Primary care physicians know how important their role is in brain care. What’s less clear is how best to implement brain care—especially when existing systems and tools don’t always seem to support them in its provision.
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.
Why Brain Care Matters
In the United States, as many as 1 in 10 adults over 65 suffers from dementia. This figure is significant—but dementia isn’t 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’s why making brain care a cornerstone of health care 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.
How to Take Care of the Brain
As we’ve seen, “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 to improve biomarkers, prevent diabetes, promote healthy lifestyle choices—contribute to brain health too.
Here are a few additional health areas that fall under brain care—and ideas on improving care provision around it.
Cognitive Health
When we think about brain care, odds are Alzheimer’s disease and other types of dementia come quickly to mind. With an aging population and high incidence of cognitive dysfunction among American adults over 65, it’s no wonder cognitive health is a leading concern among healthcare providers.
It’s not only seniors who struggle with cognitive health. Neurological disorders fall under this umbrella, as does cognitive impairment resulting from traumatic brain injury and viruses like COVID-19. Studies also find that about 110 people in every 100,000 aged 30-64 suffers from 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
It comes as no surprise that mental health is important to brain care. After all, some studies suggest that better mental health can benefit cognitive health. A 2020 study from Desai et al., for example, found that sufferers of depression over 50 were impaired on cognitive function tests compared to non-sufferers. 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. For example, we know that 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. Riganello et al. found in 2023 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 isn’t the only physical wellness habit that affects brain health. One 2018 study 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, eating well, 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 2018 study from Japan found that regular social contact was correlated with lower rates of dementia among adults over 65.
What’s interesting about this study is that several kinds of social activity were shown to be related with seniors’ cognitive health. Talking with friends, support from family, seeking community engagement, and even talking with one’s spouse were all social activities linked with lower rates of dementia.
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 different aspects of experience matter to cognitive health—and some of them are not under a patient’s control.
For example, education in early life—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, meanwhile, were shown in a 2023 study to be more likely to face dementia later in life. Research has also established that socio-economic circumstances have consequences for brain health in adults 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 can’t be controlled?
Hobbies
There may be some cognitive benefits to pursuing hobbies. 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—for example, reading 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.
The latest research suggests lifestyle factors account for a significant amount of variation in cognitive capacity (up to 9%). But there is not a 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’s 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.
A common barrier to measuring cognitive health is patients expressing: "I don't want to know,” and "it's too hard" is a common refrain that gets in the way of long-term lifestyle changes. 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. A focus group of migrant women in Toronto identified the factors they 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—it has been shown to effectively invest patients in their own care. This can even have systemic results, including reduced service costs, efficient resource allocation, and 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.
When it comes to brain care, Yukon Neurology puts a strong emphasis on patient-physician relationships. Learn how they achieve 99% cognitive test completion rates. Read the case study
Measuring 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’re probably already on the lookout for the early signs of cognitive decline in your patients—but there’s a strong argument to be made for treating cognition testing 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, the MMSE, and the SLUMS exam—but 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’re recovering on schedule.
While their points of view are undoubtedly, even crucially, important in screening for brain health, subjective measures aren’t 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, and 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
Studies show that primary care physicians see themselves as key interventionists in dementia diagnosis and care. They also sometimes perceive existing healthcare systems to be unable to efficiently support them in these interventions.
Some traditional tools like the MoCA and MMSE screeners are less successful in identifying 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’s 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.
This post was edited by Mike Battista, Director of Science and Research at Creyos (formerly Cambridge Brain Sciences).