GPs to use 'brain tool' to risk assess dementia in early middle aged patients
GPs will be asked to use a new lifetime dementia risk tool that gives young middle-aged patients a ‘brain age’ to ‘scare’ them into adopting healthier lifestyles under new plans formulated by public health officials.
The tool, which is set to be piloted in England in a month’s time, will estimate a person’s degree of ‘brain ageing’ from various cardiovascular risk factors such as diabetes and high blood pressure that are also known risk factors for dementia.
Dr Charles Alessi, GP and Public Health England (PHE) lead on dementia, said the tool could be used in NHS Health Checks as part of a drive to target people in young middle age, who are more likely to change their lifestyles based on a fear of developing dementia in later life than they would be for other long-term health problems.
But GP leaders questioned the value of such a tool without ‘robust’ evidence to support its use.
The tool has been adapted from the lifetime cardiovascular risk calculator launched recently by the Joint British Societies (JBS), which is already being piloted by PHE for use in the NHS Health Check programme.
Dr Alessi said the brain ageing tool currently includes the same risk factors as the JBS lifetime risk calculator, but giving people their estimated ‘brain age’ relative to their real age as the read-out. In future, the tool could also incorporate other risk factors such as depression and genetic factors, he said.
Dr Alessi, who is also on the board of NHS Clinical Commissioners, told Pulse: ‘Dementia is going through that phase where people are very scared of it - but you can use the fact they are willing to change their behaviour because they are scared of it to enable to make that change take place.
‘And if we’re successful we will also see a reduction in people with type 2 diabetes, which would be wonderful, and very many fewer strokes, which is great. So there are many advantages to doing this.’
The move comes after NICE recommended giving advice on dementia in the NHS Health Checks programme, and following renewed calls from the Alzheimer’s Society for the Government to raise dementia diagnosis rates and increase support for patients in the community through its ‘Dementia Friends’ initiative.
The Society says the prevalence of dementia remains static, despite the success of existing public health initiatives on risk factors, such as stopping smoking and controlling hypertension, meaning the number of people with dementia in the UK will continue to rise over coming decades and could reach two million by 2050.
In line with this, Public Health England is now looking at strategies to improve the management of risk factors for dementia, starting in people as young as 30 years.
Speaking at the annual Public Health England conference, Dr Alessi stressed that messages around reducing lifetime risk of dementia needed to be tempered to mitigate the stigma surrounding dementia, however.
He told delegates in a session on public health approaches to dementia: ‘One has to be careful in the messaging - there is a subtlety needed. If one makes a statement that dementia is totally preventable and if anyone has it because it’s totally their fault, that’s not helpful or true.
‘It needs to be about risk reduction, compressing years of disability into the latter years of life because that is much more defensible but assists people. I think we’ve got a lot of work to do around the messaging on this - not only around Health Checks, but also about training carers and health professionals - a lot of physicians don’t realise the potential of this risk reduction in the way they could.’
Dr Bill Beeby, deputy chair of the GPC clinical and prescribing subcommittee, questioned the value of adopting another risk tool in consultations on risk management, however, and called for ‘robust’ evidence that the approach would change outcomes.
Dr Beeby said: ‘I think if somebody is going to contend this is a useful tool that is going to change the way people behave they need to produce some evidence of that first, I don’t just mean from an enthusiast - I mean from a real-world example, with people doing it on a day-to-day basis, rather than from enthusiasts trying to prove a point.’
He added: ‘If it doesn’t involve doing anything extra - just saying not only do you have a 30% chance of a heart attack but your brain is also ageing rapidly, then maybe it is useful as an extra lever. But we need to be aware in the current climate, the prospect of practices embracing this without extraordinarily strong evidence is remote.’