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. 2024 Feb 29:6:100214.
doi: 10.1016/j.cccb.2024.100214. eCollection 2024.

Validation of the brain health index in the European Prevention of Alzheimer's Dementia cohort

Jodi K Watt  1 , David Alexander Dickie  1 , Frederick K Ho  2 , Donald M Lyall  2 , Jesse Dawson  1 , Terence J Quinn  1
Affiliations

Validation of the brain health index in the European Prevention of Alzheimer's Dementia cohort

Jodi K Watt et al. Cereb Circ Cogn Behav. .

Abstract

Background: Brain Health Index (BHI) assimilates various MRI sequences, giving a quantitative measure of brain health. To date, BHI validation has been cross-sectional and limited to selected populations. Further large-scale validation and assessment of temporal change is required to understand its clinical utility.

Aim: Assess 1) relationships between variables associated with cognitive decline and BHI 2) associations between BHI and measures of cognition and 3) longitudinal changes in BHI and relationship with cognitive function.

Methods: BHI computation involved Gaussian mixture-model cluster analysis of T1, T2, T2*, and T2 FLAIR MRI data from participants within the European Prevention of Alzheimer's Dementia (EPAD) cohort. Group differences (gender- and health-based) were evaluated using independent samples Welch's t-tests. Relationships between BHI, age and cognitive tests used linear regression. Longitudinal analysis (12/24 months) utilised mixed linear regression models to examine BHI changes, and paired BHI/cognition associations.

Results: Data from N = 1496 predominantly Caucasian participants (50-88 years old, 43.32% male) were used. BHI scores were lower in those with diabetes (p < 0.001, d = 0.419), hypertension (p < 0.001, d = 0.375), hypercholesterolemia (p < 0.001, d = 0.193) and stroke (p < 0.05, d = 0.512). APOE was not significantly related to BHI scores. After correction for age, cross-sectional BHI scores were significantly associated with all measures of cognitive function in males, but only the Four Mountains Test (4MT) in females. Longitudinal change in BHI and cognition were not consistently related.

Conclusions: BHI is a valid marker of cognitive decline and relatively stable over 1-2 year follow-up periods. Further work should assess temporal changes over a longer duration and determine relationships between BHI and cognition in more diverse populations.

Keywords: Brain Health Index; European Prevention of Alzheimer's Dementia; Neuroimaging; aging; longitudinal; structural MRI.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This work used data and/or samples from the EPAD project which received support from the EU/EFPIA Innovative Medicines Initiative Joint Undertaking EPAD grant agreement n° 115736 and an Alzheimer's Association Grant (SG21-818099-EPAD). JKW was funded for the work herein by a Chief Scientist Office Research Grant (Reference: TCS/19/31).

Figures

Fig 1:
Fig. 1
Flow diagram of the processes involved in the computation of the Brain Health Index.
Fig 2:
Fig. 2
Key demographic findings in the cross-sectional cohort: (A) Linear regressions assessing the relationship between the age of participants and the BHI; (B) Gender differences in BHI scoring; (C) uncorrected linear regressions assessing the relationship between years of education and BHI scores; and (D) BHI scores by APOE status in the full cross-sectional cohort. In (A) and (C), male participants are depicted in blue, and female participants in green.
Fig 3:
Fig. 3
Comparison of BHI scores in the cross-sectional cohort in participants who did and did not report MCI in their medical histories.
Fig 4:
Fig. 4
BHI scores by alcohol consumption (units per week) in the full cross-sectional cohort.
Fig 5:
Fig. 5
Uncorrected linear regressions depicting the relationship between BHI scores and (A) MMSE; (B) 4MT; (C) RBANS total; and (D) RBANS DMI scores. Male participants are depicted in blue, and female participants in green.
See this image and copyright information in PMC

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