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Brain Care Score and Neuroimaging Markers of Brain Health in Asymptomatic Middle-Age Persons
Cyprien A Rivier1, Sanjula Singh1, Jasper Senff1
1From the Department of Neurology (C.A.R., S.C.-T., S.H., D.R., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Yale Center for Brain and Mind Health (C.A.R., S.C.-T., S.H., D.R., S.P., K.N.S., G.J.F.); Henry and Allison McCance Center for Brain Health (S.S., J.S., R.W.T., S.M., Z.C., C.K., M.B.W., G.F., R.E.T., N.Y., C.D.A., J.R.); Departments of Neurology (S.S., J.S., R.W.T., S.M., Z.C., C.K., M.B.W., N.Y., C.D.A., J.R.), Psychiatry (A.N.), and Medicine (A.N.), Massachusetts General Hospital, Boston; Broad Institute of MIT and Harvard (S.S., J.S., R.W.T., S.M., C.K., N.Y., C.D.A., J.R.), Cambridge, MA; Department of Neurology (S.S., J.S., R.W.T., H.B.B.), Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, the Netherlands; Cancer Epidemiology Unit (K.P.), Nuffield Department of Population Health (M.C., T.J.L., C.M.V.D.), Big Data Institute, University of Oxford, United Kingdom; UAB McKnight Brain Institute (R.M.L.), Department of Neurology, UAB Heersink School of Medicine, University of Alabama at Birmingham; Department of Medicine (Neurology) (A.P.), University of Toronto; Krembil Brain Institute (A.P.), Toronto, Ontario, Canada; Program for Health System and Technology Evaluation (S.I.); Toronto General Hospital Research Institute; The Jay and Sari Sonshine Centre for Stroke Prevention & Cerebrovascular Brain Health (A.P., S.I.), University Health Network, Toronto; Centre for Advancing Collaborative Healthcare & Education (CACHE) and Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health (S.I.), University of Toronto, Ontario, Canada; Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurosurgery (H.B.B.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Benson-Henry Institute for Mind Body Medicine (G.F.), Massachusetts General Hospital; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.
Objectives:
To investigate associations between health-related behaviors as measured using the Brain Care Score (BCS) and neuroimaging markers of white matter injury.
Methods:
This prospective cohort study in the UK Biobank assessed the BCS, a novel tool designed to empower patients to address 12 dementia and stroke risk factors. The BCS ranges from 0 to 21, with higher scores suggesting better brain care. Outcomes included white matter hyperintensities (WMH) volume, fractional anisotropy (FA), and mean diffusivity (MD) obtained during 2 imaging assessments, as well as their progression between assessments, using multivariable linear regression adjusted for age and sex.
Results:
We included 34,509 participants (average age 55 years, 53% female) with no stroke or dementia history. At first and repeat imaging assessments, every 5-point increase in baseline BCS was linked to significantly lower WMH volumes (25% 95% CI [23%-27%] first, 33% [27%-39%] repeat) and higher FA (18% [16%-20%] first, 22% [15%-28%] repeat), with a decrease in MD (9% [7%-11%] first, 10% [4%-16%] repeat). In addition, a higher baseline BCS was associated with a 10% [3%-17%] reduction in WMH progression and FA decline over time.
Discussion:
This study extends the impact of the BCS to neuroimaging markers of clinically silent cerebrovascular disease. Our results suggest that improving one's BCS could be a valuable intervention to prevent early brain health decline.
