Top Things to Know: A Primary Care Agenda for Brain Health

Published: March 15, 2021

  1. A healthy brain is critical for living a longer and fuller life.
  2. The risk of cognitive impairment increases with age across all race/ethnic groups, education and socioeconomic groups, but the rates are higher among certain race/ethnic groups (e.g. African Americans and Latinos in the US).
  3. This statement has identified four topics related to brain heath; specifically, definition of brain health, risk factors for cognitive impairment, prevention strategies, and integration of best practices into primary care.
  4. Cognition refers to all brain functions that support the perception, acquisition, storage, retrieval, and complex processing of information, including communication, planning, and navigation. It is a rubric, not a single entity, that encompasses many domains. This statement explores the continuum of cognitive decline that is targeted to mitigate.
  5. There are several contributors to cognitive impairment that are unfavorable or unhealthy that occur in the absence of clinical cardiovascular disease. Modifiable RFs include: depression, midlife hypertension, physical inactivity, diabetes, midlife obesity, hyperlipidemia and smoking.
  6. One report on approaches to dementia modeled the life course of modifiable RFs and estimated that 35% of dementia cases could be prevented if known RFs - including obesity, hypertension, depression, smoking, physical inactivity, diabetes, hearing impairment, less education and social isolation - were eliminated.
  7. Newer data show that modifiable RFs, including hypertension, diabetes and smoking in middle-life, accelerate cognitive decline in older age and increase the odds of cognitive decline in middle-age.
  8. A focus on the AHA’s Life’s Simple 7 can address risk factors and optimize brain health.
  9. Other factors that should be considered in preserving brain health are alcohol use consumption, education level, mood: depression, hearing deficits, problems social engagement, and sleep. All can play a part in cognitive decline.
  10. The primary care setting can provide comprehensive coordinated care, continuity of care in the clinician-patient relationship, promotion of over-all health including brain health, secondary prevention using AHA’s Life’s Simple 7 as a guide. Primary care is the right setting for practice-based efforts to prevention or postpone cognitive decline among Americans.


Lazar RM, Howard VJ, Kernan WN, Aparicio HJ, Levine DA, Viera AJ, Jordan LC, Nyenhuis DL, Possin KL, Sorond FA, White CL; on behalf of the American Heart Association Stroke Council. A primary care agenda for brain health: a scientific statement from the American Heart Association [published online ahead of print March 15, 2021]. Stroke doi: 10.1161/STR.0000000000000367