A Primary Care Agenda for Brain Health: A Scientific Statement From the American Heart Association
Open accessAbstract
A healthy brain is critical for living a longer and fuller life. The projected aging of the population, however, raises new challenges in maintaining quality of life. As we age, there is increasing compromise of neuronal activity that affects functions such as cognition, also making the brain vulnerable to disease. Once pathology-induced decline begins, few therapeutic options are available. Prevention is therefore paramount, and primary care can play a critical role. The purpose of this American Heart Association scientific statement is to provide an up-to-date summary for primary care providers in the assessment and modification of risk factors at the individual level that maintain brain health and prevent cognitive impairment. Building on the 2017 American Heart Association/American Stroke Association presidential advisory on defining brain health that included “Life’s Simple 7,” we describe here modifiable risk factors for cognitive decline, including depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidemia, poor diet, smoking, social isolation, excessive alcohol use, sleep disorders, and hearing loss. These risk factors include behaviors, conditions, and lifestyles that can emerge before adulthood and can be routinely identified and managed by primary care clinicians.
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Eight guidelines explicitly stated that they were prepared by, or in consultation with, people working in primary care.
“Eight guidelines explicitly stated that they were prepared by, or in consultation with, people working in primary care [36, 45–51].”
From Dementia Risk Reduction in Primary Care: A Scoping Review of Clinical Guidelines Using a Behavioral Specificity Framework (2022) · cites this paper as [45]
Some guidelines targeted patients spanning midlife and late life, or across the life course.
“For age, some guidelines targeted patients spanning midlife and late life [37, 38, 49, 51, 52], or across the life course [45, 47].”
From Dementia Risk Reduction in Primary Care: A Scoping Review of Clinical Guidelines Using a Behavioral Specificity Framework (2022) · cites this paper as [45]
Guidelines recommending the management of risk factors typically suggested that healthcare professionals follow existing clinical guidelines for individual risk factors.
“Guidelines recommending the management of risk factors typically suggested that healthcare professionals follow existing clinical guidelines for individual risk factors [2, 45, 51–53, 57].”
From Dementia Risk Reduction in Primary Care: A Scoping Review of Clinical Guidelines Using a Behavioral Specificity Framework (2022) · cites this paper as [45]
It would technically be possible to follow five of the included guidelines without ever mentioning dementia to patients.
“It would technically be possible to follow five of the included guidelines without ever mentioning dementia to patients [38, 45, 52–54].”
From Dementia Risk Reduction in Primary Care: A Scoping Review of Clinical Guidelines Using a Behavioral Specificity Framework (2022) · cites this paper as [45]
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The ARIC (Atherosclerosis Risk In Communities) Study
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Self-citationThe Role of Vascular Risk Factors in Cognitive Impairment and Dementia and Prospects for Prevention
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Self-citationLife's Essential 8 and Poor Brain Health Outcomes in Middle-Aged Adults
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Carotid Intima-Media Thickness and Amyloid-β Deposition: The ARIC-PET Study
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Interdisciplinary Engagement In Neurocardiology: A Key Opportunity
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Obesity, Hypertension and Brain Health
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Public interest and engagement in care for brain health in Slovenia: the role of education
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Dementia and Cognitive Impairment
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Patients reported outcome of cognitive function scale: a psychometric evaluation
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Hypertension and Intracranial Hypertension Association: A Narrative Review
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Frailty as a Modifier of the Associations Between Vascular Risk Factors and Incident Dementia
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Is 112 the New 10 000?—Step Count and Dementia Risk in the UK Biobank
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RetractedHeart and Brain: Exploring Connections and Therapeutic Opportunities Throughout the Lifespan
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Aivoterveyden edistäminen perusterveydenhuollossa vaatii vielä vahvistusta
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Role of sex steroid hormone on hand grip strength and cognitive function in the elderly
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Practical Approaches to Lifestyle Interventions for Enhancing Brain Health in Older AdultsPreprint
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Targeting modifiable risk and protective factors to prevent dementia
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Evaluating Brain Health in Women
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Cognitive Effects of Cannabis Use Across the Lifespan: A Review for Clinical Practice
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Importance of radiation-related cognitive decline in older adults who receive cranial radiation
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Impaired Intracranial Compliance: A New Hypertension-Mediated Brain Organ Damage?
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Neurons on the rocks: A case of alcohol use and early onset Alzheimer's disease
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- Authors
- Lazar, R. M., Howard, V. J., Kernan, W. N., Aparicio, H. J., Levine, D. A., Viera, A. J., Jordan, L. C., Nyenhuis, D. L., Possin, K. L., Sorond, F. A., White, C. L., & on behalf of the American Heart Association Stroke Council
- ORCID
- Venue
- Stroke
- Published
- 2021-06
- Volume
- 52
- Issue
- 6
- Pages
- e295-e308
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC8995075
- OpenAlex
- W3138548852
- Cited by
- 109
- References
- 155
- Citations by year
- 2026: 29 · 2025: 22 · 2024: 21 · 2023: 17 · 2022: 12 · 2021: 8
- FWCI
- 2.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (U10NS086728, UH3NS105557, L30 NS093634, U24NS107223)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Keywords
- brain health, cognitive decline, cognitive impairment prevention, primary care, modifiable risk factors, Life's Simple 7, depression, hypertension, physical inactivity, diabetes mellitus, obesity, hyperlipidemia, unhealthy diet, smoking, social isolation, excessive alcohol use, sleep disorders, hearing loss, aging
- MeSH terms
- American Heart Association, Brain, Health Status, Humans, Hypertension, Primary Health Care, Quality of Life, Risk Factors, Social Isolation, United States, Practice Guidelines as Topic, Stroke, Risk Reduction Behavior, Cognitive Dysfunction
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