Brain health clinics – An evolving clinical pathway? - 04/02/25

Doi : 10.1016/j.tjpad.2024.100051 
Anneka F․ Butters a, b, , Jonathan Blackman a, b, Hannah Farouk a, c, Saba Meky a, c, Margaret․ A Newson a, b, Tomas Lemke a, b, c, Natalie Rosewell a, James․ A․ Selwood a, b, Nicholas․ L․ Turner a, b, Elizabeth․ J․ Coulthard a, b, Hilary․ A․ Archer a, b,
a Southmead Hospital, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, BS10 5NB, UK 
b ReMemBr Group, University of Bristol Medical School, Level 1, Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK 
c University of Bath, Claverton Down, Bath, Somerset, BA2 7AY, UK 

Corresponding author at: ReMemBr Group, University of Bristol Medical School, Level 1, Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB.ReMemBr GroupUniversity of Bristol Medical SchoolLevel 1, Learning and Research Building, Southmead Hospital, Westbury-on-TrymBristolBS10 5NB⁎⁎Corresponding author at: Southmead Hospital, North Bristol NHS Trust, Southmead Road, Westbury-on Trym, BS10 5NB.Southmead HospitalNorth Bristol NHS Trust, Southmead Road, Westbury-on TrymBS10 5NB

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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.

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Keywords : Brain Health, Dementia risk, Preventative lifestyle intervention, CSF biomarkers, Alzheimer's disease


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