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Observational Study
. 2025 Mar;12(3):100051.
doi: 10.1016/j.tjpad.2024.100051. Epub 2025 Feb 3.

Brain health clinics - An evolving clinical pathway?

Anneka F Butters  1 , Jonathan Blackman  2 , Hannah Farouk  3 , Saba Meky  3 , Margaret A Newson  2 , Tomas Lemke  4 , Natalie Rosewell  5 , James A Selwood  2 , Nicholas L Turner  2 , Elizabeth J Coulthard  2 , Hilary A Archer  6
Affiliations
Observational Study

Brain health clinics - An evolving clinical pathway?

Anneka F Butters et al. J Prev Alzheimers Dis. 2025 Mar.

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.

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

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Elizabeth Coulthard reports a relationship with National Institute for Health and Care Research that includes: funding grants. Elizabeth Coulthard reports a relationship with Rosetrees Trust that includes: funding grants. Elizabeth Coulthard reports a relationship with Bristol Research into Alzheimers and Care of the Elderly that includes: funding grants. Elizabeth Coulthard reports a relationship with Medical research council that includes: funding grants. Elizabeth Coulthard reports a relationship with Biomedical research centre that includes: funding grants. Elizabeth Coulthard reports a relationship with Eisai Inc that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Elizabeth Coulthard reports a relationship with Lilly that includes: consulting or advisory, speaking and lecture fees, and travel reimbursement. Elizabeth Coulthard reports a relationship with Biogen Inc that includes: consulting or advisory. Elizabeth Coulthard reports a relationship with Top Hat Clinical Trial (DSMB) that includes: board membership. Elizabeth Coulthard reports a relationship with DESPIAD that includes: board membership. Jonathan Blackman reports a relationship with Alzheimers Research UK that includes: funding grants. Jonathan Blackman reports a relationship with David Telling Charitable Trust that includes: funding grants. Nicholas Turner reports a relationship with National Institute for Health and Care Research that includes: board membership and funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Patient pathway in the NBT Cognitive Disorders Clinic and Brain Health Clinic.
See this image and copyright information in PMC

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