thinking, reasoning, communication, and problem solving that enables people to thrive and navigate the world on an everyday basis.
The ability to think, solve problems, remember, perceive and communicate are crucial to successful living; their loss can lead to dependency.
“Studies have shown that these domains are impacted by factors that are within our control to change,” Professor Lazar says.
“Prevention and mitigation are important, because once people have impaired cognition, the current treatment options are very limited.”
According to the study:
- Recent data show that hypertension, diabetes and smoking in adulthood and middle-life increase the odds of cognitive decline in middle-age and accelerate cognitive decline in older age.
- People with dementia experience lower quality of life, and caregivers – typically family members – experience high rates of psychological stress and physical ill-health. Dementia is more costly than heart disease or cancer, with worldwide costs estimated at $818 billion in 2015.
- Primary care is the right place for practice-based efforts to prevent or postpone cognitive decline. This setting can provide comprehensive coordinated care to promote AHA‘s Life’s Simple 7 as a guide for brain health and overall wellness.
- Professional guidelines also recommend routine screening for depression and counselling patients to focus on healthy eating and exercising a minimum of 150 minutes a week.
- Implementation of practices to prevent cognitive decline often fall short – referred to as an evidence-practice gap. However, new practices and technology like telehealth, which are more common as a result of the COVID-19 pandemic, are addressing this gap.
- Lack of access to primary care services may be a barrier to prevention. Even with the Affordable Care Act, an estimated 15 per cent of Americans adults still lack health insurance, and 25 per cent of Americans do not have a source of primary care.
“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. Patients might be more likely to pay attention to the importance of addressing modifiable risk factors if they understood the links,” adds Professor Lazar.
