Chuck Vega, MD, FAAFP - Minding Cognitive Health Across the Continuum: Collaborative Workflows and Tools to Support Preservation, Screening, and Early Diagnosis

And I know you've already seen these questions, but I'm going to go through it really quickly.

Linda, a 67-year-old who is coming in for a follow-up visit, she is being seen for hypertension.

She is with supportive controls.

She's taking a Sinopril.

She's taking Gavipent as well for sciatica, has elevated LDL and has overweight.

And she has a positive family history of dementia.

Mother diagnosed with Alzheimer's dementia at age 75.

And how should we address her brain health and risk factors of dementia with her as part of routine care? And the best answer here is actually the brain care score.

If you're not familiar with the brain care score, this is a tool that we can use to assess someone's risk factors for dementia well before they develop any of the symptoms or signs of cognitive impairment.

um in terms of other testing the apoe testing might give us some idea of her risk overall but it's a little fraught the brain care score gives us modifiable information that you know we can work on together i'll talk about how it can actually help folks to to lower their risk of dementia by improving their brain care score Blood biomarkers are really only used for Alzheimer's disease in folks who are symptomatic.

So that's a real basic rule.

She is not symptomatic, so therefore I would not use it for her.

And MRI, similarly, that's only for folks who are symptomatic.

Now, we

are going more upstream than we used to, and we want to go as upstream as possible because the pathological processes in terms of deposition of tau and beta amyloid began decades before the onset of symptoms.

So this is where a lot of the research is.

It's difficult to treat Alzheimer's disease in a meaningful way once you're at moderate to severe Alzheimer's dementia stage.

But if we can go upstream and help prevent that or delay disease progression, that is a big difference.

And we now have amyloid targeted therapies that do exactly that with a lot more research going on.

But I think that we want to think about brain health as something that goes throughout the entire lifespan.

And especially in primary care, we can have a significant role in terms of preventing dementia and if nothing else, staving off those symptoms for as long as possible.

So risk reduction is something we do throughout the lifespan, and I'll be talking about that in a second.

The other thing that's really important, this is a disease, unfortunately, when we think about dementia broadly and Alzheimer's disease specifically, we don't diagnose it soon enough.

We get too many patients presenting in my practice in a safety net clinic here in Orange County, California.

I have way too many patients who present with moderate dementia, even severe dementia, And that's their first visit.