. 2024 Aug 27;103(4):e209687.

doi: 10.1212/WNL.0000000000209687. Epub 2024 Jul 25.

Brain Care Score and Neuroimaging Markers of Brain Health in Asymptomatic Middle-Age Persons

Cyprien A Rivier¹, Sanjula Singh¹, Jasper Senff¹, Reinier W Tack¹, Sandro Marini¹, Santiago Clocchiatti-Tuozzo¹, Shufan Huo¹, Daniela Renedo¹, Keren Papier¹, Megan Conroy¹, Thomas J Littlejohns¹, Zeina Chemali¹, Christina Kourkoulis¹, Seyedmehdi Payabvash¹, Amy Newhouse¹, M Brandon Westover¹, Ronald M Lazar¹, Aleksandra Pikula¹, Sarah Ibrahim¹, Virginia J Howard¹, George Howard¹, H Bart Brouwers¹, Cornelia M Van Duijn¹, Gregory Fricchione¹, Rudolph E Tanzi¹, Nirupama Yechoor¹, Kevin N Sheth¹, Christopher D Anderson¹, Jonathan Rosand¹, Guido J Falcone¹

Affiliations

Affiliation

¹ From 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.

PMID: 39052961
PMCID: PMC11760050
DOI: 10.1212/WNL.0000000000209687

Brain Care Score and Neuroimaging Markers of Brain Health in Asymptomatic Middle-Age Persons

Cyprien A Rivier et al. Neurology. 2024.

. 2024 Aug 27;103(4):e209687.

doi: 10.1212/WNL.0000000000209687. Epub 2024 Jul 25.

Authors

Affiliation

¹ From 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.

PMID: 39052961
PMCID: PMC11760050
DOI: 10.1212/WNL.0000000000209687

Erratum in

Correction to Author Disclosures.
[No authors listed] [No authors listed] Neurology. 2024 Dec 24;103(12):e210123. doi: 10.1212/WNL.0000000000210123. Epub 2024 Nov 21. Neurology. 2024. PMID: 39571126 Free PMC article. No abstract available.

Abstract

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.

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Conflict of interest statement

C.A. Rivier is supported by the American Heart Association (817874). C.D. Anderson receives sponsored research support from the US National Institutes of Health, the American Heart Association, and Bayer AG, and has consulted for ApoPharma. K. Papier is funded by Cancer Research UK (C570/A16491 and A29186). The salary of M. Conroy is funded in part by Wellcome [223600/Z/21/Z]. M. Conroy is supported by the Wellcome Trust [205339/Z/16/Z]. J. Rosand receives sponsored research support from the US National Institutes of Health and the American Heart Association, receives payments for consulting and expert testimony from the National Football League and Eli Lilly, and has a leadership or fiduciary role with Columbia University and Lancet Neurology. G.J. Falcone receives sponsored research support from the National Institute of Mental Health Clinical Global Mental Health Research T32 Fellowship, receives royalties or licenses from Johns Hopkins University Press, University of Chicago Press, Belvoir Press, and the American Psychiatric Press, is on a Data Safety Monitoring Board or Advisory Board of Healthy Hearts Healthy Minds DSMB, is a Board of Directors member at the Rosalynn Carter Institute, and has stock or stock options from Revival Therapeutics Consultant. S. Clocchiatti-Tuozzo is funded by NIH T32 AG019134 and P30 AG021342. AP receives support from the Canadian Institute of Health Research and the Jay and Sari Sonshine Chair in Stroke Prevention and Cerebrovascular Brain Health at the UHN/KBI. R.M. Lazar receives support from the National Institutes of Neurological Disorders and Stroke and the National Institute of Aging of the US National Institutes of Health, and the McKnight Brain Research Foundation. The other authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Figures

**Figure. Associations of Total BCS at Baseline With Neuroimaging Markers**
(A and B) The thick line is the change in white matter hyperintensities volume (A.a and B.a), fractional anisotropy (A.b and B.b), or mean diffusivity (A.c and B.c) standard deviation units (z-score units) over the range of the Brain Care Score on a percentage axis; the shaded areas correspond to the 95% confidence intervals. The associations were adjusted for age and sex and plotted relative to the median Brain Care Score. (C) The thick line is the change in the evolution of white matter hyperintensities volume (C.a), average fractional anisotropy (C.b), or mean diffusivity (C.c) between the first and repeat imaging assessments over the range of the Brain Care Score on a percentage axis; the shaded areas correspond to the 95% CIs. The associations were adjusted for age, sex, and time between imaging assessments and plotted relative to the median Brain Care Score.

See this image and copyright information in PMC

References

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Brain Care Score and Neuroimaging Markers of Brain Health in Asymptomatic Middle-Age Persons

Affiliation

Brain Care Score and Neuroimaging Markers of Brain Health in Asymptomatic Middle-Age Persons

Authors

Affiliation

Erratum in

Abstract

Conflict of interest statement

Figures

References

MeSH terms

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