Boosting Brain Health in Later Life

On Dec. 8, 2023, the American Association of Geriatric Psychiatry (AAGP) and Baker Institute held their first Brain Health Summit. Chaired by Dr. Helen Lavretsky, president of the AAGP, the virtual gathering included invited speakers, stakeholders, and Baker Institute brain health fellow Dr. Harris A. Eyre.

This report summarizes issues discussed at the summit and outlines key strategies that emerged from discussions held at the event. View a recording of the summit here.

Dementia Rate and Risk Reduction

Dr. Bruce Miller, founding director of the Global Brain Health Institute (GBHI) at the University of California, San Francisco (UCSF), opened the summit with Dr. Kristine Yaffe from UCSF and Dr. Brian Lawlor of GBHI and Trinity College Dublin to discuss their work protecting aging populations around the world. The group described how — in their clinical trials to reduce dementia rates in low and middle-income communities — they include underserved communities via the GBHI international fellowship program, which aims to train future leaders in the field of brain health. Their collaboration is an example of a global brain health movement focusing on the modifiable lifestyle factors for dementia risk reduction.

Brain Capital and Supporting Brain Health

Dr. Harris A. Eyre presented an update on the recent efforts of the Brain Capital Alliance and the Baker Institute, highlighting the importance of supporting brain health against the impact of climate extremes, pandemics, chronic stress, and plastic pollution. Citing the negative socioeconomic impacts of neglecting brain health, he stressed the need for a system-level approach and transdisciplinary collaboration and the importance of investing in brain capital to address societal challenges and drive innovation.

Eyre noted that the book "Convergence Mental Health: A Transdisciplinary Approach to Innovation" — which he co-edited with AAGP experts, Lavretsky, Dr. Charles Reynolds, and Michael Berk — served as inspiration for the development of the brain capital movement. Eyre also referred to the AAGP position statement that he recently co-authored with many AAGP experts in the American Journal of Geriatric Psychiatry: “Life-Course Brain Health as a Determinant of Late-Life Mental Health: American Association for Geriatric Psychiatry Expert Panel Recommendations.”

Work Throughout the Brain Health Field

Other speakers — including Dr. Mitchell Elkind from the American Heart Association (AHA) and Columbia University, Sarah Lock of AARP, David Evans of the American Academy of Neurology (AAN), and Courtney Closke of the Alzheimer’s Association — discussed the roles of their respective organizations in the field of brain health. All were eager to explore opportunities for collaboration and agreed on the importance of training the next generation of experts. The changing narrative around dementia care and prevention efforts was another theme, as well as advocacy for older adults and their families and caregivers.

Baycrest Research and Initiatives

Dr. William “Bill” Reichman of Baycrest and the University of Toronto, former president of the AAGP and the International Psychogeriatrics Association (IPA), was the final speaker. He described the very successful and innovative Baycrest Centre for Brain Health and Aging Innovation (CABHI) programs, which offer senior health and residential care, along with research initiatives. CABHI has established 165 sites across the U.S. and Canada to support promising solutions for aging and brain health. He stressed the need for sustained research contributions in the senior care sector and mentioned various initiatives and programs related to brain health. The session concluded with Reichman announcing that Baycrest secured an additional $106 million Canadian dollars in funding.

New Directions and Collaborations

Social Determinants of Health

Researchers and academic leaders of the AAGP then discussed new directions and collaborations that stress the importance of brain health and the need for a transdisciplinary approach that addresses the social determinants of brain health and the risk of inequities. They suggested reaching out to those who could benefit most and discussed the interconnectedness of brain and mental health.

The conversation concluded on a positive note, with Dr. Kiran Rabheru from the University of Ottawa proposing a human rights-based approach to addressing social determinants of health. The group agreed on the importance of incorporating recent advances in neuroscience into the framework of brain health and decided to explore this further through longitudinal cohort studies.

Dementia and Mental Disorder

Dr. Benoit Mulsant of the University of Toronto pointed out the interplay between cognition and mental health, noting the importance of focusing on dementia and severe mental illness.

All agreed that two ways to help reduce or prevent the mental disorders of aging would be to 1) successfully treat mental disorders in younger adults, children, and adolescents when issues first arise, and 2) start prevention early by training young people in brain health techniques, using music and stress reduction.

Use of Biomarkers in Research

Dr. Breno Diniz from the University of Connecticut focused on the use of biomarkers of biological aging through the life span to examine the effect that early trauma in younger patients may have in later life. The potential of using biomarkers to identify those at higher risk for Alzheimer’s disease and other dementias was suggested by Dr. Paul Newhouse of Vanderbilt University, who also advocated considering what biological and psychological markers should be recommended for optimal brain health.

Strategies for the Future

The importance of collaborations across different disciplines and the potential for these to benefit career development programs was highlighted by Dr. Olu Ajilore from the University of Illinois at Chicago. Editor-in-Chief of the American Journal of Geriatric Psychiatry, Dr. Charles Reynolds of the University of Pittsburgh, urged a staging approach to understand risk and protective factors for brain health by instituting four levels of prevention strategies:

1. Primordial — social determinants of health in the general population.
2. Primary — general population.
3. Secondary — at risk groups.
4. Tertiary — in patients with conditions.

Finally, they also discussed the need to consolidate and clarify information for the general public.

Next Steps in the New Year

The summit concluded with plans to continue the conversation at the 2024 AAGP Annual Meeting, to take place in Atlanta, Georgia, on March 15–18, 2024, and to organize a steering committee for the AAGP Brain Health Initiative.

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