Brain Health Services

Over the last 40 or 50 years, when people have developed Alzheimer’s disease, they’ve tended to present to clinical services when they get to the dementia phase of illness, which is, as we know, a very late stage of the actual disease itself. This has been because we haven’t really been able to pick up disease early in its course. So people present when they start to develop symptoms. And those symptoms that people tend to associate with Alzheimer’s disease and, indeed, Alzheimer’s dementia, tend to be what we call cognitive symptoms, particularly memory symptoms. So memory clinics have been established to try and help people identify, diagnose, these conditions, and put in place what are called post-diagnostic plans.

Treatments for people with Alzheimer’s dementia tend to focus on what are called biopsychosocial approaches. Biological treatments, for instance, might be drugs that help the symptoms of the disease. And psychosocial approaches is to provide support to carers, support to the patient, as well as social interventions like getting involved in group activities and clubs and societies. And if need be, at the tail end of the condition, to be placed in supported accommodation, indeed, even nursing homes.

As we think about the way that we’re being able to pick up Alzheimer’s disease earlier in its course, through early detection, through risk profiling, we have to set up new services, new services that are really accessible to people before they even have the slightest hint of any symptoms. They may have concerns about their brain health, because of a strong family history. They may have evidence of quite a few risk factors. And they want some early assessment of their brain health to determine whether or not they’re at risk of developing Alzheimer’s dementia in the future. So those services, necessarily, have to be based in the community. They have to be accessible.

And this is what we’re developing at the moment is things called brain health services, where people can drop in if they’ve got concerns about their brain health, and have an early assessment for early detection, risk profiling and, ultimately, a personalised prevention plan. And I think one of the very important things about brain health services is that they’re not, by definition, dementia prevention services. They’re focused on brain health. They’re focused on health. They’re focus on preserving what people have, rather than, necessarily, trying to prevent the development of a dementia syndrome.

And this is I think where we want to draw a distinction between memory clinics, which are based predominantly in hospital settings and outpatient clinics, and in the UK, and other parts of the world, run predominately by psychiatrists, and move instead, or develop also, some services that are actually for people earlier in the course of disease, which will be based in the community, will be very accessible, and principally run, in fact, by primary care physicians, who will then be able to refer on if the person needs further assessment or treatment.