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How to implement brain-healthy behaviour in clinical practice

AAN 2019
Neurologists often advise patients to adopt healthy lifestyles (e.g. physical exercise, Mediterranean diet, cognitively/socially stimulating activities), but often focus on more immediate medical issues during follow-up visits. Closing the gap between consensus recommendations for lifestyle changes and their implementation in clinical practice remains a huge challenge. Utilising relatively low-cost college graduates as 'brain health champions' (BHCs) showed promising results in a pilot study [1].

The BHC program is an inexpensive, interactive, multi-modal health coaching approach, that assists patients in adopting consensus-based brain health recommendations. It was tested in a 6-month, single-centre, randomised controlled trial of 40 patients with dementia, MCI, or subjective cognitive decline. In the active intervention arm, a BHC was added to the clinical team who made weekly motivational phone call interviews and additional in-person visits every 6 weeks. BHCs and patients/caregivers also met to establish and update personalised, attainable goals. Primary outcomes were changes in physical activity, dietary pattern, and cognitive/social engagement.

BHC participants had statistically significant and clinically meaningful increases in brain-healthy behaviour scores and quality of life compared to the standard-of-care control group. Cohen’s d effect sizes were in the large to very large range for:

  • physical activity (d=1.37, P<0.001);
  • Mediterranean diet (d=0.87, P=0.016);
  • cognitive and social activity (d=1.09, P=0.003);
  • quality of life (d=1.54, P<0.001).

BHCs helped participants access existing, cost-effective, community-based resources to achieve their goals.

1. Gale S, et al. AAN 2019, S9.003.

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