A Preventive Neurology Perspective on Promoting Brain Health and Preventing Cardiovascular Disease

BackgroundWith the deepening of population aging, the disease burden associated with brain health in older adults is increasingly severe. To develop targeted strategies for promoting brain health among older adults, it is essential to first understand their awareness of brain health as well as their motivations and barriers to health promotion. This study aims to explore older adults’ cognition and attitudes toward brain health, along with their needs and preferences regarding brain health promotion.MethodsIndividual, face-to-face and semi-structured interviews were conducted with 17 older adults from Zhengzhou, Henan Province. Questions, used in our study, focused perception of brain health, attitudes and beliefs toward brain health promotion, and needs and preferences regarding brain health promotion. Responses were analyzed using inductive qualitative content analysis.ResultsThe following themes and sub-themes were identified: (1) Multidimensional yet compartmentalized brain health perceptions, including physiological function, disease association, psychological well-being, behavioral coordination; (2) Diverse attitudes toward brain health promotion, including proactive prevention, cognitive-behavioral dissonance, fatalistic neglect; (3) Intrinsic motivators for brain health promotion, including health awareness, quality of life, family responsibility, disease-related anxiety; (4) External support as a moderating factor in brain health promotion, including family support, peer support, community support; (5) Barriers to brain health promotion activities, including physical limitations, role conflict, cognitive misconceptions, information quality; (6)Needs and preferences for brain health promotion, including authoritative yet practical content, and diversified age-friendly formats.ConclusionsOlder adults have a compartmentalized understanding of brain health, often accompanied by misconceptions and tend to hold negative attitudes toward brain health promotion, highlighting an urgent need for professional guidance to provide correct education and direction. Our study reveals that effective brain health promotion requires enhancing internal motivation, building external support networks, and overcoming implementation barriers through integrated strategies, while crucially tailoring approaches to individual needs and preferences for maximum effectiveness.

We sought to understand healthcare workers' (HCW) cardiovascular disease (CVD) prevention knowledge, attitudes, and practices to help inform future healthcare policies and optimize preventive cardiology care. Data was collected via an anonymous, online questionnaire which consisted of pre-validated CVD prevention and smoking cessation scales adapted from the Preventive Medicine Attitudes and Activities Questionnaire. Six hundred sixty-eight HCWs (60.5% doctors, 27.8% nurses, 11.7% medical students) from 25 nations responded to the survey. Overall, 74.9% of HCWs routinely assessed patients' cardiovascular risk profiles in clinical practice. About 65.7% of HCWs counselled patients who were asymptomatic for CVD on tangible lifestyle changes to improve their cardiovascular risk profiles, while 68.2% of HCWs did so when patients were overweight. Of note, only 51.3% of HCWs implemented comprehensive smoking cessation interventions for their patients. Practising HCWs demonstrated higher levels of CVD prevention promotion than medical students in all aspects, except for self-reported importance of CVD risk factor counselling (Tukey honestly significant difference diff: 0.31, P-value: .051). Among practising HCWs, there were no significant differences in their CVD prevention practices across varying lengths of clinical practice. HCWs from higher income nations tended to fare worse than their lower income counterparts. A large multi-national survey reveals significant gaps in the promotion of CVD prevention by HCWs. Significant differences between medical students and practising HCWs' CVD prevention behaviours, highlight the role of education for the promotion of long-term positive CVD prevention practices. Further efforts should target the medical education of early-career HCWs, especially in higher income nations. Key message What is already known on this topic: The importance of lifestyle modification for the primordial prevention (risk factor prevention) and primary prevention (risk factor management) of cardiovascular disease (CVD) is indisputable. Studies have shown that physicians and other healthcare workers (HCWs) may be best placed to encourage tangible lifestyle changes and enact meaningful modification in patients' cardiovascular health-related behaviours. What this study adds: However, in practice, the role of HCWs in monitoring and encouraging patients' health behaviours is complicated by the challenges of real-life clinical practice, such as time constraints or lack of manpower. Hence, this large multi-national survey sought to understand HCWs' CVD prevention knowledge, attitudes, and practices to help inform future healthcare policies and optimize preventive cardiology care. How this study might affect research, practice, or policy: This study reveals significant gaps in the promotion of CVD prevention by HCWs, highlighting key differences in CVD prevention practices based on profession, level of training, subspecialty, and national income status. Nurses, cardiology subspecialists, and HCWs from lower middle-income nations were found to be more proficient in promoting CVD prevention compared to their counterparts. Further efforts should target the medical education of undergraduate HCWs, especially in higher income nations, as established clinical practices learned during clinical education typically persist and are resistant to change over time.

