Primary care physicians know how important their role in brain care is. Research on the key role in dementia care played by primary care confirms it. What is less clear is how best to implement brain care, especially given the system-level barriers that existing systems and tools create.
Brain care that addresses signs of early decline, injury, and dysfunction is important, especially in the treatment of and care planning for conditions like dementia. But brain care is also a preventive and long-term pursuit. Addressing brain care early and often can offer a key avenue to preventive care practices that can make a substantial difference in patient quality of life.
In this article, we define brain care, discuss why it matters, and offer solutions for care providers looking to implement brain care in their day-to-day practice.
Article Highlights
Brain care covers cognitive health, mental health, physical wellness, social wellbeing, and social determinants of health.
- In the United States, as many as 1 in 10 adults over 65 is living with dementia.
- Roughly 110 people per 100,000 aged 30 to 64 have early-onset dementia, so brain care is not only a geriatric concern.
- Lifestyle factors account for up to 9% of the variation in cognitive capacity, but no single combination works for every patient.
What is brain care?
Brain care is the ongoing practice of protecting and monitoring cognitive health across a patient's lifespan. It covers signs of early decline, injury, and dysfunction, and it is also a preventive and long-term pursuit.
"Brain care" is a broad term that includes a wide array of health considerations, and brain care is interconnected with other areas of health. In other words, the work that primary care providers already do to monitor and treat physical conditions, such as managing blood pressure, blood sugar, and cholesterol, preventing diabetes, and promoting healthy lifestyle choices, contributes to brain health too.
Why does brain care matter?
In the United States, dementia prevalence data shows as many as 1 in 10 adults over 65 is living with dementia. This figure is significant, but dementia is not the only aspect of brain care that matters. From concussion and traumatic brain injury to neurological disorders and even to COVID-related brain fog, brain care is a leading concern for a significant portion of the population.
And as the population ages, that concern is only going to grow.
That is why making brain care a cornerstone of healthcare provision is more important than ever. Early detection of cognitive change can make all the difference where intervention, prevention, and quality of life are concerned.
Simply put, preventive care saves lives, and when healthcare providers put brain care at the forefront of their medical practice, they take a proactive approach to patient care. This means setting patients up for better patient-provider relationships, early intervention, and, most importantly, a higher quality of life.
Here are the health areas that fall under brain care, along with ideas on improving care provision around each.
Cognitive health
When we think about brain care, Alzheimer's disease and other dementias usually come to mind first. With an aging population and high prevalence in older adults, it is no wonder cognitive health is a leading concern among healthcare providers.
Cognitive health is not only an older-adult concern. Neurological disorders fall under this umbrella, as does cognitive impairment resulting from traumatic brain injury and viruses like COVID-19. Research on early-onset dementia rates finds that about 110 people in every 100,000 aged 30 to 64 have early-onset dementia. This makes cognitive health screening of potential importance to everyone.
This said, cognitive decline can be difficult to identify. It can be hard to know when to apply cognitive screening, and even harder to know which screening tools are most effective. We talk more about cognitive screening and brain care later on.
Mental health
Mental health is central to brain care. Some studies suggest that better mental health can benefit cognitive health. Depression and cognition research from 2020, for example, found that people over 50 with depression performed worse on cognitive function tests than people without depression. The results even suggested that when older adults report symptoms of depression, it may predict cognitive disorders down the road.
In other words, psychological concerns are important to brain health now, and serve as predictors for brain health as patients age. Tests like the Perceived Stress Scale, the GAD-7 questionnaire for anxiety, and the PHQ-9 measure for depression are just a few ways to screen for mental health conditions.
Physical wellness
It is impossible to separate physical wellness from brain health, and any steps taken to improve physical wellness will benefit the body's most important organ: the brain. Lifestyle factors account for up to 9% of the variation in cognitive capacity, and exercise is among them. A regular, appropriate exercise routine can help improve mental health and physical health outcomes, especially where these categories overlap.
A similar relationship exists between exercise and cognitive health. An aerobic exercise study from 2023 found that aerobic exercise improved performance on Creyos cognitive tasks measuring aspects of memory, reasoning, and verbal ability. In other words, when patients get their heart rate up, it lowers their risk for further cognitive decline.
Exercise is not the only physical wellness habit that affects brain health. Sleep duration research from 2018 noted that not getting enough sleep (or getting too much) was associated with impaired performance in reasoning and verbal abilities. The same study found that sleeping well for just one night was enough to improve cognitive function.
In other words, improving physical wellness is a large part of improving patient brain health. Getting appropriate exercise, maintaining a nutritious diet, and getting an appropriate amount of sleep are some of the most basic ways to enhance cognitive performance.
Social wellbeing
Exercise and sleep are only two examples of lifestyle habits that may play a role in maintaining brain health. A Japanese cohort study from 2018 found that regular social contact was correlated with lower rates of dementia among adults over 65.
What is interesting about this study is that several kinds of social activity were shown to be related with seniors' cognitive health. All of the following were linked with lower rates of dementia:
- Talking with friends
- Support from family
- Seeking community engagement
- Talking with one's spouse
Social determinants of health
Talking to patients about brain care means elaborating on the complex factors that contribute to a person's health, and some of the most complex of those conversations have to do with social determinants of health. Many whole-person care factors matter to cognitive health, and some of them are not under a patient's control.
For example, early-life education, especially before the age of 20, can be a significant predictor of brain health in old age. People who experienced low socio-economic circumstances in childhood were shown in childhood circumstances research to be more likely to face dementia later in life. Research has also established that adult socioeconomic factors have consequences for brain health later in life. That may be relevant for policy makers and parents raising the next generation, but how can aging patients be counseled on determinants that already happened and cannot be controlled?
