THE BRAIN HEALTH CHAMPION STUDY: PROMOTING NONPHARMACOLOGICAL INTERVENTIONS IN PATIENTS WITH COGNITIVE DISORDERS

Background: Although dementia specialists often advise patients to adopt healthy lifestyles, the current standard of care does not systematically promote or monitor adherence to recommendations for brain health. More immediate medical and neuropsychiatric issues commonly become the focus of attention during follow-up visits for these challenging patients. Encouraging brain-healthy lifestyle changes is particularly relevant in the absence of disease-modifying pharmacological treatments for mild cognitive impairment (MCI) and dementia. The current study aims to investigate novel and potentially scalable ways to augment brain-healthy behaviors in patients treated at an academic Alzheimer center. Methods: We are piloting a 6-month, randomized, controlled study measuring the effect of increased patient education and clinical contact on adherence to brain health recommendations. Our target enrollment is 40 patients with subjective cognitive decline, MCI, or early dementia from the Alzheimer Center at Brigham and Women's Hospital. Subjects and caregivers in the treatment program work with an additional clinical team member, a “brain health champion” (BHC), setting personalized goals and participating in weekly motivational interviewing phone calls, with additional in-person visits every 6 weeks. Using questionnaires validated in cognitively impaired populations, we are measuring changes in physical activity, dietary pattern, and social and cognitive engagement. Secondary outcomes include cognitive function, neuropsychiatric status, quality of life (QOL), and sleep behavior. Additional analyses will examine the effect of biweekly “booster” sessions on sustaining brain-healthy changes following the primary intervention period. Results: To date, 38 subjects have enrolled in the study, and we anticipate finishing data collection and analysis by Summer 2018. Nine subjects have completed the 6-month protocol. Preliminary results suggest increases in physical and cognitive activity levels and QOL measures for participants in the BHC program relative to subjects receiving standard care. Subjects also report greater awareness of, and adherence to, the Mediterranean-style diet. Improvements appear to be driven by enrollment in organized group exercise classes and personal training, as well as increased engagement in community-based cognitive and social activities. Conclusions: If the BHC pilot study continues to yield promising results, it would provide a potential model for actively promoting brain health in MCI and dementia clinical care.