WHO launches its Global Action Plan for brain health

The rise in incidence of age-related cognitive impairment is a global health concern. Ageing is associated with a number of changes in the brain that, collectively, contribute to the declines in cognitive function observed in older adults. Structurally, the ageing brain atrophies as white and grey matter volumes decrease. Oxidative stress and inflammation promote endothelial dysfunction thereby hampering cerebral perfusion and thus delivery of energy substrates and nutrients. Further, the development of amyloid plaques and neurofibrillary tangles contributes to neuronal loss. Of interest, there are substantial inter-individual differences in the degree to which these physical and functional changes impact upon cognitive function as we grow older. This review describes how engaging in physical activity and cognitive activities and adhering to a Mediterranean style diet promote 'brain health'. From a physiological perspective, we discuss the effects of these modifiable lifestyle behaviours on the brain, and how some recent human trials are beginning to show some promise as to the effectiveness of lifestyle behaviours in combating cognitive impairment. Moreover, we propose that these lifestyle behaviours, through numerous mechanisms, serve to increase brain, cerebrovascular and cognitive reserve, thereby preserving and enhancing cognitive function for longer.

Most cardiovascular disease (CVD) related risk factors are prevalent in children and adolescents, especially obesity, elevated blood pressure (BP) and increased unhealthy lifestyle. To prevent CVD in adulthood, it is necessary to attach importance to the prevention and control of CVD risk factors in childhood. Of note, the prevention of childhood obesity is key measure, the control of childhood BP is the first goal, and the development of healthy lifestyle is important basis. The prevention and control of CVD risk factors in childhood can benefit the future prevention and treatment of CVD in adulthood, provide scientific base for the prevention and intervention of cardiovascular risk factors in childhood, and provide new perspective for the early prevention of cardiovascular diseases in adulthood.

Prevention of Cardiovascular Disease in Persons with Type 2 Diabetes Mellitus: Current Knowledge and Rationale for the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial

BackgroundLatino/a/e/x caregivers of children or individuals with disabilities or developmental delays face significant stress, which increases their risk for cognitive decline, including Alzheimer's disease and related dementias. While Mindfulness‐Based Interventions effectively reduce stress and promote brain health, culturally tailored programs for this population remain limited. The purpose of this study is to describe the acceptability and feasibility of culturally tailored mindfulness workshop that promotes brain health among Latino/a/e/x caregivers.MethodTwo workshops were conducted in 2024consisting of six weekly one‐hour sessions incorporating mindfulness techniques. Sessions were conducted in Spanish, with supporting materials tailored for cultural relevance and practical application. In the final session of each workshop, participants shared feedback on how the program helped them better understand their stress responses and behavioral patterns.ResultA total of 23 caregivers participated in the workshops hosted by both organizations, with 69.57% attending at least five of the six sessions. During the final session, participants reported a deeper understanding of how stress manifests in their daily lives, including its physical effects such as headaches, fatigue, and muscle tension, as well as its emotional impact, such as irritability and feelings of being overwhelmed. Also, participants highlighted the value of emotional regulation techniques in diffusing tense situations with their families. Others noted that the group discussions fostered a sense of belonging, helping them feel less isolated in their caregiving challenges. Host organizations emphasized that the program was highly relevant to the caregivers' needs and aligned with their cultural values and experiences. However, both programs faced challenges related to scheduling. Sessions rarely started on time, as adjustments were often required to accommodate participants' arrival and to ensure adequate session completion. This logistical issue impacted the overall timing and required flexibility from facilitators.ConclusionThese pilot programs demonstrate that culturally adapted mindfulness workshops are feasible and effective in addressing stress among Latino/a/e/x caregivers of children with or without disabilities. These interventions show promise for improving brain health and well‐being in underserved populations.

Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review

Optimizing Cardiovascular Health Worldwide: The Global Cardiovascular Nursing Leadership Forum.

