The Scottish Brain Health Service Model: Rationale and Scientific Basis for a National Care Pathway of Brain Health Services in Scotland.

In order to address the oft-cited societal, economic, and health and social care impacts of neurodegenerative diseases, such as Alzheimer's disease, we must move decisively from reactive to proactive clinical practice and to embed evidence-based brain health education throughout society. Most disease processes can be at least partially prevented, slowed, or reversed. We have long neglected to intervene in neurodegenerative disease processes, largely due to a misconception that their predominant symptom - cognitive decline - is a normal, age-related process, but also due to a lack of multi-disciplinary collaboration. We now understand that there are modifiable risk factors for neurodegenerative diseases, that successful management of common comorbidities (such as diabetes and hypertension) can reduce the incidence of neurodegenerative disease, and that disease processes begin (and, crucially, can be detected, reduced, and delayed, prevented, or treated) decades earlier in life than had previously been appreciated. Brain Health Scotland, established by Scottish Government and working in partnership with Alzheimer Scotland, propose far-reaching public health and clinical practice approaches to reduce neurodegenerative disease incidence. Focusing here on Brain Health Scotland's clinical offerings, we present the Scottish Model for Brain Health Services. To our knowledge, the Scottish Model for Brain Health, built on foundations of personalised risk profiling, targeted risk reduction and prevention, early disease detection, equity of access, and harnessing comprehensive data to assist in clinical decision-making, marks the first example of a nationwide approach to overhauling clinical, societal, and political approaches to the prevention, assessment, and treatment of neurodegenerative disease.

Déclaration de conflit d'intérêts

CWR is the director of Brain Health Scotland and receives consultancy fees for this role. JMJW, AB, and NF are employed by Brain Health Scotland (Alzheimer Scotland). The following authors wish to declare additional conflicts of interest and funding received for work unrelated to the present manuscript: CWR has received consultancy fees (Biogen, Eisai, MSD, Actinogen, Roche, Eli Lilly), speaker fees (Eisai, Roche), sits on an NIHR data safety monitoring board (DSMB), and is the unpaid chair of the Brain Health Clinic Consortium and the Scottish Dementia Research Consortium. JMJW received salary support through an education grant provided to Brain Health Scotland from Biogen, and has previously received studentship funding from TauRx Pharmaceuticals. CP receives funding from the Scottish Government’s Chief Scientist Office through a Career Researcher Fellowship. LM received funding from Baillie Gifford, currently receives grant/contract funding from the Scottish Government Chief Scientist Office, is a director of a limited personal services company providing independent medical testimony in court cases, sits on the editorial board of the British Journal of Psychiatry, and on the board of directors of the British Neuropsychiatry Association. GT has received consulting fees from QMENTA. DT has received grant/contract funding from the Public Health Agency Northern Ireland, the Irish Research Council, the Health Research Board, HealthLat, the National Health and Medical Research Council, and the Global Brain Health Institute. TJQ has received grant/contract funding from NIHR, Scottish Government’s Chief Scientist Office, ESPRC, Stroke Association, Dunhill Medical, and sits on the DSMB for Novartis. The remaining authors (MEP, SOD, SS, and AK) have no funding or conflicts of interest to declare.