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Ronald M. Lazar, Ph.D.Ronald M. Lazar, Ph.D. In 2022, The University of Alabama at Birmingham launched a research pilot project called the Brain Health Advocacy Mission (BHAM), which provides brain health lifestyle strategies to patients at two UAB Family and Community Medicine Clinics.

BHAM's primary objective is to develop individualized plans for preventing cognitive decline while encouraging study participants to make better choices in improving their brain health.

“Brain Health successfully enrolled 100 patients from the UAB Highlands and Hoover Clinics for its initial phase,” said principal investigator Ronald M. Lazar, Ph.D., Evelyn F. McKnight Endowed Chair for Learning and Memory in Aging and director of the Evelyn F. McKnight Brain Institute at the UAB Heersink School of Medicine. “Currently, the study is in the process of conducting follow-ups with these participants. As Phase II of the BHAM study begins, the enrollment process is set to restart in the two clinics, UAB Highlands and Hoover Family and Community Medicine Clinics.”

To be eligible to participate in the Brain Health study, patients must meet specific criteria, including 18 years of age and older, and have no history of mild cognitive impairment, neurologic disease, or injury that would affect cognition, stroke, or cancer.

Following enrollment, study participant information is entered into a secure registry database. A newly expanded version of the McCance Brain Care Score is administered for a more comprehensive look at participant lifestyle behaviors. This scoring system enables study personnel to have more excellent knowledge of the various aspects of a participant’s brain health and lifestyle choices.

“A notable trend has emerged from analyzing data from the initial 100 BHAM pilot project participants,” said Lazar. “There was an unexpected history of anxiety and depression among these individuals. The investigators believe these mental health conditions may reflect the impact of social determinants on overall brain health.”

As the investigators proceed with the BHAM study, results will likely contribute to a better understanding of the relationship between multiple lifestyle factors and brain health. This knowledge will further inform future strategies and interventions to promote better brain health outcomes for individuals.

The research team’s initial discoveries are primarily based on analyzing baseline data from the first 100 participants, with ongoing follow-up. Preliminary results find the average individual enrolled in the project is obese (using body mass index, or BM, as the weight measure), rarely exercises, and has a poor diet, which may explain why about half of the cohort has a history of hypertension. Also, a quarter of participants have a history of treated anxiety or depression; however, only two percent of the cohort chose stress reduction as a lifestyle target they wanted to address.

“In response to this finding, we have incorporated more comprehensive questionnaires to address stress and anxiety,” Lazar said.
Over the past year, the BHAM pilot project has achieved significant milestones and made commendable progress. The BHAM team has welcomed Amy Knight, Ph.D., ADDP, associate professor in the Department of Neurology’s Division of Neuropsychology with expertise in stress management, who will offer future behavioral health consultations to support individuals whose personal lifestyle goal is to focus on decreasing stress. With the opportunity to meet with a skilled behavioral clinician, the study team hopes that more participants will actively consider a focus on their levels of stress.

Furthermore, the investigators have secured a $150,000 grant from the McCance Center for Brain Health at Mass General Brigham, matched by funds from UAB McKnight, to explore how exercise may reduce hypertension by increasing growth factors that promote blood vessel growth. In collaboration with Edmund Arthur, O.D., Ph.D., FAAO assistant professor of Optometry, they will use Optical Coherence Tomography Angiography (OCT-A) to non-invasively examine the retina for changes in vascular density.

“Looking ahead, the BHAM team is highly interested in expanding their program to other Primary Care and Family Clinics outside the Birmingham Metro Area, and they are seeking new collaborators to serve as "brain health champions" in all locations,” said Lazar.