It usually starts with something small. A name that takes a beat too long to surface. A familiar word that vanishes mid-sentence. The unsettling pause before you remember why you walked into a room. Most people chalk it up to stress, sleep deprivation, or the general noise of a busy life. But for a growing number of older adults, these moments carry a different weight — one that sits quietly in the back of the mind, hard to name and harder to raise with a doctor.
The worry tends to follow a familiar script: If I say something, what happens next? What if it’s nothing? What if it isn’t?
For too long, the health care system’s answer to that question was essentially to come back when things get worse. However, Providence Health Care’s (PHC) Early Intervention Memory Clinic (EIMC), based at St. Paul’s Hospital (SPH) in Vancouver, is trying to rewrite that script entirely.
Catching the signal early
“Many people fear the worst when they start to experience changes in memory,” says Dr. Heather Gilley, head of the Division of Geriatric Medicine at Providence Health Care. “They come to the EIMC often very worried, anxious about the future, and seeking knowledge and understanding. The EIMC is a powerful experience for them. Patients have told us they appreciate the in‑depth assessment of something that has frightened them, and at the same time, want to try and do something about it.”
The premise of the EIMC is deceptively simple: what if you could reach people in the window before a diagnosis, when changes are noticed by the individual, but may not be noticed by others or even be detectable on testing?
“Patients and families have shown us they want to take a proactive approach to cognitive health,” explains Dr. Philip Lee, Physician Lead for the EIMC. “By participating in the EIMC, they have access to tools that support positive, preventive measures to optimize brain health.”
The clinic serves adults who have noticed subtle shifts in memory or thinking over the past one to two years, but who don’t yet have a diagnosis of mild cognitive impairment or dementia. Crucially, patients need to have some awareness of these changes and a genuine motivation to do something about them. That last part matters more than it might seem.
Most health care infrastructure is built to respond to crisis, to catch people when symptoms have become disruptive enough to force action. The EIMC operates on a fundamentally different logic, they want to intervene upstream, when the urgency is lower and the opportunity to influence outcomes is higher. The clinic even allows self-referral, sidestepping the gatekeeping that often delays care for people reluctant to raise early concerns in a traditional clinical setting.
“A high percentage of people were arriving to the older adult clinic when they were already in the stages of mild cognitive impairment or dementia,” says Karen Gilbert, occupational therapist and coordinator with the EIMC. “If people arrive when cognitive changes are very subtle, we have a much longer runway to reduce risk and create change in the brain. Many people worry they’re wasting our time if they come too early — that’s the narrative we want to change.”
What looks like a quiet bet is, in fact, a well‑supported one. The Lancet Commission has shown that 40–45% of dementia cases could potentially be prevented or delayed by intervening on modifiable risk factors, particularly during preclinical stages — well before traditional diagnostic thresholds are crossed.
What actually happens there
Walk through the doors of the EIMC and you’re not immediately handed a diagnosis or a prescription. Instead, the first appointment is with an occupational therapist, who sits down to talk through daily functioning, lifestyle habits, and the specific nature of a patient’s cognitive concerns. A brief cognitive screen is completed, and together — clinician and patient — they begin sketching out a personalized cognitive wellness plan.
“People notice that something has changed, but it’s not bad enough for them to bring up during a 10‑minute visit with their family physician,” explains Annie Chen, an occupational therapist with Providence Health Care’s Early Intervention Memory Clinic (EIMC). “When people recognize there are tangible things they can do that help, they walk out knowing the things they can take control of. It helps them stay away from jumping to the conclusion that cognitive change is just a part of aging, there’s nothing they can do, or only a doctor can help.”
The word together is doing real work there. This isn’t a clinic that processes patients. It’s one that tries to build a partnership with them.
From there, a one-time consultation with a geriatric specialist physician reviews medical history, medications, cardiovascular risk factors, and lifestyle. Any findings or recommendations loop back to the patient’s family physician or nurse practitioner, keeping continuity of care intact rather than creating a parallel silo.
Patients often engage with the clinic for one to two years — checking in periodically with their occupational therapist, joining group programming, and gradually building the habits and confidence that support longer-term independence.