Funding Acknowledgements Type of funding sources: None. Introduction In 2012, coronary heart disease and stroke are the leading causes of death worldwide, accounting for more than 31% of deaths from all causes. In 2020, PH statistics showed that ischemic heart diseases were the leading causes of death in the Philippines (PH), responsible for 17.3% of the total deaths. Objective To determine the knowledge, perceptions, insights and attitudes on cardiovascular disease (CVD) prevention, personal health-related lifestyle practices, and lifestyle counseling practices of selected female physicians who are practicing or training in the PH through an online survey. Methods A descriptive ambispective cross-sectional study where the survey questionnaire of Ameh, et al. (2019) was modified with the authors' permission, was conducted online and answered by consenting female physicians. 484 participants’ data were collated and analyzed. Results Majority had accurate responses for the CVD prevention knowledge items (Figures 1 and 2). Among the participants, 36.98% had hypertension, 32% were obese, 28.5% had dyslipidemia, and 17.2% had diabetes mellitus. Sleep of 6-8 hours is practiced by 60.33%, 53.51% eat vegetables and fruits daily, 55.79% prefer fish and seafood, 89.05% do not smoke, 61.2% take coffee or black tea daily, 84.51% have no regular exercise, and 30.79% of those who do only exercise for 10-20 minutes. Moreover, 67.98% add salt, soy or fish sauce to their meals, and 72.73% do not drink enough water daily. In addition, 44.42% do not undergo annual general check-up and 58.06% do not have a personal physician. Limitations due to COVID-19 pandemic, lack of education, and expensive screening tests are perceived to be major barriers to CVD screening. More than 90% of our participants practice health teachings on diabetes mellitus prevention, high blood pressure screening, cholesterol screening and management, nutrition, and weight management. Counseling on regular exercise, smoking, and alcohol abuse are being practiced by 88.02%, 85.74%, and 83.88% of our respondents, respectively. Conclusion There are female physicians who are not aware of the World Health Organization’s recommendations on the prevention of CVD, who do not do health teaching and counseling, and who practice unhealthy lifestyle. Changing physicians’ knowledge and behavior towards CVD prevention is a great challenge to improve standards of CVD prevention. Improvement and enhancement in education of both physicians and patients, together with more consultation time, financing for CVD prevention, and comprehensive, multidisciplinary preventive cardiology programs supported by government and societies in favor of prevention are some of the best ways to improve management of CVD risk factors and prevention.

Cardiology Patient Page. C-reactive protein: a simple test to help predict risk of heart attack and stroke.

The goal of this American Heart Association Guide for Improving Cardiovascular Health at the Community Level (AHA Community Guide) is to provide a comprehensive inventory of evidence-based goals, strategies, and recommendations for cardiovascular disease (CVD) and stroke prevention that can be implemented on a community level. This guide advances the 2003 AHA Community Guide1 and the 2005 AHA statement on guidance for implementation2 by incorporating new evidence for community interventions gained over the past decade, expanding the target audience to include a broader range of community advocates, aligning with the concepts and terminology of the AHA 2020 Impact Goals, and recognizing the contributions of new public and private sector programs involving community interventions. In recent years, expanding arrays of programs and policies have been implemented in increasingly diverse communities to provide tools, strategies, and other best practices to potentially reduce the incidence of initial and recurrent cardiovascular events. The AHA Community Guide complements the AHA statement entitled “Population Approaches to Improve Diet, Physical Activity, and Smoking Habits”3 and supports the AHA 2020 goal4 to “improve the cardiovascular health of all Americans by 20%, while reducing deaths from CVDs and stroke by 20%.” The present AHA Community Guide supports the AHA 2020 goal by identifying exemplary regional or national programs that encourage cardiovascular health behaviors and health factors (formerly addressing risk behaviors and risk factors) from which communities might acquire proven strategies, expertise, and technical assistance for improving cardiovascular health. The AHA Community Guide seeks to prevent the onset of disease (primary prevention) and to maintain optimal cardiovascular health (primordial prevention) among broader segments of the population. Prior research indicates that using public health strategies such as sodium reduction in processed foods to lower blood pressure,5–8 tobacco laws to promote smoking cessation,9–11 and modification of …

Adults with intellectual and/or developmental disabilities (IDD) face increased risks of age‐related health issues, including dementia, yet current brain health initiatives often overlook the needs of this unique population. To address this gap, our team developed the Brain Health‐IDD program ‐ a co‐designed virtual education initiative aimed at promoting brain health among aging adults with IDD (aged 40+), and family caregivers. The program utilizes an integrated Knowledge Mobilization (KMb) approach, engaging individuals with lived experience, community members, and professionals throughout the co‐design process to ensure relevance and inclusivity.Family caregivers of individuals with IDD are at a heightened risk of developing dementia themselves, due to the chronic stress associated with the caregiver role. Although some supports focus on assisting aging parents and siblings supporting these individuals, minimal attention has focused on the long term impacts of caregiving on their brain health. The Brain Health‐IDD Family course aims to mitigate this risk by providing caregivers with critical information on brain health, stress management, and strategies for improving their own cognitive and physical well‐being. By improving caregiver self‐efficacy, the program seeks to reduce stress, promote resilience, and ultimately improve the long‐term health outcomes for caregivers, in addition to the individuals they support. Because the program is virtual, it is available to aging family caregivers from across Canada, and not reliant on local expertise.The Brain Health‐IDD Family course consists of 6 weekly 90‐minute virtual sessions, co‐led by interdisciplinary teams of caregivers, brain health experts and clinician scientists. The primary objectives of the program are to encourage changes in health behaviors, physical and mental well‐being, and the initiation of cognitive screening among participants. To evaluate impact of our Program, we use a mixed‐methods, pre‐post study to collect caregivers’ outcomes at baseline, 7 weeks (post‐intervention), and 18 weeks. Data from satisfaction surveys, qualitative interviews, and open‐text surveys from the first cohort have informed the iterative refinement of course content and delivery. The third cohort will participate in the program between February and March of 2025, with analysis completed on over 100 aging family caregivers by summer of 2025.