Hobbies and cognitive reserve
Pursuing hobbies may support cognitive health. The ideal hobby for learning a new cognitive skill should be challenging, complex, and repeatable.
Having a diverse set of cognitive skills may contribute to cognitive reserve, the idea that some people are more resilient to the brain changes resulting from diseases like dementia, perhaps because they have more cognitive skills to fall back on when their cognitive capacity declines.
Leisure activities may also promote other changes known to affect brain health. Reading, for example, has been proposed as a way to reduce stress and improve sleep. This said, be wary of "brain training" apps and puzzles. They may make big claims, but they aren't always scientifically validated.
There is no perfect combination of lifestyle factors. Each patient will still have to find lifestyle changes and hobbies that work for them.
A whole-person approach to brain care
Brain care is a multifaceted issue that needs a multifaceted strategy. Care providers often wonder what strategies to implement to ensure this complex issue is addressed in patient care.
Especially in an era where telehealth is a key player in care provision, it is important to make communication a cornerstone of your practice. Communication is even more important when brain health is a concern because patients who are experiencing cognitive symptoms may have trouble communicating if their verbal abilities are declining.
Two refrains commonly get in the way. Patients say "I don't want to know," which stalls measurement, and "it's too hard," which stalls long-term lifestyle change. These are both things that communication and a whole-person approach can help address.
Communication has been found to be centrally important in patients' perceptions of health provision. Patient priorities research identified the factors patients valued most highly in care practitioners, including:
- Listening. When care providers were attentive to the explicit reason for the visit and other patient answers, patients felt cared for. Listening may expand beyond the patient, and include listening to caregivers or family members with concerns.
- Clear, detailed communication. Asking questions, providing detailed information, and not rushing conversations helped patients feel more at ease during doctor's visits.
- High respect for privacy. Particularly on tricky topics like brain health and cognitive function, a sense of privacy may help patients to overcome feelings of shame around their health concerns or cognitive performance.
Not only is a patient-centered approach to care important to patients, patient-centered care research shows it effectively invests patients in their own care. This can even have systemic results:
- Reduced service costs
- Efficient resource allocation
- Improved patient-provider relationships
Brain care is one component in a positive feedback loop with whole-person care. When foregrounded as an aspect of preventive care, brain care can improve detection rates for cognitive decline, boost quality of life, and make patients feel valued in the course of your practice.
How do you measure brain health over time?
Conversation and communication form only part of brain-related care practice. In fact, it can be hard to assign cognitive care without a clear idea of how a patient's brain function measures up.
As a care provider, you are probably already on the lookout for the early signs of cognitive decline in your patients, but there is a strong argument for routine cognitive testing treated just like testing blood pressure. Routine cognitive testing is an effective way to ensure patients are healthy, motivate long-term lifestyle improvement, and spot signs of decline as early as possible.
The question becomes how best to conveniently and effectively test cognitive function in a way that also returns useful data. Already familiar to many physicians and neurologists are cognitive function tests like the MoCA, MMSE, and SLUMS exam, short for the Montreal Cognitive Assessment, the Mini-Mental State Examination, and the Saint Louis University Mental Status exam. None of these tests on their own provide all the info providers need to make an informed decision on brain care. Clinicians can benefit from having multiple tools, plus clinical experience, in the toolbox.
Here are some of the features to consider when choosing a cognitive function measurement tool:
Establish a baseline
Cognitive function can change over time, but it can be hard to measure that change without a baseline to compare against new figures.
Establishing a cognitive function baseline early will more confidently allow you to detect changes in the future. Appropriate times to set up this sort of preventive care testing may include the annual wellness visit, new patient intake visits, or when patients pass a certain age threshold.
Gather objective data
Listening carefully to patient concerns can give care providers important data on their patients' state of mind and self-perception. This said, it can be hard to validate subjective concerns on their own.
Consider the 68-year-old woman who still feels sharp as a tack, but whose son has expressed concern that she can never find her keys. Or the patient recovering from a traumatic brain injury who is anxious about whether they are recovering on schedule.
While their points of view are undoubtedly, even crucially, important in screening for brain health, subjective measures are not always sufficient care guidance on their own. Cognitive function tests can help determine if objective performance lines up with subjective reports. Data can put patients and care providers alike at ease by showing proof of progress, or it can offer insights on areas to work on toward recovery.
Capture clear insights on deficits
When shifts in cognitive abilities occur, it can be hard to pin down the areas of most concern. Measurement tools can help identify which skills are most affected, including:
- Working memory
- Spatial reasoning
- Attention
- Language abilities
This level of precise identification can make all the difference in terms of identifying a treatment plan or care plan. It can also help in advising patients on things to watch out for in their day-to-day, and which treatments to consider.
Detect age-related decline early
Some traditional tools like the MoCA and MMSE screeners run into MCI detection limits, missing subtle changes associated with mild cognitive impairment (MCI), early cognitive disruption, and other subtle brain health concerns. Creyos tools aim to bridge that gap by providing assessments that are sensitive enough to catch subtle signs of cognitive decline and mild cognitive impairment.
Tests sensitive enough to capture diverse manifestations of cognitive disruption can be especially helpful as preventive tools. In short, the quality of cognitive testing can make the difference between early intervention and identifying cognitive decline after it has already happened.
Final thoughts: raising the bar for brain health
Brain health means a wide array of things across a wide array of areas, which can make it difficult to screen for. Fortunately, tools like the Creyos dementia screen and care plan make it easier to make brain health a key focus of your practice.
Written by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.