Brain health as a practice, not a destination
The EIMC’s programming reflects increasingly well-supported research in neuroscience in which several risk factors for cognitive decline are modifiable. Blood pressure, physical inactivity, social isolation, sleep or hearing loss aren’t just lifestyle variables, they’re levers.
“Shifting the focus from asking for a test or a pill to taking control over 19 modifiable risk factors,” says Chen. “There’s a lot more within people’s control than they realize.”
The clinic’s Brain Health in Action program brings participants together for guided sessions on exactly this terrain, translating research into practical strategies and, critically, helping people sustain behaviour change over time. Anyone who has ever tried to exercise more or stress less knows that the gap between knowing and doing is where most wellness initiatives die. The EIMC takes that gap seriously.
“People often feel reassured about the areas they are already doing well and can focus their efforts on a select number of risk factors that need some improvement,” says Chen
A partnership with the BC Brain Wellness Program brings satellite exercise classes directly to SPH, designed specifically to support brain health, with a high level of supervision and accessibility. Participants routinely describe not just physical benefits, but the motivational pull of working alongside peers who are navigating the same terrain.
The clinic also hosts regular question-and-answer sessions, where patients and family members can speak candidly with clinicians outside the formality of a clinical appointment. It makes the space feel less like a system and more like a community.
The emotional architecture
Cognitive concerns carry a particular kind of dread. Unlike a pulled muscle or a worrying lab result, a change in memory brushes up against identity, against the fear of losing not just capacity, but self. Patients frequently arrive assuming that what they’re noticing is the beginning of an inevitable slide.
The clinic’s careful assessments help draw a clearer distinction between normal age-related change and patterns that warrant closer monitoring. But the impact goes beyond clinical clarification. People leave knowing not just what’s happening in their brains, but what they can actually do about it. That shift from passive fear to informed agency is transformative.
Reducing stigma is baked into the design. A space where people can talk openly about cognitive concerns, without judgment and without waiting until things have gotten bad, quietly dismantles one of the more stubborn barriers in memory care.
Why the system needs this
Canada is aging and dementia rates are climbing in step. British Columbia alone is projected to see a significant rise in the number of people living with dementia in the coming decades. The downstream costs, both human and financial, of late-stage cognitive disease are substantial.
The EIMC represents a different calculation: invest earlier, when the intervention is lighter, the person is more engaged, and the window to influence modifiable risk factors is still open. Earlier support potentially delays progression. It also means fewer people arriving at the health care system in crisis, requiring the kind of intensive assessment and care that strains already-stretched resources.
“It’s been reported that up to 45 per cent of cases of dementia could be prevented or delayed if we could adequately address modifiable risk factors. The EIMC may not be able to address all of a person’s risk factors, but it does help participants reduce many of them,” explains Dr. Philip Lee, physician lead, Early Intervention Memory Clinic.
The clinic is examining how to measure outcomes that matter most to patients and families, and contributing to research that advances the understanding of early cognitive change.
“There is optimism on the horizon with the research and new therapies coming, and the more people we can bring into our care the better,” says Gilley
There’s also a larger question taking shape: how might this model scale across BC, reaching more people in that critical early window?
“Normalizing seeking help early could significantly change the trajectory for many people,” says Gilbert. “This is a low‑cost, high‑impact model that could be adopted in any community.”
A rare thing in medicine
March is Brain Health Awareness Month in Canada, and it presents a moment to ask harder questions about where and how the health care system shows up for people navigating cognitive concerns.
The EIMC is attempting a cultural shift, from a disease‑and‑diagnosis model to one grounded in proactive wellness. That’s not an easy change. It runs up against human nature: the tendency to downplay aging, to postpone difficult conversations, and to underestimate how social factors like isolation, income, housing, and access to care shape brain health long before symptoms demand attention.
What the EIMC offers is something genuinely uncommon in memory care: a conversation that happens before things get bad, with clinicians who have the time and tools to meet people where they actually are. Not in crisis. Not after years of silent worry. But at the beginning, when the most meaningful choices can still be made.
That’s not just good medicine. It’s a different philosophy about what medicine is for.
By Faye Alexander
