Brain health clinics - An evolving clinical pathway?

Abstract

Background: Dementia clinics traditionally focus on diagnosis and post-diagnostic care. Awareness is increasing that attention to risk factors and their prevention also forms a key part of dementia management.

Objectives: To describe our Bristol Brain Health clinic including 1) Clinical pathway 2) Patient population 3) Patient experience 4) Evaluation in line with published gold standards.

Design/ setting: Observational, (longitudinal/retrospective) clinical cohort study of patients attending the North Bristol NHS Trust's Brain Health Service.

Participants: One-hundred and ten patients with mild cognitive disorders attending clinic between 2017- 2023.

Measurements: We collected data from medical records including clinical assessments, cerebrospinal fluid (CSF) for biomarkers of Alzheimer's Disease (AD), and a lifestyle questionnaire. Descriptive statistics were performed and a clinic evaluation was carried out using recommendations from The European Task Force for Brain Health Services.

Results: Average age was 63.9 years (SD: 11.2). 74 patients were male (62.8 %). The mean baseline Montreal Cognitive Assessment (MoCA) score was 24.4 (SD: 3.6). 73 patients (66.4 %) received a preventative lifestyle intervention with a review of risk and protective factors for dementia, and development of a bespoke risk reduction plan. Commonly identified risk factors; low mood; n = 61 (55.5 %), hypertension; n = 54 (49.1 %), high cholesterol; n = 42 (47.3 %), and hearing loss; n = 44 (40 %). CSF testing for AD was carried out in 38 individuals and was positive in 17 cases. At last review, one fifth of patients had progressed to dementia. Most common diagnoses; AD; n = 22 (20 %), Functional Cognitive Disorder; n = 16 (14.6 %), Vascular; n = 8 (7.3 %). Patient feedback was good, with all responders recommending the clinic and more than three-quarters of patients being 'extremely likely" to. Clinic evaluation highlighted 'Risk Assessment' and 'Personalised Intervention' as brain health pillar strengths. 'Cognitive Enhancement' was an area for further development.

Conclusions: Our patients had access to a range of cutting-edge, diagnostic assessments, in addition to a preventative lifestyle intervention. Our population had a high rate of dementia risk factors and a heterogeneous range of diagnoses. CSF biomarker testing was helpful for differentiating between those with early AD, and others with a multi-factorial presentation. The attendance rates for our preventative intervention suggests patients are receptive to taking a proactive approach to managing risk. This population merits further investigation and continued targeting with preventative measures.