An estimated one in five Americans 65 years or older has mild cognitive impairment, and one in seven has dementia. By 2050, the number of Americans with dementia is expected to triple. In response to this coming challenge, the University of Alabama at Birmingham has started a pilot program at two primary care clinics that focuses on helping patients prevent cognitive decline. The Brain Health Advocacy Mission (BHAM) will encourage patients make smart choices to improve their brain health.

"It is now well-understood that risk factors of cognitive decline and dementia are largely treatable," said Ronald Lazar, PhD, a UAB professor of neurology and director of the Evelyn F. McKnight Brain Institute. "It's not that these risk factors cause dementia. They just make the brain more vulnerable to these things that cause dementia. And when we attack these early, it makes dementia much less likely to occur later on."

Lazar was the lead author of A Primary Care Agenda for Brain Health, a scientific statement issued by the American Heart Association that provides the framework for the BHAM clinics. The clinics provide patients a roadmap to maintaining brain health that is built around the AHA's Life's Simple 7, a set of lifestyle targets that include managing blood pressure; maintaining healthy cholesterol levels; reducing blood sugar; physical activity; healthy diet; healthy weight; and not smoking, along with five other factors that impact brain health - depression, social isolation, excessive alcohol use, sleep disorders and hearing loss.

"A large number of Americans are affected by these lifestyle issues. About one-third of our population has hypertension, and approximately 10 percent has diabetes. Almost half of the US population is obese," Lazar said.

Operating as a clinic within a clinic at UAB Hospital-Highlands and UAB Hoover Primary & Specialty Care, a BHAM Brain Health nurse investigator will meet with interested patients to establish a baseline brain health score based on the lifestyle targets. From there, the nurse will offer a choice of strategies and resources to improve their scores, and patients will decide for themselves which initial targets they want to address.

"We allow patients to make their own choices about what they want to focus on and then we tailor the program to them," Lazar said. "We direct them to resources in the community depending on what lifestyle target they want to work on. For example, if someone wants to exercise more, we help them find the various places they can visit for that, as well as giving them examples of activities they can do for exercise.

"It's important to note that all our recommended strategies are evidence-based. Unfortunately, there are many products out there that have no supporting evidence, but people take them anyway because of advertising."

The BHAM Brain Health program chose to locate in the two primary care clinics because primary care providers see people throughout their life so they are a good fit for strategies that need to be practiced continually.

The BHAM Brain Health pilot project has enrolled 50 patients at each clinic, all of whom are over age 18 with no significant brain issues such as stroke or cognitive decline. The program will follow these participants for a year to determine whether their brain care scores improve after incorporating the suggested strategies.

To spread the message of brain health, Lazar's project group is building a website to make the information more accessible to people who are not in the program. "We hope to put this into more clinics in the Birmingham area, potentially more throughout the state of Alabama and we want to create a national model that people can follow," he said.

Lazar also wants to expand the program into areas where healthcare disparities are apparent such as the African-American church community in Birmingham. "It's important for us to go into those communities, and rather than telling them what they should do, listen to them first and find out what their concerns are because we have to establish trust," Lazar said.

Future plans include building a brain health app based on community needs and desires. "We see an app as a way to engage people in a way that will be motivational and individualized to each person," Lazar said. "The app would serve as a tracker, motivator and source for links to places where people can get help with achieving any of the targets -- where to purchase healthy foods, for example. Through social media, it will also provide an opportunity bring people together with common health interests."