Mind the Future

How the Trager Optimal Aging Clinic is putting brain health first 

Changes in brain function don’t always follow a major event or diagnosis. Instead, they can appear gradually - subtle delays in recall or moments of confusion that quietly build over time. What some dismiss as normal aging can, in fact, signal the early stages of cognitive decline.

While many adults begin to notice these small memory lapses in their 50s, often they don’t realize they can be part of a larger, preventable story. 

“There is this misconception that nothing can be done about dementia,” explains Josephine Gomes, medical director of the Brain Health and Dementia Care program at the University of Louisville’s Trager Optimal Aging Clinic. “But interventions are available, and early diagnosis is crucial to their effectiveness.”

However, cognitive screenings are not a part of the annual wellness visit, until age 65 when one enrolls in Medicare. “By this time some people are already downstream in the disease process. The greatest opportunity is in midlife, when the most number of modifiable risk factors for brain health can still be changed,” Gomes said.

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Without early screening or education, both patients and providers often overlook cognitive changes, delaying the lifestyle interventions that may help prevent decline altogether. It’s a narrative that clinicians at the Trager Institute Optimal Aging Clinic, a comprehensive center dedicated to helping people thrive as they age, are determined to change.

Thanks to over half a million dollars in funding from the Lilly Foundation, the Trager Institute aims to reach patients before they’re diagnosed with dementia by embedding proactive cognitive care into routine checkups for all adults starting at age 50. This approach, dubbed the FlourishCare Cognitive Health Integration and Risk Reduction Initiative, is based on research that shows midlife is often when patients experience brain changes, and that lifestyle adjustments during this time could prevent or delay nearly half of all dementia cases worldwide. 

“By talking to patients at age 50, we may be able to delay or potentially prevent cognitive disease,” Gomes said. “Alzheimer’s and dementia have prolonged courses with many years of independent functioning early on, and if you incorporate lifestyle changes, you can delay the impact of these diseases even more."

To shift the perspective on dementia from a condition that can only be treated to one that can also be prevented, providers at the Trager Institute Optimal Aging Clinic know they must work to destigmatize conversations around memory loss and cognitive changes by promoting brain health throughout the entire lifespan. 

“It’s not something you need to wait until you’re experiencing changes to talk about. We talk about what you can do to keep your heart healthy, but it’s not as common when you’re in your 50s to talk about the things you’re doing now to keep your brain healthy for longer,” said Beth Pace, program manager at the Trager Institute.

Often patients in their 40s and 50s fear being dismissed by their doctors when expressing concerns about brain function. By introducing the topic of brain health early, the Trager Institute’s new program hopes to build resilience, normalizing conversations that are often clouded by stigma. 

“By affirming that cognitive change is a part of life, we empower people to take a more proactive approach and lower their risk,” Pace said.

Integrating prevention into practice

For patients already diagnosed with dementia, the Trager Institute offers a comprehensive, interdisciplinary care program designed to help Medicare beneficiaries and their caregivers navigate healthcare obstacles, access diagnostics and therapeutics, and find education and support. Funding from the new Lilly Foundation grant helps expand this mission by reaching patients before diagnosis, with the goal of making early education and prevention a part of standard patient practice. 

Currently, there is no documented education provided to patients explaining the connection of dementia to conditions like hearing and vision loss, obesity, depression, diabetes or high cholesterol. By addressing key modifiable risk factors like these, the brain health team at the Trager Institute aims to help patients connect the dots and expand cognitive screening and brain health awareness.

Anna Faul, executive director of the Trager Institute, explains how this effort reframes from cognitive health through the lens of a public health approach. “Our goal is to talk about dementia just like you would talk about high blood pressure. Currently clinical systems are not set up to implement this kind of strategy, and without standardized workflows and tools, even evidence-based methods will fail to translate into everyday practice.”

The new FlourishCare initiative will help standardize workflows for annual preventative visits, including processes for cognitive health discussions. Recognizing that these can be difficult conversations, the team is developing training for both providers and patients to help them navigate cognitive health conversations with greater confidence and care. 

“It’s just as important for patients to know they can ask these questions as it is for providers to know how to lead the conversation on what is considered a sensitive topic,” Faul said.

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Once patients at risk have been identified during their annual visits, providers will work to develop a personalized cognitive health plan. These plans will be implemented by a team of care navigators and social workers trained to guide patients through the cognitive health journey.

The Trager Institute’s interdisciplinary team and collaborative approach to aging and wellness uniquely position them to deploy these integrated health plans. On site, the institute offers tai chi, yoga and exercise coaching to promote movement and balance, community nutrition classes in its culinary medicine kitchen, as well as social clubs and art sessions that foster connection and creativity. Behavioral health services are also embedded within the clinic to ensure accessible mental health support. Together, these programs address the key lifestyle and social factors known to reduce dementia.

The FlourishCare initiative will launch at the Optimal Aging Clinic before expanding to Cardinal Station and Mary & Elizabeth Hospital, with plans to scale across the UofL Health system and other primary care practices in the region. Faul’s team hopes to see 80% of patients age 50 and older receive annual cognitive health assessments and personalized plans.

Looking ahead, the Trager Institute’s vision is about more than early detection. It’s changing how we think and talk about brain health - reshaping the culture around cognitive wellness, one conversation, and one patient, at a time.