Primary care clinicians are mostly the initial point of contact in providing patient care; however, many clinicians report inadequate training and a lack of confidence in promoting brain health among their patients from a nutrition perspective. This participatory mixed-methods study evaluated the impact of a Project ECHO® pilot program on clinicians' perceived self-efficacy in promoting brain health through nutrition among Latino older adults in South Texas. Employing an explanatory sequential design, a training curriculum was designed for primary care clinicians using the Project ECHO® model. Four virtual sessions were provided once a week on nutrition-related topics through the videoconferencing platform Zoom. Quantitative data were collected via pre- and post-program surveys (N = 13) and analyzed using the Wilcoxon signed-rank test in GraphPad Prism Version 10.6.0 to inform subsequent qualitative interviews. Thematic analysis was conducted to examine the transcripts from individual interviews with 4 of the 13 participating clinicians using Taguette (Version 1.3, Open-Source Software). Data indicated a statistically significant increase in mean self-efficacy scores among clinicians following program participation (P < .005). Participant satisfaction with the program exceeded 90%, and clinicians intended to integrate nutrition into brain health counseling with patients. Thematic analysis of individual interviews identified 3 key themes, including perceived training outcomes, evaluation of the study design, and suggested areas for program improvement. Findings suggest that the Project ECHO® Nutrition and Brain Health program is a feasible intervention for improving clinician self-efficacy in delivering nutrition-based brain health care to Latino older adult populations. Future research should examine whether enhanced self-efficacy translates into practice change and improved patient outcomes.

Background Evidence-based digital health interventions (DHIs) can aide cardiovascular disease (CVD) prevention (e.g., though telemonitoring, mHealth apps, etc). Despite this, the global uptake of DHIs in CVD prevention remains slow [1]. Healthcare providers (HCPs) often fulfil the role of gatekeepers and implementers of DHIs for patient care and their perspectives are valuable to understand barriers and facilitators of DHI uptake. Purpose The purpose of this study was to synthesise barriers and facilitators to DHI uptake in CVD (primary and secondary) prevention reported in the international scientific literature from the perspectives of HCPs. Methods We conducted a systematic review of qualitative and quantitative primary studies published January 2020 to May 2024 which explored HCPs’ perspectives of DHIs in CVD prevention. Excluded were non-peer reviewed articles, review papers, studies with non-generalisable feedback on a specific product, and studies with non-patient-facing digital tools. We retrieved records from Ovid MEDLINE, EMBASE, CINAHL, ACM Digital Library, Web of Science, Google scholar, IEEE Xplore, and Scopus. We used the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields to assess the quality of included studies [2]. For this abstract, we present partial findings of the systematic review pertaining to the qualitative data extracted from included studies. We extracted and coded reported barriers and facilitators according to an inductively created codebook and categorized each to one of four roadblocks described by the World Heart Federation roadmap on digital health in cardiology: ‘health system’, ‘health workforce’, ‘patient’ and ‘technological’ [1]. We used vote counting to describe which barriers and facilitators are most prevalent across studies. Results A total of 7,638 search results from the databases was retrieved. Following de-duplication and abstract/full-text screening, 110 studies reporting qualitative findings were included. Our findings represent a total of 2,594 HCP perspectives with their geographic distribution shown in figure 1. Study quality was median 80% (range 40-100%) out of a possible 100%. Across all categories ‘health system’, ‘health workforce’, ‘patient’ and ‘technological’, we extracted 82 barriers and 84 facilitators from the perspectives of HCPs. Table 1 shows all barriers and facilitators reported in ≥11 (10%) of included studies. Conclusion Our findings provide a global perspective on the current factors encouraging and hindering HCPs from adopting DHIs into their practice. Implementation scientists can use these findings to plan best approaches for efficient and long-term uptake of DHIs in CVD prevention. Overall, our findings align with the World Health Organization (WHO) Global Strategy on Digital Health 2020-2025 strategic objective 4: advocating for people-centred health systems that are enabled by digital health.Geographic distribution of respondents Barriers and facilitators