The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort

Sanjula D Singh; Tin Oreskovic; Sinclair Carr; Keren Papier; Megan Conroy; Jasper R Senff; Zeina Chemali; Leidys Gutierrez-Martinez; Livia Parodi; Ernst Mayerhofer; Sandro Marini; Courtney Nunley; Amy Newhouse; An Ouyang; H Bart Brouwers; Brandon Westover; Cyprien Rivier; Guido Falcone; Virginia Howard; George Howard; Aleksandra Pikula; Sarah Ibrahim; Kevin N Sheth; Nirupama Yechoor; Ronald M Lazar; Christopher D Anderson; Rudolph E Tanzi; Gregory Fricchione; Thomas Littlejohns; Jonathan Rosand

doi:10.3389/fneur.2023.1291020

The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort

Front Neurol. 2023 Dec 1:14:1291020. doi: 10.3389/fneur.2023.1291020. eCollection 2023.

Authors

Sanjula D Singh^#^{1

2

3

4

5}, Tin Oreskovic^#², Sinclair Carr^#^{6

7}, Keren Papier², Megan Conroy², Jasper R Senff^{1

3

4

5

8}, Zeina Chemali^{1

3

9}, Leidys Gutierrez-Martinez^{1

3

4

5}, Livia Parodi^{1

3

4

5}, Ernst Mayerhofer^{1

3

4

5}, Sandro Marini^{1

3

4

5}, Courtney Nunley¹, Amy Newhouse^{1

9

10}, An Ouyang^{1

3}, H Bart Brouwers⁸, Brandon Westover^{1

3

4}, Cyprien Rivier¹¹, Guido Falcone¹¹, Virginia Howard¹², George Howard¹², Aleksandra Pikula^{13

14

15}, Sarah Ibrahim^{13

14

15}, Kevin N Sheth¹¹, Nirupama Yechoor^{1

3

4

5}, Ronald M Lazar¹⁶, Christopher D Anderson^{1

3

4

5

17}, Rudolph E Tanzi¹, Gregory Fricchione^{1

18}, Thomas Littlejohns², Jonathan Rosand^{1

3

4

5}

Affiliations

¹ Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, United States.
² Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
³ Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
⁴ Broad Institute of MIT and Harvard, Cambridge, MA, United States.
⁵ Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States.
⁶ Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States.
⁷ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
⁸ Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
⁹ Division of Neuropsychiatry, Massachusetts General Hospital, Boston, MA, United States.
¹⁰ Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
¹¹ Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
¹² Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States.
¹³ Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada.
¹⁴ Krembil Brain Institute, Toronto, ON, Canada.
¹⁵ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
¹⁶ McKnight Brain Institute, Department of Neurology, School of Medicine, University of Alabama School of Medicine, Birmingham, AL, United States.
¹⁷ Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States.
¹⁸ Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States.

^# Contributed equally.

Abstract

Introduction: The 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke.

Methods: The BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40-69 years, recruited between 2006-2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline.

Results: The BCS (median: 12; IQR:11-14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50-59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50-59, and 33% (95%CI, 29-37%) among those aged >59.

Discussion: The BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide.

Keywords: Brain Care Score; UK Biobank (UKB); brain health; dementia; prevention; risk factors; stroke.

Copyright © 2023 Singh, Oreskovic, Carr, Papier, Conroy, Senff, Chemali, Gutierrez-Martinez, Parodi, Mayerhofer, Marini, Nunley, Newhouse, Ouyang, Brouwers, Westover, Rivier, Falcone, Howard, Howard, Pikula, Ibrahim, Sheth, Yechoor, Lazar, Anderson, Tanzi, Fricchione, Littlejohns and Rosand.

Abstract

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