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An International Initiative to Improve Dementia Care and Research

ARTICLE IN BRIEF

Geriatricians and neurologists at the University of California, San Francisco and Trinity College Dublin have launched an international training program designed to improve efforts to diagnose dementia, treat and manage patients, and implement dementia education and prevention programs.

In an effort to improve dementia care across the globe, neurologists at the University of California, San Francisco (UCSF) and Trinity College Dublin have joined forces to launch an international training program for physicians and health care professionals.

The initiative, known as the Global Brain Health Institute (GBHI), will recruit and train 120 physician-fellows and 480 health professionals in the US, Ireland, and countries in Latin America, Asia, Africa, and Australia over the next 15 years.

“The goal is to train fellows and scholars to carry out research on dementia, deliver state-of-the-art dementia care, and change practices and policies in their regions,” said Victor Valcour, MD, PhD, a professor of geriatric medicine with shared appointments in neurology and geriatric medicine at UCSF. Dr. Valcour is heading up the GBHI with Bruce Miller, MD, FAAN, director of the UCSF Memory and Aging Center, and a team at Trinity including Ian Robertson, PhD, Brian Lawlor, MD, and Rose Anne Kenny, MD.

“We have designed a comprehensive public health approach to address vascular risk factors like high blood pressure and cholesterol and enhance lifestyle factors such as exercise, diet, and social connectedness that we know are important for brain health,” Dr. Miller said.

Faculty at both institutions will instruct the participants in basic science, geriatrics, psychiatry, health law, public policy, health economics, and communication. The fellows will spend a major part of their training learning how to diagnose dementia and treat and manage patients. They will also learn how to help caregivers reduce stress and improve care for their loved ones.

The GBHI teams at UCSF and Trinity have been designing the training program for over a year; the program launched earlier this month in Cuba.

“We co-hosted a conference with Pedro Antonio Valdes-Sosa [PhD, general vice-director for research at the Cuban Neurosciences Center in Havana] and his team to bring health professionals together to think about ways to work together and set up a dialogue about preventing dementia,” said Dr. Miller.

As part of the pilot program, the GBHI will conduct a study in collaboration with the Cuban Neurosciences Center to determine whether computerized EEG can be used as a sensitive early indicator of neurodegeneration and possibly as a modifiable biomarker of efficacy in clinical interventions for dementia.

This technology is now used across the country to detect hearing loss, and the investigators will assess whether it could also be used to detect early signs of dementia, Dr. Valcour said. “We are designing ways to make our evaluations more portable.”

The GBHI is looking to partner with other countries to understand local practices and see how different regions would benefit from programs targeting dementia prevention, he said.

“Our fellows will learn how to help isolated elderly people at risk and work with families in caring for people with dementia,” Dr. Valcour said. “They will gain experience with our pilot programs for stroke prevention and use it to help educate people about how to reduce the risk for dementia.”

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DR. BRUCE MILLER: “We have designed a comprehensive public health approach to address vascular risk factors like high blood pressure and cholesterol and enhance lifestyle factors such as exercise, diet, and social connectedness that we know are important for brain health.”

Among the pilot programs being offered by the GBHI is a patient and family-centered care navigation program called the Care Ecosystem, led by Kate Possin, PhD, an assistant professor of neuropsychology at the UCSF Memory and Aging Center, which will be available on the GBHI caregiver portal. Fellows and scholars will be trained to help individuals use the Ecosystem to educate, manage, and provide psychological supports for caregivers and patients. It is designed to teach caregivers to be proactive in caring for people with dementia.

UCSF has been collecting data from a study of 1,400 caregivers in which half are using the Care Ecosystem program and half are receiving more traditional services, Dr. Miller said. The key will be translating this program to serve poor and underserved regions where language barriers, cultures and beliefs, and diminished resources make it hard to help people with dementia, he said.

Physicians who apply to become a fellow must commit to two years of training at either UCSF or Trinity College. There will be eight new candidates a year during the 15-year program.

THE TRAINING PROGRAMS

In addition, as part of an Exchange Scholars Program, 32 training spots will be available for those who want a shorter stint at the medical centers. Training will be available to doctors, nurses, and public health professionals, as well as people with a broad range of skills, including health economists, writers, artists, and poets. They can study for a few months or up to one year.

GBHI's commitment does not end when the fellows and scholars return to their communities, said Dr. Miller. “They will have access to career-long mentoring as they establish and implement dementia education and prevention programs,” he said, adding that the program hopes to make funding available for them to implement their ideas in their communities.

The second year of the fellowship will be devoted to a specific research project. As an example, Dr. Robertson of Trinity College said he and his colleagues hope fellows will help mine data from their Irish Longitudinal Study on Aging to better understand who will succumb to dementia in old age.

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DR. VICTOR VALCOUR: “The goal is to train fellows and scholars to carry out research on dementia, deliver state-of-the-art dementia care, and change practices and policies in their regions.”

“There are so many factors that come into play in dementia, and we don't know the relative contribution of each of these factors,” Dr. Robertson said. Such information will help focus interventions, he added.

GBHI has also created an Elder Ambassador Program that promotes volunteerism as a way to protect brain function and encourages others to volunteer; researchers are also testing a separate program developed at Trinity that will teach volunteers to deliver psychosocial interventions to at-risk elderly people living alone at home.

GBHI was developed with a $177 million grant from Atlantic Philanthropies, a foundation started in the early 1980s by Charles (Chuck) Feeney, an 84-year-old California businessman. Atlantic Philanthropies has had a strong relationship with UCSF, contributing $394 million in funding for three major research buildings and other projects on the UCSF campus.

Chris Oechsli, president and chief executive officer of Atlantic Philanthropies, said the foundation is completing its grant-making by 2016 and wanted to address aging and brain health. “Chuck Feeney sees aging well as a big challenge and a big opportunity,” he said. “We are investing in people already addressing these problems.”

LINK UP FOR MORE INFORMATION:

•. The Global Brain Health Initiative: http://www.gbhi.org