The study authors note that to effectively implement tools, processes, and strategies within practices, the stigma surrounding cognitive impairment must be addressed.
According to results of a study published in BMC Primary Care, early conversations about brain health between health care professionals and patients are rare because of the stigma that is associated with Alzheimer disease and other dementia diagnoses. About 4 out of 5 primary care clinicians consider themselves to be on the frontlines of brain health and are most likely to be the first to evaluate patients who are experiencing cognitive impairment.
“Similar to the HIV/AIDS epidemic in the 1980s or the public fear of cancer in the 1970s, Alzheimer disease and related dementia diagnoses are stigmatized…” said senior author Malaz Boustani, MD, MPH, research scientist, Regenstrief Institute and Indiana University School of Medicine, in a press release. “The stigma around Alzheimer disease and related dementias creates a barrier between clinicians and patients causing the lack of conversation about brain health or cognitive concerns. To create the necessary and potentially effective tools, processes, and strategies, we must move past the stigma that surrounds having a brain health or cognitive concern conversation.”
The study had also indicated that both clinicians and patients are hesitant to initiate these conversations, brain health interventions are often poorly communicated, and both social and cultural factors can influence the interactions between clinicians and their patients. The results suggest that when cognitive impairment is suspected by health care professionals, the language and approach should be tailored to the patient’s social and cultural context.
“Having a conversation about your brain health when you go and see your provider, who is responsible for your health overall, should be a normal occurrence,” said Boustani in the press release. “Why would you have a conversation about your kidney or liver, your heart, your lung, your muscle, your bone, and not have the conversation about your brain, which is the most prestigious or precious organ and the one that you don't have a chance to regain if you lose it?”
Further, the investigators identified the Agile Diffusion Process as an alternative approach for physicians to engage with their patients. This method provides a framework for expediting the rapid uptake and diffusion of evidence-based solutions.
The Agile Diffusion Process has 2 concepts, the first of which refers to a small change in the environment—or nudge—that can positively impact the individual’s behaviors or choices (eg, encouraging patients to ask questions about their cognition), and the second uses an evidence-based intervention prior to rollout and scale-up within an organization—or market demand (eg, the sudden increase in the demand for telehealth appointments during the COVID-19 pandemic). Boustani notes that experts should consider the agile processes when implementing early conversations about cognition at the practice or system level.
“Clinicians can play a vital role in making early conversations around brain health and cognitive concerns as part of routine health care long before symptoms appear,” said Boustani in the press release. “It's so important for us to have a brain health conversation with our clinician. We need clinicians to have the brain health conversation become routine, because, at the end of the day, there is no health without brain health.”
Regenstrief Institute. Overcoming the stigma: study recommends steps to move past barriers of brain health conversation. News release. January 29, 2024. Accessed February 1, 2024. https://www.eurekalert.org/news-releases/1032631