The University of Alabama at Birmingham is now offering brain health checkups at two UAB family and community medicine clinics as part of a pilot project to assess ways to help patients prevent cognitive decline. The Brain Health Advocacy Mission, or BHAM, will encourage patients to make smart choices to improve their brain health.

"The earlier a person engages in the appropriate lifestyle changes to promote good brain health, the better," said Ronald M. Lazar, Ph.D., the Evelyn F. McKnight Endowed Chair for Learning and Memory in Aging and director of the Evelyn F. McKnight Brain Institute at the UAB Heersink School of Medicine. "Changes made as young as 18 years of age can have a tremendous impact many years later."

Lazar says BHAM is unique in that the brain health visit is done in conjunction with patient's regular visits to their health care professional.

"We believe this is the first brain health clinic in the country to be integrated with a primary care clinic so that patients don't have to make a special visit," he said. "Rather, we go to where the patients are and simply fold the brain health visit within their routine medical care."

The BHAM brain health clinics employ the American Heart Association's Life's Simple 7, a set of strategies to improving cardiovascular health, along with five other factors associated with cognitive decline. Together, they provide a road map that can lead to better brain health. Last year, Lazar was lead author of "A Primary Care Agenda for Brain Health," a scientific statement issued by the AHA that provides the framework for the BHAM clinics.

Life's Simple 7 focuses on seven lifestyle targets: managing blood pressure, maintaining healthy cholesterol levels, reducing blood sugar, increasing physical activity, eating a healthy diet, maintaining a healthy weight and not smoking.

The additional targets that have impact on optimal brain health are depression, social isolation, excessive alcohol use, sleep disorders and hearing loss.

The pilot "clinics within a clinic" employ a nurse investigator to meet with interested patients during their normal medical visits at clinics in UAB Hospital-Highlands and UAB Medicine Hoover Primary and Specialty Care. The nurse and patient work together to establish a baseline brain health score. Given a choice of strategies and resources to improve their scores, patients then decide for themselves which initial targets they wish to address. Follow-up visits will track their progress.

"We create a total score, but also set individual scores on each factor," Lazar said. "Patients can work on the factors they believe are most attainable, picking one or more to focus on. The hope is to establish healthy lifelong habits."

The pilot project plans to enroll 50 patients at each of the two test clinics. Eligible patients will be over 18 years of age with no significant brain issues such as stroke or cognitive decline. The program will expand over time but is currently limited to UAB Family and Community Medicine patients who can come to the clinics of Sameera Davuluri, M.D., and Erin DeLaney, M.D., assistant professors in the Department of Family and Community Medicine in the UAB Heersink School of Medicine.

"Primary care is the right home for practice-based efforts to prevent or postpone cognitive decline," Lazar said. "Primary care professionals are most likely to identify and monitor risk factors early and throughout the lifespan."

Preserving brain health in an aging population is a growing concern in the United States. 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.

Lazar says 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, individualized and personalized 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."

BHAM is supported by funding from the UAB McKnight Brain Institute. Jessica Lane is the program director, and Pamela Bowen, Ph.D., is the clinical director.